Heart Failure Flashcards
inability of heart to pump blood at an adequate rate to meet the metabolic demands of the body
heart failure
impaired contractility (MI, volume overload, dilated cardiomyopathy) and increased afterload (aortic stenosis, HTN) cause ___________ dysfunction leading to left sided heart failure
systolic
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
diastolic
pregnancy, hypertension, aortic stenosis, and aortic insufficiency lead to LVH causing?
left axis deviation (lead 1 +, avF -)
pulmonic stenosis, pulmonic insufficiency, mitral stenosis, and high altitude lead to RVH causing?
right axis deviation (lead 1 -, avF +)
hypertrophy of ventricular myocytes increases ________ to interior of cell, also consumes more O2 than normal so mycocardial ischemia may occur esp. upon increased effort
diffusion distance
conditions which result in pressure and/or volume overload increase cardiac work which leads to ventricular ________, which has greater O2 demand
hypertrophy
as heart failure develops, cardiac output decreases which results in _______ MAP
decreased
diminished capacity to eject blood from the affected ventricle due to impaired myocardial contractility or increased afterload (destruction of myocytes, fibrosis)
systolic dysfunction
the max ventricular volume at the end of filling
EDV
the minimal ventricular volume at the end of ejection
ESV
normal EF?
0.5 to 0.7
ejection fraction will be lower than normal in?
systolic dysfunction
increased stiffness of ventricular wall (restrictive cardiomyopathy, ventricular hypertrophy), reduced ventricular relaxation during diastole (cytosolic calcium remains elevated, impairs stretch)
diastolic dysfunction
in heart failure the reduced stroke volume will _________ arterial pulse pressure
decrease
dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, sweating, tachycardia, pulmonary rales and edema are symptoms of _______ HF
left sided
RUQ discomfort (hepatic enlargement), fatigue, JVD, peripheral edema, sweating and tachycardia are symptoms of _______ HF
right sided
ventricular _______ volume is increased in systolic and diastolic dysfunction, which means pressures upstream this structure will be increased
EDP
capillary pressure increased due to local dilation, increased _______ pressure
venous
pulmonary arterioles vasoconstrict in response to _______ levels, which increases pulmonary vascular resistance and causes pulm HTN
low oxygen
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
end diastolic
baroreflex response to decreased MAP due to reduced cardiac output?
beta-1 -increase HR and SV
alpha -1 : arteriolar constriction to increase TPR and venoconstriction to increase venous return
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
downregulation
- 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
ACE inhibitors
- 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
diastole
stretch of atria due to increased blood volume releases this, causes vasodilation and sodium excretion
ANP
