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Pathophysiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What does chronotropy mean?

A

Heart rate

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2
Q

What is vascular resistance/peripheral resistance?

A

Squeeze of blood vessels outside the heart resisting blood flow

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3
Q

What is Cardiac Output (CO) a measure of?

A

How much blood is pumped out of the left ventricle in 1 minute

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4
Q

What is Stroke Volume (SV) a measure of?

A

The volume of the blood ejected with each beat of the heart

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5
Q

Define: Ionotropy

A

Contractility

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6
Q

Define: Preload

A

Filling of ventricles and stretch of walls (dealing with the tension applied to the ventricular walls)

Stretch (IN)

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7
Q

What happens if we increase preload?

A

The tension on the walls increase which causes oxygen demand to increase as well.

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8
Q

Define: Afterload

A

The amount of pressure that is acting on the heart.

Squeeze (OUT)

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9
Q

Describe how low and high after loads affect the blood’s travels.

A

Low afterload: easy for blood to exit the heart

High afterload: hard for blood to exit the heart

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10
Q

What is stroke volume affected by?

A

Contractility (ionotropy)
Afterload (squeeze/resistance)
Preload (stretch/filling)

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11
Q

If stroke volume increases, cardiac output (CO) ______.

A

Increases

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12
Q

How would you increase stroke volume?

A

Increase contractility
Increase preload
Decrease afterload

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13
Q

How would you decrease stroke volume?

A

Decrease contractility
Decrease preload
Increase afterload

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14
Q

LVEDV (preload)

A

Left ventricular end diastolic volume (The volume at the end of rest-so when it is filling).

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15
Q

What two ways can heart failure occur?

A
  1. MI (myocardial infarction) - heart dies! One lane of blood traffic is shut down.
  2. High blood pressure acts as a traffic jam for blood

**Both of these things cause a decrease in stroke volume.

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16
Q

What 4 things can be done to compensate for heart failure?

A
  1. Increase heart rate
  2. Increase amount of blood (increases preload - RAAS)
  3. Redirect blood to heart (vasoconstriction of blood vessels, endothelin, RAAS, SNS)
  4. Construct more lanes (Ventricular hypertrophy & remodelling)
17
Q

What are the pros and cons of:

1. increase heart rate

A

Pro:
Helps maintain cardiac output

Con:
short filling time, increase BP, increase oxygen demand, risk of arrhythmias, puts stress on the heart

18
Q

What are the pros and cons of:

2. increase amount of blood

A

Pro:
Increase stroke volume (more stretch, more preload)

Con:
Pulmonary and or peripheral edema, increased oxygen demand, water retention

19
Q

What are the pros and cons of:

3. redirect blood to the heart

A

Pro:
Helps maintain blood pressure, recruits blood to heart and brain.

Con:
Increased afterload (resistance) which decreases stroke volume
20
Q

What are the pros and cons of:

4. ventricular hypertrophy & remodelling

A

Pro:
Helps to maintain CO, decreases oxygen demand

Con:
Increased risk of ischemia, dysfunction, fibrosis and arrhythmias, ventricle becomes smaller

21
Q

Describe natuiretic hormones and how they cause vasoconstriction.

A
  • causes an increase in intracellular sodium and calcium (bad)
  • inhibits the cellular Na/K ATPase (sodium builds up in the cell and it becomes more excitable and causes our vessels to constrict)
22
Q

Describe natuiretic peptides and how they cause vasodilation.

A
  • secreted by the brain and atria to try and counteract negative compensatory mechanisms in heart failure (good)
  • promote water loss (diuresis which causes vasodilation) to decrease total peripheral resistance (TPR)
23
Q

What is the difference between left and right sided heart failure?

A

Right-sided HF:

  • right side is failing
  • blood backed up in abdominal organs and periphery

Left-sided HF:

  • left side is failing
  • blood backed up in lungs
24
Q

List some symptoms of heart failure.

A

Fluid retention and edema:

  • rales (crackling sound upon auscultation with stethoscope)
  • rapid weight gain
  • pitting edema (squishy feet and ankles)
  • elevated jugular venous pressure (JVP)

Shortness of Breath:

  • orthopnea - difficulty breathing when lying down
  • cough
  • dyspnea - difficult breathing

Fatigue (especially with activity)
Confusion
Cyanosis (oxgen depletion) - blue lips, fingers or toes

25
Q

Describe the 2 types of diagnostic imaging used on the heart: CXR and ECHO

A

Chest X Ray (CXR):

  • shows an enlarged cardiac silhouette
  • if the cardiothoracic ratio is > 50% then the heart is enlarged (not normal)

Echocardiogram (ECHO):

  • uses ultrasound waves to image the heart
  • detects abnormalities in both structure and function
26
Q

What is LVEF?

A

Left ventricular ejection fraction: It is how much blood is being expelled from the left ventricle

Normal: 55-70%
Heart failure: less than 40%

27
Q

Describe what JVP is and what a normal value is.

A

JVP (jugular venous pressure)
Elevation indicates volume overload
Normal: less than 4 cm above sternal angle

28
Q

Define: Ascites

A

Fluid accumulation in the peritoneal space

29
Q

What are some non-pharmacological treatments available to patients to decrease their risk of heart failure?

A
  • salt restriction
  • fluid restriction
  • stop smoking
  • monitor weight daily
  • exercise once symptoms are controlled
30
Q

Describe using the Frank-Starling Law how stroke volume and preload are connected in both a normal patient and a patient with heart failure

A

In a patient with heart failure, the stroke volume is decreased from what it would be in a normal patient. Because the HF patient has lower stroke volume, that means you have less blood getting to the heart and it is not able to be pumped out.

31
Q

Describe using the Frank-Starling Law how stroke volume and afterload are connected in both a normal patient and a patient with heart failure

A

In a patient with heart failure, the stroke volume is decreased from what it would be in a normal patient.

32
Q

Why would a patient with HF be experiencing weight gain?

A

due to excess water retention

33
Q

Why would a patient with HF be experiencing peripheral edema?

A

due to excess water retention in feet/ankles

34
Q

Why would a patient with HF be experiencing SOB/coughing?

A

Fluid in lungs; not getting enough blood to lungs to trade off oxygen and CO2

35
Q

Recall Matthew from the clinical case study: What types of medication could help Matthew with his symptoms?

A
  • A diuretic
  • Drugs to disrupt RAAS (angiotensin receptor blockers/inhibitors)
  • Beta blockers - slow the heart rate by blocking the affect of adrenaline
  • Aldosterone antagonists
  • Digoxin (when patient is dying) - this is a positive ionotrope (contractile) which squeezes the heart to give the patient a little bit of extra time of life

Pathophysiology (15 decks)

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