Heart failure Flashcards

1
Q

what is heart failure

A

abnormality of cardiac structure or function leading to failure of the heart to deliver oxygen at a rate that fulfills the requirements of tissues in the body

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2
Q

how do you calculate the ejection fraction of the heart

A

amount of blood pumped out of the ventricle divided by the total amount of blood in the ventricle

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3
Q

what ejection fraction is considered heart failure

A

50%

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4
Q

how do cardiomyocytes resspond to an action potential

A

depolarization of the membrane then shortens the contractile proteins then relaxes to return to resting state

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5
Q

what is echocardiography

A

send soundwaves into the body which are reflected at the interfaces between tissue, the return time tells the depth of the reflecting surface

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6
Q

what is the force of muscle contraction related to

A

amount of cytosolic calcium

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7
Q

what causes the initiation of the contractile process

A

calcoium enters from outside the cell which triggers release from the sarcoplasmic reticulum and mitochondria stores

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8
Q

how is muscle relaxtion achieved after the release of calcium

A

removal of free calcium by Na/Ca exchangers and reuptake into SR and mitochondria

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9
Q

why is heart failure initially not perceived by the patient

A

compensatory mechanisms

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10
Q

3 ways the body tries to correct failure

A

increase sodium retention
activate RAAS (angiotensin, aldosterone)
sympathetic nerve activation

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11
Q

how does increased sodium retention increase BP

A

increases blood volume slowly

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12
Q

how does activating RAAS increase BP

A

angiotensin constricts arteries and veins

aldosterone causes sodium retention

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13
Q

how does activating SNS increase BP

A

increase heart rate

increase contractility

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14
Q

what happens as a result of overly increased plasma volume and constriction of veins due to compensatory mechanisms

A

venous return stretches the already overstretched ventricles
heart cant increase force of contraction
heart enlarges and thickens
venous presure increases causing edema

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15
Q

what happens as a result of overly increased constriction of arteries dur to compensatory mechanisms

A

increased TPR heard for heart to empty against

increased resistance to outflow more than heart can overcome

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16
Q

result of cardiac overstimulation due to compensatory mechanisms

A

down regulation of beta receptors, increased fibrosis and apoptosis

17
Q

what happens in left sided heart failure

A

blood backs up into lungs and periphery causing pulmonary edema which can be life threatening

18
Q

what happens in right sided failure

A

blood backs up into periphery causing peripheral edema

19
Q

main signs and symptoms of heart failure

A

edema, cough and dyspnea (difficulty breathing)

20
Q

with each acute event, myocardial injury may contribute to what

A

progressive LV dysfunction

21
Q

two examples of inhibitors of the RAAS

A
ACEI = enalapril 
ARB = losartan
22
Q

two examples of beta blockers

A

metoprolol

carvediol

23
Q

two examples of inotropes

A

digoxin

dobutamine

24
Q

5 examples of diuretics

A

furosemide
metolazone
aldosterone antagonist
spironolactone

25
Q

why are ACE inhibitors used in heart failure

A

vasoconstriction and blood volume retention from the RAAS become a problem and these reduce that

26
Q

first line in heart failure because it slows the course and decreases mortality

A

ACE inhibitor

27
Q

can ACE inhibitors be used in pregnancy

A

no causes birth defect

28
Q

side effects of ACE inhibitors

A

hyperkalemia

dry cough

29
Q

do ACE inhibitors effect lipids or blood glucose

A

no metabolically neutral

30
Q

what other drugs cant be used with enalipril because they increase potassium levels

A

ibuprofen, indomethacin
losartan
alka-seltzer
trimethoprim

31
Q

how is losartan different from enalipril

A

doesnt increase bradykinin or cause of cough