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Cardio Final Jeopardy > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What does the term heart failure refer to?

A

The inability of the CO to keep pace with the body’s demands for supply of nutrients and removal of wastes

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2
Q

What does most causes of heart failure result from?

A

Dysfunction of the left ventricle (systolic and diastolic heart failure)

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3
Q

When might the right ventricle be dysfunctional?

A

In right ventricular failure - pulmonary disease dysfunction

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4
Q

What are the 2 most common reasons for heart failure?

A

Damage to the heart muscle

Prolonged pumping against a chronically increased afterload

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5
Q

What are the two major compensatory mechanisms to help restore SV to normal in the early stages of heart failure?

A
  1. Sympathetic activity to the heart is reflexively increased
  2. When CO is reduced, the kidneys try to compensate to improve their blood flow by retaining extra salt and water in the body during urine formation to increase blood volume
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6
Q

How is heart failure normally functionally classified?

A

Class I - no limitations; no symptoms from ordinary activities
Class II - slight, mild limitation of activity; pt. comfortable at rest or with mild exertion
Class III - marked limitation of any activity; pt. only comfortable at rest
Class IV - any physical activity brings on discomfort and symptoms occur at rest

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7
Q

What are the FOUR stages of heart failure?

A

Stage A - a high risk HF in the future but NO structural disorder
Stage B - a structural heart disorder but no symptoms at any stage
Stage C - previous or current symptoms of heart failure in the context of an underlying structural heart problem; managed with treatment
Stage D - advanced disease requiring hospital-based support, a heart transport or palliative care

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8
Q

What is decompensated heart failure?

A

As disease progresses and contractility of the heart declines further, the heart reaches a point at which it can no longer pump out a normal SV despite the compensatory measures

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9
Q

What does left sided heart failure commonly lead to?

A

Leads to pulmonary edema because blood dams up in the lungs - Left side > right side heart failure

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10
Q

What is systolic heart failure?

A

This is defined as an inability of the heart to generate an adequate CO to perfuse vital tissues

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11
Q

What is the most common cause of decreased contractility and what is disrupted leading to the decrease?

A

MI is the most common cause of the decreased contractility and this disrupts (or results from the disruption of) myocyte activity

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12
Q

What does preload increase with?

A

Preload, or LVEDV, increases with decreased contractility or when there is an excess of plasma volume (IV administration, renal failure, mitral valvular disease)

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13
Q

What is the most common cause of increased afterload?

A

Increased afterload is most commonly a result of increased peripheral vascular resistance (PVR) such that as seen with hypertension

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14
Q

What do catecholamines do in heart failure?

A

SNS activation initially compensates for a decrease in CO by increasing HR and PVR

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15
Q

What does angiotensin II do in heart failure?

A

Activation of the RAA system not only causes increases in preload and afterload but also causes direct toxicity to the myocardium

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16
Q

What does aldosteron do in heart failure?

A

Aldosterone not only causes salt and water retention by the kidney but also contributes to myocardial fibrosis, autonomic dysfunction, and dysrhyhtmias

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17
Q

What does arginine vasopressin (ADH) do in HF?

A

ADH causes both peripheral vasoconstriction and renal fluid retention which exacerbate hyponatremia and edema in CHF

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18
Q

What effects may atrial and brain natriuretic peptides have in CHF?

A

They are increased in CHF and may have some proactive effect by decreasing preload

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19
Q

What is endothlin and what is it associated with in regards to CHF?

A

Endothelin is a potent vasoconstrictor and it is associated with a poor prognosis in individuals with CHF

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20
Q

What does endotoxin to in CHF?

A

Increased serum levels of endotoxin have been found in many individuals with CHF, especially those with significant peripheral edema, and has been linked to myocoyte apoptosis and release of TNF and interleukins

21
Q

What does TNF do in CHF? What is it?

A

TNF is a cytokine and is elevated in CHF and contributes to myocardial remodeling, downregulates the synthesis of vasodilator NO, induces myocoyte apoptosis, and may contribute to weight loss and weakness in individuals with CHF - cardiac cachexia

22
Q

What is cardiac cachexia?

A

Sudden and severe weight loss in individuals with heart disease

23
Q

What is IL-6 and what role does it play in CHF?

A

IL-6 is a cytokine and is high in pts. with severe CHF and cardiogenic shock, and may contribute to further deleterious immune activation responses

24
Q

What are the clinical manifestations of left heart failure a result of and what are they?

A

Left heart failure symptoms are a result of pulmonary vascular congestion and inadequate pefusion of the systemic circulation. Pts. may present with:

  • Dyspnea
  • Orthopnea - shortness of breath lying flat - need pillows
  • Cough of frothy sputum
  • Fatigue
  • Decreased urine output
  • Edema
25
Q

How is left heart failure managed?

