Heart Failure Flashcards
What is a short term adaptive mechanism to compensate for the start of heart failure?
The Frank-Starling mechanism
What is an intermediate adaptive mechanism to compensate for the start of heart failure?
Neurohormonal mechanisms. The SNS or increased plasma NE.
As heart failure ensues what does the body do in terms of flow?
It maintains flow to the brain and the heart at the expense of skin, skeletal muscle, gut, and kidneys.
How is the kidney affected by CHF? What effects take place?
There is decrease in globular filtration rate, decrease in renal blood flow, and an increase in aldosterone production. The response is an increase in Na and H2O retention, increase in plasma volume, increase venous return, and increase in venous pressure.
What happens to Beta receptors in the hear with CHF? Describe both B1 and B2
B1 receptor density is reduced. B2 receptor density not reduced by heart failure.
In congestive heart failure what happens to concentrations of Atrial natriuretic factor, brain natriuretic (from ventricle), endothelin, and inflammatory cytokines? What are the effect of each?
They all increase. ANF promotes vasodilation, natriuresis, suppresses RAS. BNF has actions similar to ANF. Endothelin is a potent vasoconstrictor. Inflammatory cytokines such as TNF alpha promote cell hypertrophy, apoptosis.
There are two main ways the heart hypertrophies, what are they?
Due to pressure overload (often aortic stenosis). Due to a volume overload (regurgitation)
In concentric hypertrophy what happens?
It is typically from increased systolic wall stress (aortic stenosis) what happens is that parallel sarcomeres are put in place and the lumen of the ventricle stays approximately the same size but the wall becomes much thicker.
In eccentric hypertrophy what happens?
It is typically from increased diastolic wall stress. The lumen becomes much larger while the wall remains the same thickness, however, it does grow.
When is the LV thickest (ie. during which type of hypertrohpic pathology)?
Greater with pressure overload.
When is the LV volume greatest (ie. during which type of hypertrohpic pathology)?
Greater with volume overload
When is the h/R ratio of wall thickness to chamber radius largest?
Greater in pressure overload.
Which sided heart failure does mitral stenosis lead to?
Right sided
