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Cardio Final > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Define Heart Failure

A

Usually progressive clinical syndrome that develops when the heart is unable to pump blood at a rate sufficient to meet the metabolic demands of the tissues or can do so only at elevated filling pressures

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2
Q

Heart failure starts out

A

As an outcome of multiple disease

It begins only when you put your heart under some type of stress (exercise, etc)

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3
Q

Acute HF is caused by:

A

hemodynamic stress

  • Fluid overload
  • Acute valvular dysfunction
  • A large MI
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4
Q

Chronic HF is caused by:

A

Ischemic Heart Disease

Chronic work overload (hypertension, valve disease)

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5
Q

Intrinsic cardiac mechanisms include

A

Specifically occur with the heart

- Frank-Starling and strecth of the right atrial wall

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6
Q

Extrinsic cardiac mechanisms include:

A

Things that occur outside the body that causes changes to the heart (rate and contraction)
- Autonomic Nervous System

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7
Q

IHD leads to

A

cardiac function impairment

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8
Q

HTN leads to

A

Increased wrokload

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9
Q

IHD and HTN both lead to

A

activation of compensatory mechanisms to amintain arterial pressure and perfusion of vital organs

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10
Q

Define Frank-Starling mechanism

A

Increased filling volumes dilate the heart and increase cross-bridge formation within the sarcomeres which leads to enhanced contractility

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11
Q

Define Myocardial adaptations

A

Hypertrophy and ventricular remodeling (caused by hypertrophy)

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12
Q

What promotes ventricular remodeling?

A

IHD due to fibrosis production in the heart where the dead tissues is

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13
Q

Define Activation of neurohumoral systems

A

Release of NE causes increased HR and augments myocardial contractility and resistance
Activation of RAAS
Release of atrial natiuretic peptide

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14
Q

Compensatory mechanisms are:

A

initially adequate to maintain normal cardiac output but later they become overwhelmed leading to cardiac dysfucn

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15
Q

Pathological changes that occur as a result of adaptive changes cause:

A

Functional and structural problems such as myocyte apoptosis, cytoskeletal alterations, and fibrosis

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16
Q

Frank Starling Mechanisms Limitations

A

There is only so much increase in right atrial pressure or end diastolic volume that will increase the cardiac output and for a while this is linear but eventually it will plateau

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17
Q

Define Myocardial Hypertrophy

A 
Myocyte size increase
Protein synthesis increase
Enlarged nuclei
Numerous mitochondria (need more energy)
Increase in DNA ploidy
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18
Q

What can cause Myocardial Hypertrophy?

A

Increased hydrostatic pressure
Volume overload
Activation of beta adrenergic receptors (catecholamine stimulation)

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19
Q

Pressure Overload hypertrophy + Myocardial Hypertrophy

A

Cause increase in wall thickness
New sarcomeres are assembled in parallel
- Thicker

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20
Q

Volume Overload hypertrophy + Myocardial Hypertrophy

A

Ventricular dilation occurs
New sarcomeres assemble in response to volume and are in series with current ones
-Heavier

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21
Q

HTN =

A

Pressure overload

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22
Q

Valvular disease =

A

Pressure and/or volume overload

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23
Q

MI =

A

Regional dysfunction with volume overload

24
Q

Cardiac dysfunction occurs via

A

Abnormal myocardial metabolism
Alteration of intracellular Ca
Apoptosis of myocytes
Reprogramming of gene expression (miRNA)

25
Q

Why are miRNA important

A

They regulate the expression of other genes

26
Q

Myocardial Hypertrophy prognosis

A

Increased heart mass is correlated with increase cardiac mortality and morbidity
- Usually involves increased mass but not increased vessels so there is a lack of perfusion

27
Q

More catecholamines produced leads to

A

More stimulation of beta adrenergic receptors in the heart which leads to vasoconstriction and reduced blood flow to the limbs

28
Q

Define Systolic Dysfunction

A

Progressive deterioration of myocardial contractile function

- IHD

29
Q

Diastolic dysfunction

A

Incapability of the heart chamber to expand and fill sufficiently during diastole
- Pericarditis

30
Q

HF with a depressed ejection fraction =

A

Systolic failure

31
Q

HF with a preserved ejection fraction =

A

Diastolic failure

32
Q

Define Forward Failure

A

Decreased cardiac output and tissue perfusion

33
Q

Define Backward failure

A

Congestion in the venous system

34
Q

Left ventricular dysfunction leads to

A

Tissue hypoperfusion

35
Q

Right ventricular dysfunction leads to

A

Venous congestion so low blood oxygenation bc the blood cannot get to the lungs and out to the tissues

