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Pathophysiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

T/F: the heart stores up lots of energy

A

FALSE
the heart matches its energy needs for its contractile activity with energy synthesis in real time

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2
Q

describe the importance of the O2 supply chain to cardiac activity

A

the heart generates almost all of its energy needed through aerobic metabolism

if O2 cannot be delivered to cardiac tissue, we will not have enough available for synthesis of energy and thus dysfunction occurs

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3
Q

what are the cardinal s/s of cardiac dysfunction?

A
  1. inappropriate fatigue and/or weakness
  2. dyspnea (SOB)
  3. exercise intolerance
  4. rapid or irregular heartbeat
  5. bilateral LE swelling
  6. persistent cough
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4
Q

explain how EF can remain unchanged despite changes in LVEDV or LVESV

A

relate it to the gas gauge in a smart car vs a truck.

their gas gauges may look the same but it doesn’t tell you the actual volume of gas in each car

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5
Q

what factors determine SV? HR? CO?

A

CO = SV * HR

HR → parasympathetic and sympathtic tone influence HR

SV → preload, contractility, and afterload all influence SV

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6
Q

what regulates coronary arteries?

A
  1. coronary artery pressure
  2. local metabolic signals
  3. signals from the endothelium
  4. neutral and hormonal molecules
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7
Q

define heart failure

A

a complex clinical syndrome that results from any structural or functional impairment of ventricular filling (preload) or ejection of blood (afterload)

The situation where the heart is incapable of maintaining a CO adequate to accomodate metabolic needs and venous returns

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8
Q

list some causes of heart failure

A
  1. CAD/ischemic heart disease (IHD)
  2. uncontrolled HTN (pulmonary or systemic)
  3. Valvular disease
  4. uncontrolled diabetes
  5. long standing ETOH abuse
  6. Hx of MIs
  7. Age
  8. Age associated increased ventricular stiffness
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9
Q

what are the s/s of HF?

A
  1. exertional dyspnea
  2. orthopnea (SOB in supine)
  3. Paroxysmal nocturnal dyspnea (SOB at night)
  4. fatigue
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10
Q

List common clinical signs of HF

A
  1. fluid retention
  2. ascites
  3. pleural effusions
  4. jugular venous distension (JVD)
  5. heptomegaly (enlargement of liver)
  6. pitting edema
  7. tachycardia
  8. S3 gallop (specific EKG change)
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11
Q

how is HF classified?

A

Right vs Left sided heart failure

congestive heart failure

HFpEF vs HFrEF

Functional

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12
Q

describe left sided HF

A

contractility of LV is reduced → LV does not pump as efficiently as a healthy heart

this results in:

  • reduced SV, EF, and CO
  • collectively blood flow to the body is reduced
  • fatigue, exercise intolerance, SOB
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13
Q

what are some causes of left sided HF?

A
  1. HTN → cardiac hypertophy leads to cardiac remodeling and reduced contractility
  2. CAD → chronic ischemic damage to the myocardium leads to remodeling and scaring in myocardium which reduces contractility
  3. Arrhythmias
  4. decreased CO caused by impaired ventricular filling and decreased ventricular relaxation
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14
Q

describe the progression of left sided HF

A
  1. reduced LV contractility
  2. reduced LV SV and EF
  3. causes vascular congestion:
    • increase in LVEDV and thus increase in LVEDP (pressure increase)
    • specifically pulmonary congestion
  4. decrease in blood movement from LA to LV during ventricular diastole
  5. increase in blood accumulation in LA causing an increase in LA diastolic pressure
  6. decreased blood mvoement from lungs into LA
  7. increase in blood volume in pulmonary circulation (congestion)
  8. pulmonary edema
    • hemoptysis → blood suptum
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15
Q

list s/s of left sided HF

A
  1. SOB, dyspnea
  2. fatigue, tiredness, exertional dyspnea
  3. waking up feeling like you are suffocating
    • orthopnea
    • paroxysmal nocturnal dyspnea
  4. decreased urine production
  5. cough that develops with reclining
  6. mitral valve regurgitation
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16
Q

describe right sided HF

A

contractility of RV is reduced → RV does not pump as efficiently as a healthy heart

impact:

  • accumulation (congestion) of blood in RV, RA, and in systemic circulation resulting in systemic s/s
17
Q

list s/s of right sided HF

A
  1. abdominal blotting/swelling/ascites
  2. kidney failure
  3. JVD
  4. weight gain
  5. dependent edema
  6. increased frequency of deep vein thrombi and PE’s
18
Q

what is congestive heart failure (CHF)?

