Heart Failure

Question 1

inability of heart to pump blood at an adequate rate to meet the metabolic demands of the body

Answer 1

heart failure

Question 2

impaired contractility (MI, volume overload, dilated cardiomyopathy) and increased afterload (aortic stenosis, HTN) cause ___________ dysfunction leading to left sided heart failure

Answer 2

systolic

Question 3

impaired ventricular relaxation (LVH, hypertrophic cardiomyopathy, restrictive cardiomyopathy, TMI), or obstruction of ventricular filling (mitral stenosis, pericardial tamponade) cause ________ dysfunction leading to left sided heart failure

Answer 3

diastolic

Question 4

pregnancy, hypertension, aortic stenosis, and aortic insufficiency lead to LVH causing?

Answer 4

left axis deviation (lead 1 +, avF -)

Question 5

pulmonic stenosis, pulmonic insufficiency, mitral stenosis, and high altitude lead to RVH causing?

Answer 5

right axis deviation (lead 1 -, avF +)

Question 6

hypertrophy of ventricular myocytes increases ________ to interior of cell, also consumes more O2 than normal so mycocardial ischemia may occur esp. upon increased effort

Answer 6

diffusion distance

Question 7

conditions which result in pressure and/or volume overload increase cardiac work which leads to ventricular ________, which has greater O2 demand

Answer 7

hypertrophy

Question 8

as heart failure develops, cardiac output decreases which results in _______ MAP

Answer 8

decreased

Question 9

diminished capacity to eject blood from the affected ventricle due to impaired myocardial contractility or increased afterload (destruction of myocytes, fibrosis)

Answer 9

systolic dysfunction

Question 10

the max ventricular volume at the end of filling

Answer 10

EDV

Question 11

the minimal ventricular volume at the end of ejection

Answer 11

ESV

Question 12

normal EF?

Answer 12

0.5 to 0.7

Question 13

ejection fraction will be lower than normal in?

Answer 13

systolic dysfunction

Question 14

increased stiffness of ventricular wall (restrictive cardiomyopathy, ventricular hypertrophy), reduced ventricular relaxation during diastole (cytosolic calcium remains elevated, impairs stretch)

Answer 14

diastolic dysfunction

Question 15

in heart failure the reduced stroke volume will _________ arterial pulse pressure

Answer 15

decrease

Question 16

dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, sweating, tachycardia, pulmonary rales and edema are symptoms of _______ HF

Answer 16

left sided

Question 17

RUQ discomfort (hepatic enlargement), fatigue, JVD, peripheral edema, sweating and tachycardia are symptoms of _______ HF

Answer 17

right sided

Question 18

ventricular _______ volume is increased in systolic and diastolic dysfunction, which means pressures upstream this structure will be increased

Answer 18

EDP

Question 19

capillary pressure increased due to local dilation, increased _______ pressure

Answer 19

venous

Question 20

pulmonary arterioles vasoconstrict in response to _______ levels, which increases pulmonary vascular resistance and causes pulm HTN

Answer 20

low oxygen

Question 21

when a person layds down venous return to the heart increases, so the increased filling of the heart would increase ventricular ________ pressure, atrial pressure, and venous pressure

Answer 21

end diastolic

Question 22

baroreflex response to decreased MAP due to reduced cardiac output?

Answer 22

beta-1 -increase HR and SV

alpha -1 : arteriolar constriction to increase TPR and venoconstriction to increase venous return

Question 23

chronic sympathetic stimulation of the heart results in _______ of cardiac beta adrenergic receptors, which further decreases the inotropic state of the heart (lowering CO) and decrease the sensitivity to catecholamines

Answer 23

downregulation

Question 24

• cause decreased afterload due to lower plasma ang2 levels –> TPR decreased –> SV increased
• decreased blood volume due to lower plasma aldosterone levels, reduces EDV and decreases likelihood of pulmonary edema

Answer 24

ACE inhibitors

Question 25

• 80% of blood flow to left ventricle occurs during ________
• aortic diastolic pressure will be decreased when afterload is reduced by ACE inhibitors
• if decrease is too much, MI could become more severe

Answer 25

diastole

Question 26

stretch of atria due to increased blood volume releases this, causes vasodilation and sodium excretion

Answer 26

ANP