36
Q

LSHF symptoms

A

May be quite subtle and often related to pulmonary congestion and edema (cough and dyspnea)
Fatigue
Decreased kidney perfusion (increased RAAS)
Pre-renal azotemia

37
Q

Define Orthopnea

A

Dyspnea occuring when laying down or leaning back

Redistribution of fluids from the splanchnic circulation and lower extremities into the central circulation

38
Q

Increase in pulmonary capillary pressure seen with orthopnea is bad because:

A

It will lead to leakage of the fluid to other parts of the body

39
Q

Define Paroxysmal Nocturnal Dyspnea

A

Acute episodes of severe SOB and coughing

Occurs at night and awakens the patient from sleep

40
Q

Paroxysmal Nocturnal Dyspnea Patho

A

Increased pressure in the bronchial arteries leading to airway compression, along with interstitial pulmonary edema that increases airway resistance

41
Q

Afib =

A

Arrhythmia characterized by uncoordinated, chaotic contraction of the atrium
Stasis increases risk of thrombosis and TE stroke

42
Q

RSHF shows as

A 
Hepatosplenomegaly
Peripheral edema
Pleural effusion
Ascites
Venous congestion (kidney azotemia, brain encepthalopathy)
43
Q

Define Ascites

A

Accumulation of flluid in the peripheral cavity caused by congestion in the venous system which leads to increased hydrostatic pressure and fluid being pushed into open cavities of the body (edema)

44
Q

Pleural effusion leads to

A

Dyspnea bc the fluid accumulation leads to compression of the lung parenchyma

45
Q

Define Jugular venous pulsation

A

RSHF

Push on the abdomen and there will be increased pressure in the neck which leads to elevation of this muscle

46
Q

GI Symptoms of HF

A

Anorexia, nausea, early satiety bc ab pain
Right upper quadrant pain
Edema of bowel wall or congested liver

47
Q

Cerebral symptoms of HF

A

Confusion
Disorientation
Sleep and mood distrubances
Nocturia and insomnia

48
Q

Cheyne-Stokes Respiration

A

Associated with low cardiac output
Caused by diminished sensitivity of the repiratory center to PCo2
- This means the patient is about to die and shows as phases of intense breathing, rest, and repeat

49
Q

Physical Exam findings for HF patients

A

Reduced systolic BP due to LV dysfunction
Reduced pulse pressure due to reduced stroke volume
Sinus tachycardia (adrenergic activity)
Cool extremities and peripheral cyanosis (adrenergic activity)
Pulmonary crackles
Plural effusion
Cardiomegaly
Murmurs of bi and tricuspid valvues
Hepatomegaly
Ascites, Jaundice, peripheral edema and pigmented skin

50
Q

LSHF Symptoms

A 
Coughing
SOB
Tiredness
Pulmonary congestion and pressure
Pulmonary edema
51
Q

RSHF

A

Pleural effusion
Ascites
Enlarged veins in the abdomen
Peripheral edema

52
Q

Cardiogenic Shock and Cardiogenic PE

A

Severe LV dysfunction leading to congestion and hypoperfusion
Decreased cardiac index and systolic hypotension

53
Q

CS and Cardiogenic PE Causes

A 
Acute MI/ischemia bc of LV failure, papillary muscle/chordal rupture with severe mitral regurgitation
Wall rupture + tamponade
Acute myocarditis
PE (RSHF)
Severe Valvular HD
54
Q

Define Tamponade

A

Blood accumulates in the pericardium which causes acute LSHF bc the heart cannot expand (diastolic)

55
Q

Systolic Myocardial Dysfunction leads to

A

Decreased cardiac output
Decreased stroke volume which can lead to (1) hypotension which decreases coronary perfusion pressure and causes ischemic or (2) decreased systemic perfusion which leads to compensatory vasoconstriction (both then lead to progessive myocardial dysfunction and death)

56
Q

Diastolic myocardial dysfunction leads to

A

Increase LVEDP and pulmonary congestion which leads to hypoxemia which ultimately causes ischemia –> progressive dysfunction and death

57
Q

HF + MI

A

There is already ischemia from the MI so now if they have systolic/diastolic dysfunction then there is even more ischemia

Cardio Final (12 decks)

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