A

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 the myocardium

often used synonymously with left HF and right HF

19
Q

T/F: CHF is the most common type of HF seen in clinic

A

TRUE

20
Q

describe the clinical progression/changes that occurs with CHF

A
  1. Normal
    • no symptoms, normal exercise, normal LV fxn
  2. Asymptomatic LV dysfunction
    • no symptoms, normal exercise, abnormal LV fxn
  3. Compensated CHF
    • no symptoms, decreased exercise, abnormal LV fxn
  4. Decompensated CHF
    • symptoms, decline in exericse, abnormal LV fxn
  5. Refractory CHF
    • symptoms not controlled with trx
21
Q

how can HF be staged?

A

Stages A → D

22
Q

describe stage A HF

A

people at high risk for developing HF in the future but no functional or structural heart disorder.

pre-heart failure

23
Q

describe Stage B HF

A

a structural heart disorder but no symptoms at any stage

24
Q

describe Stage C HF

A

previous or current symptoms of HF in the context of an underlying structural heart problem, but managed with medical trx

25
Q

describe Stage D HF

A

advanced disease requiring hospital based support, a heart transplant or palliative care

26
Q

describe acute HF

A

HF symtpoms appear suddenly or a rapid worsening of existing symptoms of HF occurs

sudden onset of dyspnea and limb and LE swelling

5 lb rule

27
Q

what is the 5lb rule?

A

if you see an increase in 5lbs within 25 hrs call your physcian

28
Q

describe systolic HF (also called HFrEF)

A

LV contractility is reduced in turn reducing EF and O2 delivery to the periphery

also called HF with reduced ejection fraction (HFrEF)

net effect reduced delivery of blood into systemic circulation and subsequent O2 delivery

29
Q

describe diastolic HF (HFpEF)

A

reduced ability for filling of chambers

nearly half of all pts with HF have a normal EF

seen more frequently in:

  • females
  • older age
  • HTN
  • metabolic syndrome, renal dysfunction
  • Obesity
30
Q

describe the pathophysiology of diastolic HF

A
  1. the ventricles lose their ability to relax normally
  2. ventricles become stiffer and less compliant
  3. heart chambers cannot fill normally during diastole
  4. global loss of cardiac, vascular and peripheral reserve
  5. often have pulmonary HTN and exercise intoleranc
31
Q

which type of HF impacts men more than women?

A

Systolic HF (HFrEF)

32
Q

which type of HF impacts women more than men?

A

diastolic HF (HFpEF)

33
Q

which type of HF results in more hospitalizations?

A

Systolic HF (HFrEF)

34
Q

T/F: HF is recognized as a neuroendocrine disease

A

TRUE

35
Q

what types of medications might your pt be on if they have HF?

A
  1. Diuretics
  2. Beta blockers
  3. ACE inhibitors/ARBs
  4. Calcium channel blockers
  5. Vasodilators
  6. Positive iontropes
36
Q

HF is not an exclusive cardio-centric disease, what other organs/tissues can it impact?

A
  1. endothelial dysfunction
  2. skeletal muscle damage
  3. decreased systemic blood flow and accompanying increased total peripheral resistance secondary to excessive sympathetic stimulation causing vasoconstriction
  4. kidney dysfunction
37
Q

T/F: we should not exercise a pt with HF

A

FALSE
exercise training is a key intervention for pts with HF

Pathophysiology (18 decks)

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