A

The treatment is aimed at interrupting the worsening cycle of decreasing contractility, increasing preload and increasing afterload, as well as blocking the neurohumoral mediators of myocardial toxicity.

26
Q

What improves myocardial oxygenation in left sided heart failure?

A

Oxygen, nitrates, and morphine administration

27
Q

What can help raise BP in hypotensive pts. in left sided heart failure?

A

IV inotropic drugs which increases contractility to help raise BP

28
Q

What drugs reduces preload in left sided heart failure?

A

Diuretics reduce preload and ACE inhibitors reduce BOTH preload and afterload by decreasing aldosterone levels and reducing PVR

29
Q

What can improve preload and contractility in left sided heart failure?

A

Short acting IV beta blockers can reduce mortality

IV adminstration of brain natiuretic peptide (nesiritide) also improves preload and contractility

30
Q

What surgical treatments may help pts. in left sided heart failure?

A

Acute coronary bypass or PCI

31
Q

What is diastolic HF?

A

Isolated diastolic HF is defined as pulmonary congestion despite a normal SV and CO

32
Q

What causes diastolic HF?

A

Decreased compliance of the left ventricle and abnormal diastolic relaxation such that a normal LVEDV results in an increased left ventricular end diastolic pressure (LVEDP)

33
Q

What does the LVEDP in diastolic HF normally result in?

A

Pulmonary edema

34
Q

What are the major causes of diastolic dysfunction?

A

Hypertension-induced myocardial hypertropy and myocardial ischemia with resultant ventricular modeling

35
Q

How do pts. with diastolic dysfunction present and what may there be evidence of?

A

Present with dyspnea on exertion, fatigue, evidence of pulmonary edema (rales on auscultation, pleural effusions).
There may also be evidence of underlying coronary disease, hypertension, or valvular disease

36
Q

How is diastolic dysfunction diagnosed by?

A

ECG demonstrating poor ventricular filling with normal ejection fractions

37
Q

What can right HF result from and what happens?

A

Right HF can result from left HF when the increase in left ventricular filling pressure that is reflected back into the pulmonary circulation is severe enough. As pressure in pulmonary circulation rises, the resistance to right ventricular emptying increases. The right ventricle is poorly equipped to handle this increased workload, will dilate and fail.

38
Q

What happens when right ventricle begins to fail in right HF?

A

Pressure will rise in the systemic venous circulation which results in peripheral edema and hepatosplenomegaly

39
Q

What is high-output failure?

A

It is the inability of the heart to adequately supply the body with blood borne nutrients, despite adequate blood volume and normal or elavated myocardial contactility

40
Q

What are common causes of high-output failure?

A

Anemia
Septicemia
Hyperthyroidism
Beriberi

41
Q

What does anemia do?

A

Decreases the oxygen-carrying capacity of the blood
Metabolic acidosis occurs as body cells switch to anaerobic metabolism and in response to the acidosis the HR and SV increase in an attempt to circulate blood faster

42
Q

What happens if anemia is severe?

A

Maximum CO will be unable to supply cells with enough O2 for metabolism = bad

43
Q

What is septicemia?

A

Disturbed metabolism, bacterial toxins, and the inflammatory process cause systemic vasodilation and fever - the heart may not be able to increase CO enough to compensate for vasodilation.
Body tissue will show signs of inadequate blood supply despite a very high CO

44
Q

What does hyperthyroidism do?

A

Accelerates cellular metabolism through the actions of elevate levels of thyroxine from the thyroid gland which may occur chronically (thryotoxicosis) or acutely (thyroid storm)

45
Q

What is beriberi?

A

Thiamine deficiency usually caused by malnutrition secondary to chronic alcoholism. It impairs cellular metabolism in all tissues, including the myocardium

46
Q

What does the treatment of CHF focus on?

A

Treating the symptoms and signs of CHF and preventing disease progression .
If there is a reversible cause then obviously address that.
Reversible cause treatments can include exercise, eating healthy foods, reduction in salty foods, and abstinence of drinking/smoking

47
Q

What are non-pharmacologic methods for CHF treatment?

A

Moderate physical activity
Weight reduction
Sodium restriction
Fluid restriction

48
Q

What are drugs used to treat CHF?

A 
Diuretic agents
Vasodilator agents
Positive inotropes
ACE inhibitors
Beta blockers
Aldosterone antagonists
49
Q

What would pts. with NYHA class III or IV, left ventricular ejection fraction <35% or less, and a QRS interval of 120ms or less benefit from?

A

CRT - cardiac resynchronization therapy - pacing both the left and right ventricles - through bi-ventricular pacemaker or surgical remodeling of the heart

Cardio Final Jeopardy (5 decks)

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