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S3 - Pathophysiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

HEART FAILURE: PART 1

A

HEART FAILURE: PART 1

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2
Q

The heart generates almost all of its energy needed to drive its primary function (pumping blood) through ________ metabolism (O2 requiring processes).

A

aerobic

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3
Q

Where is O2 consumed?

A

mitochondria

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4
Q

Is there energy storage within the heart?

A

No, the heart matches its energy needs for contractile activity with energy synthesis in real time.

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5
Q

An ________ to match energy synthesis (O2) with energy expenditure (contractility) compromises cardiac function.

A

inability

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6
Q

We can link the ___ supply chain to the cardinal signs and symptoms of cardiac dysfunction, what are these S/S?

A

O2

  • Inappropriate fatigue/weakness
  • dyspnea (SOB)
  • Exercise intolerance (6MWT)
  • Rapid or irregular heart beat
  • Bilateral LE swelling
  • Persistent cough
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7
Q
  • Cardiac output is a measure of ______ __________.
  • CO = __ * __
  • Resting CO = _______
  • Resting SV = ________
  • Resting HR = ________
A
  • cardiac function
  • SV*HR
  • 4.5-5.0 L/min
  • 60-70 mls
  • 70 bpm
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8
Q

What 3 important factors is SV dependant on?

A
  • preload
  • afterload
  • contractility
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9
Q

What is ejection fraction?

A

EF = (EDV-ESV)/EDV*100

-Ejection fraction is the amount of blood from the left ventricle that is ejected % wise.

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10
Q
  • What is a normal EF range?

- EF can remain ________ despite a change in EDV or ESV.

A
  • 60-75%

- unchanged

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11
Q
  • Does the heart have its own circulatory system?

- Blood flows through these vessels only during cardiac __________.

A
  • Yes, coronary arteries

- systole

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12
Q

Coronary blood flow is regulated by what 4 things?

A
  • coronary artery pressure
  • local metabolic signals
  • signals from the endothelium
  • neural and hormonal molecules
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13
Q

What is the most important determinant of CO?

A

radius of vessel

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14
Q

Look at Wiggers Diagram

A

Look at Wiggers Diagram

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15
Q

What is heart failure?

A

“The situation where the heart is incapable of maintaining a cardiac output adequate to accommodate metabolic needs and venous return”

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16
Q

Heart failure (HF) is a complex clinical syndrome that results from any __________ or __________ impairment of ventricular ______ or _______ of blood.

A
  • structural or functional

- filling or ejection

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17
Q

Is heart failure a reason to not treat a patient?

A

No

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18
Q

Causes of Heart Failure (HF):

  • _______ ________ Disease (CAD; 2/3’s of all cases)/ischemic heart disease (IHD)
  • Uncontrolled ____(pulmonary or systemic)
  • Valvular disease
  • Uncontrolled ________
  • Long standing _______ abuse
  • Hx of __’s
  • Age
  • Age associated increased ventricular stiffness (loss of compliance)
A
  • Coronary Artery Disease
  • HTN
  • diabetes
  • ETOH
  • MI
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19
Q

CAD is responsible for about / of all heart failure cases.

A

2/3

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20
Q

HEART FAILURE: PART 2

A

HEART FAILURE: PART 2

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21
Q

Heart Failure (HF) Common Clinical Signs:

  • Fluid ________
  • Ascites: Fluid retention in the _______
  • Pleural effusions (fluid between the ______ pleura)
  • _________ ________ distension(JVD)
  • _____________ (enlargement of liver)
  • Pitting edema
  • _______cardia
  • S3gallop
A
  • retention
  • abdomen
  • lung
  • Jugular Venous Distension (JVD)
  • hepatomegaly
  • tachycardia
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22
Q

Can heart failure be L or R sided?

A

Yes, it can be both

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23
Q

HFpEF vs HFrEF

A

HFpEF = Heart Failure w/ preserved ejection fraction

HFrEF = Heart Failure w/ reduced ejection fraction

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24
Q

Patients with left sided HF have compromised __________. What is the impact of this?

A

Contractility

  • reduced SV, EF, and CO
  • blood flow to the body is reduced
  • fatigue, exercise intolerance, SOB
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25
Q

What are some causes of left sided HF?

A
  • HTN
  • CAD (Coronary Artery Disease)
  • Arrhythmias
  • Decreased CO caused by impaired ventricular filling and decreased ventricular relaxation
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26
Q

How does HTN cause HF?

A

Causes cardiac hypertrophy which increases myocardial damage leading to remodeling and reduced contractility

27
Q

How does CAD cause HF?

A

chronic ischemic damage to myocardium causing remodeling and scaring which decreases contractility

28
Q

Reduced LV contractility results in a decrease in LV ___ and LV ____.

A

-SV (stroke volume) and EF (ejection fraction)

29
Q

What is vascular congestion?

A

An engorgement of a vascular structure with blood that changes the pressure within that structure.

30
Q

What is pulmonary congestion?

A

Accumulation of fluid in the lungs.

31
Q

What is PVD?

A

Peripheral Vascular Disease

-Accumulation of fluid in the peripheral vasculature causing engorgement.

32
Q

Reduced contractility leads to increased left ventricular ______ and _________ causing congestion.

A

LVEDV and LVEDP

33
Q

An increase in LVEDV and LVEDP leads to blood accumulation where?

A

Left Atrium, causing a increase in LA diastolic pressure

34
Q

An increase in LA diastolic pressure reduces blood movement from the _____ to the atrium.

