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Coronary Heart Disease > heart failure > Flashcards

heart failure Flashcards

1
Q

What is forward failure?

A

reduced CO

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2
Q

What is backward failure?

A

elevated A/V filling pressures

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3
Q

HF-REF

A

HF with reduced ejection fraction
LVEF < 40%
inability of heart to contract effectively

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4
Q

HF-PEF

A

HF with preserved ejection fraction
normal LV ejection fraction
LVEF > 50%
inability of heart to relax effectively

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5
Q

What is acute HF?

A
  • rapid onset of symptoms
  • sudden decline in cardiac function (hrs/days)
  • life threatening
  • new or as a result of chronic HF
  • decompensated failure
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6
Q

What is chronic HF?

A
  • slow onset of symptoms (months/yrs)
  • activation of adaptive responses to maintain organ perfusion in long term
  • compensated failure
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7
Q

What are causative features of HF?

A
  • intrinsic myocardial damage
  • pressure overload
  • volume overload
  • inadequate filling
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8
Q

HF-REF pathophysiology mechanisms? (3)

A
  1. cardiorenal model
  2. cardio-circulatory model
  3. neurohormonal model
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9
Q

What happens in the neurohormonal model?

A
  • drop in CO and fall in BP
  • reflex activation of several neurohormonal pathways
  • initially are beneficial
  • eventually become harmful
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10
Q

What are the beneficial effects of the neurohormonal method?

A

maintain BP
maintain CO
maintain organ perfusion

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11
Q

What are the harmful effects of the neurohormonal pathway?

A

progressive decreased cardiac function
progressive decreased CO
systemic/pulmonary congestion

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12
Q

How does the neurohormonal system effect the sympathetic nervous system?

A
  • increase in catecholamines
  • inc contractility and HR
  • inc systemic/pulmonary vasoconstriction
  • inc renin from kidneys (RAAS)
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13
Q

Neurohormonal system on RAAS

A

inc angiotensin II
inc aldosterone release
-> both toxic to heart, promote remodeling

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14
Q

neurohormonal system and ADH

A

increases ADH release

which increases water retention and vasoconstriction

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15
Q

What natriuretic peptides are released?

A

ANP and BNP

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16
Q

What are the active and inactive versions of BNP?

A

active - BNP

inactive - NT-pro BNP

17
Q

What are the 2 types of symptoms of HF?

A
  1. hypoperfusion - reduced CO

2. congestive - impeded venous return

18
Q

What are the treatment goals for drug treatment of CHF?

A
  • to improve CO
  • reduce atrial/ventricular filling pressures
  • reverse/stop remodeling
19
Q

What does myocardial stimulation do and what is used?

A

increases myocardial contractility

inotropic agents

20
Q

What does reducing cardiac workload do and what is used?

A

reduces afterload/preload

with diuretics, vasodilators

21
Q

What does arresting/reversing remodeling do and what is used?

A

inhibits chronic neurohormonal activation

with ACEIs, beta, ARBs, ARNIs, aldosterone antagonists

22
Q

5 types of drugs in the neurohormonal blockade

A
  1. ACEIs
  2. beta blockers
  3. ARBs
  4. aldosterone receptor antagonist
  5. ARNIs
23
Q

What do ANP and BNP do?

A
  • counteract the effects of the neurohormonal system
  • cause vasodilation, diuresis
  • decrease: cardiac stress, remodeling, aldosterone production
24
Q

Where is ANP released from?

A

atrial cells

25
Q

Where is BNP released from?

A

ventricular cells

26
Q

Hypoperfusion symptoms

A

fatigue

decreased exercise tolerance

27
Q

Congestive symptoms

A

pulmonary congestion

systemic congestion

28
Q

Symptoms of left ventricular backwards failure

A

pulmonary congestion

29
Q

Symptoms of left ventricular forwards failure

A

hypoperfusion (dec. CO)

30
Q

Symptoms of right ventricular forward failure

A

hypoperfusion

31
Q

Symptoms of right ventricular backwards failure

A

systemic congestion

32
Q

How to diagnose HF

A
  • clinical presentation, medical history, physical examination
  • blood tests
  • diagnostic tests (chest x-ray, ECG, natriuretic peptides, echocardiogram)
33
Q

How if HF classified?

A

NYHA 1-4

34
Q

NYHA 1

A

asymptomatic

normal activity has no symptoms

35
Q

NYHA 2

A

mild

slight limitations

36
Q

NYHA 3

A

moderate

normal activity gives limitations

37
Q

NYHA 4

A

severe

inability to carry out any physical activity

38
Q

What are the stages of HF?

A

stages 1-4

Coronary Heart Disease (14 decks)

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