Heart Failure Flashcards
What are the most common causes of left-sided heart failure?
Ischemic heart disease, Hypertension, mitral and aortic valvular disease, myocardial disease (cardimyopathy, myocarditis).
What is the Pulmonary Capillary Wedge Pressure?
It is a good approximation of left atrial pressure.
How do we measure the PCWP?
Measured with Swan-Ganz catheter.
Where will we put the Swan-Ganz catheter?
It is a venous catheter, who it’s put in either in the internal Jugular vein or the subclavian vein.
What do we measure with the Swan-Ganz catheter?
Measure Left Atrial pressure and and approximates left ventricular diastolic pressure.
What is the normal pressure of the PCWP?
PCWP
What is the normal pressure of the Left Atrial?
What is the normal pressure of the Left ventricular pressure?
Around 10 mmHg.
How are the pressures in Mitral Stenosis?
Pulmonary Capillary Wedge Pressure > Left Ventricular diastolic pressure.
What is a Heart Failure?
It’s a clinical syndrome caused by abnormal cardiac structure or function (cardiac pump dysfunction). Acquired and inherited.
Which are the symptoms finding in Heart failure?
Exercise intolerance, Fatigue, Shortness of breath, pulmonary rales, peripheral edema, pitting edema, dyspnea, Orthoptnea and JVD.
Which are the causes of decrease left ventricular contractility?
Chronic Hypertension (most common) and Ischemic cardiomyopathy.
What are the compensation of the decrease of cardiac output?
Increases sympathetic activation and Increases Renin-Angiotensin-Aldosterone.
What is the short term mechanism to regulate the blood pressure?
It is the activation of the systemic nervous system that increase Left Ventricular contractility resulting in elevation of cardiac output
What are the three ways to stimulate renin production?
1) Sympathetic nervous system stimulating Beta1- receptors on the kidneys.
2) Macula densa cells sense low sodium.
3) Juxtaglomerular apparatus sense low Blood Pressure.
What is the function of Renin?
Convert angiotensinogen to angiotensin I, after that in the lungs ECA convert angiotensin I to angiotensin II.
What organs are involved in Renin-Angiotensin-Aldosterone ?
Kidneys making Renin, Liver making Angiotensinogen and Lungs making ACE, Adrenal gland making Aldosterone.
What is the most potent Vasoconstrictor in the human body?
Angiotensin II. Also stimulates adrenal glands to secrete aldosterone.
What are the functions of the angiotensin?
Directly increase blood pressure by vasoconstriction, and indirectly increase blood pressure while expanding intra vascular volume.
What is the function of compensation in Heart failure of the renin-angiotensin-aldosterone?
R-A-A increases renal sodium and water absorption that increase systemic venous pressure and preload and finally that increase cardiac output.
What is the side effect of the increase systemic venous pressure and increase of preload during the compensation?
Peripheral edema (pitting edema).
Decrease Left ventricular contractility resulting in pulmonary venous congestion, what are the effects that this cause?
First one cause Pulmonary edema also decrease Right ventricle output that resulting in peripheral edema,
How many categories of Heart failure exist?
There are two broad categories Left heart failure and Right heart failure.
Left-sided heart failure characteristics:
Dyspnea on exertion (DOE). Cardiac dilation. Pulmonary edema: -Paroxysmal nocturnal dyspnea. -Orthoptnea.