35
Q

Reduced blood movement from the lungs to the atrium causes what?

A

Increased blood volume in pulmonary circulation (PULMONARY EDEMA)

36
Q

What is hemoptysis?

A

bloody sputum

37
Q

What are the S/S of left sided HF?

A
  • SOB, Dyspnea
  • Fatigue, tiredness, exertional dyspnea
  • Waking up feeling like you are suffocating (orthopnia, paraoxysmal nocturnal dyspnea)
  • Decreased urine production (blood flow to kidneys)
  • Coughs that develop with reclining
  • Mitral valve regurgitation
38
Q

Right sided HF is a reduced ______________ of the right ventricle. What is the impact of this?

A

Contractility

-Accumulation of blood in RV, RA, and ultimately in the systemic circulation

39
Q

Right sided HF results in __________ S/Sx.

40
Q

What are the S/Sx of right sided failure?

A
  • Reflects congestion in the systemic circulation
  • Abdominal swelling (ascites)
  • Kidney failure
  • Jugular Vein Distension (JVD)
  • Weight gain
  • Dependent edema
  • Increased frequency of DVT and PE’s
41
Q

HEART FAILURE: PART 3

A

HEART FAILURE: PART 3

42
Q

Right sided HF ultimately meets up with ______ _______ ________.

A

left sided failure

43
Q

Is the side of HF usually specified in the clinic?

44
Q

What is CHF?

A

Congestive Heart Failure
-A clinical condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in myocardium.

45
Q
  • Left HF = low ___

- Right HF = ________ venous congestion

A
  • CO

- systemic

46
Q

List the stages of chronic CHF.

A
  1. ) Normal
  2. ) Asymptomatic LV Dysfunction
  3. ) Compensated CHF
  4. ) Decompensated CHF
  5. ) Refractory CHF
47
Q

At what stage in chronic CHF do we see abnormal LV function?

A

First seen in Asymptomatc LV Dysfunction, gets worse further down the stages.

48
Q

At what stage in chronic CHF do we see a decrease in exercise tolerance?

A

First seen in Compensated CHF, gets worse further down the stages.

49
Q

At what stage in chronic CHF do we see symptoms present?

A

First seen in Decompensated CHF, gets worse in Refractory CHF.

50
Q

Describe the ABCD scheme of HF from the American Heart Association.

A

A- High-risk for CHF without structural heart disease or symptoms.
B- Diagnosed with structural heart disease, but not experiencing any CHF symptoms.
C- Structural heart disease with prior or current CHF symptoms
D- Advanced heart failure

51
Q

Describe the NYHA HF classifications.

A 
NYHA-1 = Cardiac disease, but no symptoms and no limitation in ordinary physical activity
NYHA-2 = Mild symptoms and slight limitation during ordinary activity
NYHA-3 = Significant limitation in activity due to symptoms. Comfortable only at rest.
NYHA-4 = Severe limitations. Symptoms even while at rest.
52
Q

Can HF be acute?

53
Q

In acute HF, HF symptoms appear suddenly or a rapid worsening of existing symptoms of heart failure occurs via ___________.

A

exacerbation

54
Q

How would Acute HF present in a patient?

A

Sudden onset of dyspnea and limb and LE swelling

55
Q

What is the 5lb rule?

A
  • A 5lb increase in body weight in 24hrs.

- A way to tell whether an exacerbation of HF is occuring.

56
Q

Systolic HF (HFrEF) is when the left ventricular _____________ is reduced in turn reducing EF (L or R) and O2 delivery to periphery. The net effect is reduced delivery of blood into __________ and subsequent O2 delivery.

A
  • contractility

- systemic circulation

57
Q

Diastolic HF (HFpEF) is a reduced ability for the ventricles to _____. Nearly half of all patients with HF have a normal ejection fraction.

58
Q

Diastolic HF is seen more frequently in?

A
  • Older age
  • Obese
  • Females
  • HTN
  • Metabolic syndrome, renal dysfunction
59
Q

Diastolic HF Pathophysiology:

  • The ventricles lose their ability to ______ normally
  • The ventricle becomes stiffer and less _________
  • Heart chambers can not ___ normally during diastole
  • Global loss of cardiac, vascular and peripheral reserve
  • Often have pulmonary ____ and exercise ___________
  • Says that HF can exist even in the presence of normal ___
  • These patients should be achieving or exceeding the guideline-recommended doses of physical activity
A
  • relax
  • compliant
  • fill
  • HTN and exercise intolerance
  • EF
60
Q

Diastolic HF = HF_EF (more women or men?)

Systolic HF = HF_EF (more women or men?)

A

Diastolic HF = HFpEF (women)

Systolic HF = HFrEF (men)

61
Q

Can cardiac remodeling be positive?

A

Yes

  • Aerobic Exercise- mild to moderate dilation and mild to moderate increase in LV wall thickness
  • Resistance Exercise- mild to moderate increase in LV wall thickness
62
Q
  • HF is now recognized as a ___________ disease rather than simply a heart disease.
  • HF is a response to a long term hyper_______ and/or chronic hyper_________ state.
A
  • neuroendocrine

- hyperautonomic, hyperinflammatory

63
Q

Is HF exclusively a “cardoi-centric” disease?

A

No

  • endothelial dysfunction
  • skeletal muscle damage
  • kidney dysfunction
  • decreased systemic blood flow and accompanying increased total peripheral resistance secondary to excessive sympathetic stimulation causing vasoconstriction
64
Q

What type of HF is most commonly seen in clinical practice?

S3 - Pathophysiology (14 decks)

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