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ESA 2- Cardiovascular System > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure defined as?

A

A state in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

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2
Q

What is the primary cause of systolic heart failure?

A

Ischaemic heart disease

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3
Q

Other than IHD, what are the causes of HF?

A 
Hypertension 
Dilated cardiomyopathy 
Valvular heart disease 
Restrictive cardiomyopathy 
Hypertrophic cardiomyopathy 
Pericardial disease 
High-output heart failure 
Arrythmia
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4
Q

What can cause dilated cardiomyopathy?

A 
Bugs
Alcohol
Drugs
Poisioning
Pregnancy
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5
Q

What can cause restrictive cardiomyopathy?

A

Amyloidosis

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6
Q

What does the force developed in the myocardium depend on?

A

The degree to which the fibres are stretched (or how much the heart is filled)

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7
Q

What happens to the force developed in the myocardium in heart failure?

A

The heart can no longer produce the same amount of force (or cardiac output) for a given level of filling

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8
Q

What will be seen on the Starlings Law of the Heart Curve with heart failure?

A

In mild failure, will be less cardiac output for the same filling
In gross failure, after a point, increasing filling will result in reduced cardiac output

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9
Q

What are the types of heart failure?

A

Class I
Class II
Class III
Class IV

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10
Q

What will be seen in class I heart failure?

A

No symptomatic limitation of physical activity

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11
Q

What will be seen in class II heart failure?

A

Slight limitation of physical activity
Ordinary physical activity results in symptoms
No symptoms at rest

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12
Q

What will be seen in class III heart failure?

A

Marked limitation of physical activity
Less than ordinary physical activity results in symptoms
No symptoms at rest

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13
Q

What will be seen in class IV heart failure?

A

Inability to carry out physical activity without symptoms
May have symptoms at rest
Discomfort increases with any degree of physical activity

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14
Q

Does heart failure affect one or both sides of the heart?

A

Can be either

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15
Q

Does right-sided heart failure occur on its own?

A

Rarely

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16
Q

When may right sided heart failure occur on its own?

A

In the case of chronic lung disease

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17
Q

What is the most common scenario in heart failure?

A

Left-sided heart failure that raises pulmonary arterial pressure, leading to additional right sided heart failure

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18
Q

What is it called when both ventricles are affected in heart failure?

A

Congestive heart failure

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19
Q

What is heart failure often divided to in clinical practice?

A 
Left sided heart failure 
Right sided heart failure 
Biventricular (congestive) heart failure 
Systolic heart failure 
Diastolic heart failure
20
Q

What are the symptoms of left sided heart failure?

A

Fatigue, shortness of breath upon exertion or when lying lat, waking from sleep with shortness of breath
Tachycardia
Cardiomegaly
3rd or 4th heart sound
Functional murmur of mitral regurgitation
Basal pulmonary crackles
Peripheral oedema

21
Q

What is cardiomegaly?

A

Displaced apex beat

22
Q

What is it called when there is a 3rd or 4th heart sound?

A

Gallop rhythm

23
Q

When is right sided heart failure most common?

A

Secondary to left heart failure

24
Q

What can cause right sided heart failure?

A 
Chronic lung disease 
Pulmonary embolism/hypertension 
Pulmonary/tricuspid valvular disease 
Left to right shunts (ASD/VSD)
Isolated right ventricular cardiomyopathy
25
Q

What are the symptoms of right sided heart failure?

A 
Distension and fluid accumulation (peripheral oedema) in areas drained by systemic veins 
Fatigue
Dyspnoea
Anorexia 
Nausea 
Raised JVP
Tendor, smooth hepatic enlargement 
Dependent pitting oedema 
Ascities 
Pleural effusion
26
Q

What is activated in heart failure?

A

The renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system

27
Q

Why are the sympathetic nervous system and RAAS activated in heart failure?

A

In an attempt to maintain cardiac output

28
Q

What effect does the activation of the sympathetic nervous system and RAAS have?

A

Making an already struggling heart work harder

29
Q

What does a drop in blood pressure, such as in heart failure, stimulate?

A

Renin release from the kidneys

30
Q

What is renin?

A

An enzyme which catalyses the conversion of angiotensin to angiotensin I

31
Q

What happens to angiotensin I?

A

It is converted to angiotensin II by ACE

32
Q

What is angiotensin II?

A

A strong vasoconstrictor

33
Q

What does angiotensin II promote?

A

Release of aldosterone from the kidneys

34
Q

What does aldosterone cause?

A

Salt and water retention in the kidneys, increasing blood volume

35
Q

What does the sympathetic nervous system cause when theres a drop in blood pressure?

A

Causes vasoconstriction of the blood vessels via the alpha 1 receptor, increasing blood pressure

36
Q

What is the result of SNS induced increased blood pressure in heart failure?

A

It increases the workload on the heart by increasing both the preload and the afterload

37
Q

What will sympathetic innervation of the hearts ß1 receptors cause?

A

An increase in both chronotropy and inotropy

38
Q

What drugs are used in the treatment of heart failure?

A 
ACE-inhibitors 
Diuretics 
ß-blockers 
Ca channel blockers 
Organic nitrates 
Cardiac glycosides
39
Q

Why are ACE-inhibitors used in the treatment of heart failure?

A

To prevent the conversion of angiotensin I to II, and thus have an indirect vasodilatory and diuretic effect, both of which are beneficial in the treatment of heart failure by reducing the workload of the heart

40
Q

Why are diuretics used in the treatment of heart failure?

A

Reduce blood volume and thus oedema

41
Q

What are ß-blockers used to do?

A

Prevent sympathetic innervation of the myocardium in an attempt to reduce the hearts work load

42
Q

What are the principles of the management of heart failure?

A

Correct underlying cause
pharmacological measures first, then pharmacological therapy.
Treat complications/associated conditions/cvs risk factors

43
Q

What is the purpose of pharmacological therapy in the management of heart failure?

A

Symptomatic improvement
Delay of progression of heart failure
Reduce mortality

44
Q

What is the purpose of Ca channel blockers in the treatment of heart failure?

A

Reduce contractility of the myocardium

45
Q

What is the purpose of organic nitrates in the treatment of heart failure?

A

Veno/vasofilator, resulting in a reduction in BP

46
Q

What is the purpose of cardiac glycosides in the treatment of heart failure?

A

Increase CO and heart contractility by inhibiting the Na/K pump
Raising intracellular Na inhibits NCX, so intracellular Ca increases, and so increase in contractility

ESA 2- Cardiovascular System (18 decks)

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