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Pathophys > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

How does the heart generate almost all of its energy needed to drive its primary function of pumping blood?

A

aerobic metabolism (O2 requiring processes)

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2
Q

T/F The heart matches its energy needs for its contractile activity (pumping blood) with energy synthesis in real time.

A

True, no energy storage

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3
Q

We can link this O2 supply chain to the cardinal S&Ss of cardiac dysfunction. What are they? (6)

A
  1. Inappropriate fatigue and/or weakness
  2. Dyspnea (shortness of breath or SOB)
  3. Exercise intolerance
  4. Rapid or irregular heart beat
  5. Bilateral LE swelling
  6. Persistent cough
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4
Q

What is the equation for cardiac output, the measure of cardiac function?

A

CO (Q) = HR x SV

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5
Q

What is preload?

A

blood returning to heart

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6
Q

What is afterload?

A

pressure that the heart works against

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7
Q

What three factors is stroke volume dependent on?

A
  1. Preload
  2. Afterload
  3. Contractility
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8
Q

What is LVEDV = Left Ventricular End Diastolic Volume?

A

Volume when left ventricle has finished filling up

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9
Q

What is LVESV = Left Ventricular End Systolic Volume?

A

Volume when left ventricle has finished pumping out

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10
Q

What is the equation for Ejection Fraction (EF)?

A

(LVEDV-LVESV/ LVEDV) X 100

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11
Q

What are normal EF values?

A

60-75%

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12
Q

T/F EF can remain unchanged despite a change in LVEDV or LVESV.

A

True

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13
Q

When does blood flow through the coronary arteries?

A

During cardiac systole

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14
Q

What is coronary blood flow regulated by?

A
  1. Coronary artery pressure
  2. Local metabolic signals
  3. Signals from the endothelium
  4. Neural and hormonal molecules
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15
Q

Poiseuille’s Law - Q = Π X ∆P X r4 / 8 X ή X L

Describe change in radius of blood vessels:

A

An decrease in r by factor of x will increase pressure by x^4

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16
Q

What is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood?

A

Heart failure

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17
Q

Heart failure is the situation where the heart is incapable of maintaining a cardiac output adequate to accommodate what two things?

A
  1. metabolic needs

2. venous return

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18
Q

T/F Incidence of HF increases with age

A

True

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19
Q

What causes 2/3 of all HF cases?

A

Coronary Artery Disease (CAD)

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20
Q

What causes HF? (9)

A
  1. Coronary Artery Disease (CAD; 2/3’s of all cases)
  2. ischemic heart disease (IHD)
  3. Uncontrolled HTN (pulmonary or systemic)
  4. Valvular disease
  5. Uncontrolled diabetes
  6. Long standing ETOH abuse
  7. Hx of MI’s
  8. Age
  9. Age associated increased ventricular stiffness (loss of compliance)
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21
Q

What are signs and symptoms of HF? (4)

A
  1. Exertional Dyspnea
  2. Orthopnea – SOB in supine
  3. Paroxysmal nocturnal dyspnea (SOB at night)
    (Paroxysmal – sudden onset)
  4. Fatigue
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22
Q

Common clinical signs of HF?

A
  1. Fluid retention (pitting edema)
  2. Ascites - fluid retention in abdomen
  3. Pleural effusions (fluid between the lung pleura)
  4. Jugular venous distension(JVD): blood accumulates in jugular vein
  5. Hepatomegaly: abnormal enlargement of liver
  6. Tachycardia
  7. S3gallop (ventricular gallop) – during passive ventricular filling
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23
Q

What is left sided HF?

A

Contractility of left ventricle is reduced: Left ventricle does not pump as efficiently as a healthy heart

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24
Q

What are possible impacts of left sided HF?

A
  1. Reduced stroke volume, EF and Cardiac Output
  2. Collectively blood flow to the body (and hence O2 delivery) is reduced
  3. Fatigue, exercise intolerance, SOB
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25
Q

Describe how HTN can cause left sided HF?

A

HTN: cardiac hypertrophy→ increase myocardial damage which leads to cardiac remodeling and reduced contractility

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26
Q

Describe how CAD can cause left sided HF?

A

CAD: → chronic ischemic damage to the myocardium → remodeling and scaring (Ct inappropriate and not compliant) in the myocardium which ↓ contractility

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27
Q

T/F Arrhythmias can cause left sided HF.

A

True

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28
Q

With left sided HF, you get reduced LV contractility, ↓ LV SV, ↓ LV EF. How does that affect end systolic volume?

A

more blood left in left ventricle – end systolic volume increases

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29
Q

What is vascular congestion?

A
  • An engorgement of a vascular structure with blood

- Changes the pressure within that structure

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30
Q

Vascular congestion can lead to pulmonary congestion. What is pulmonary congestion?

A

Accumulation of fluid in the lungs

31
Q

What is PVD, peripheral vascular disease?

A
  • Accumulation of fluid in the peripheral vasculature causing engorgement
  • > Left atrium can’t eject normal vl of blood into LV -> slowing of blood moving from lungs into left atrium -> accumulation of fluid in lungs -> edema
32
Q

Describe the reduced contractility of the LV in left sided HF on the LA diastolic pressure.

A

reduced contractility -> ↑ LVEDV (congestion) & ↑LVEDP -> ↓ Blood movement from the LA into the LV during ventricular diastole -> ↑ Blood accumulates in LA causing a ↑ LA diastolic pressure

33
Q

Describe the ↑ LA diastolic pressure on the blood volume in pulmonary circulation:

A

↑ LA Diastolic pressure -> ↓ Blood movement from the lungs into the LA during LA diastole [blood movement predicated on ΔP ->↑ Blood volume in pulmonary circulation (congestion)

34
Q

For a patient with left sided HF presenting with pulmonary edema, what position would be difficult for them to be in?

A

Supine

35
Q

For a patient with left sided HF, they might present with hemoptysis. What is that?

A

Bloody sputum

36
Q

What are the signs/symptoms 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
    - A severe attack or a sudden increase in intensity of these S&S
  4. Decreased urine production
  5. Cough that develops with reclining (orthopnea, lungs are boggy and congested)
  6. Mitral valve regurgitation
  7. Cyanosis
37
Q

Why do you see decreased urine production in patient with left sided HF?

A

blood flow to kidney becomes compromised

38
Q

Why might you see mitral valve regurgitation in patient with left sided HF?

A

Increase in LA diastolic VL -> expansion -> valves would not close properly -> retrograde blood flow

39
Q

What is right sided HF?

A

Contractility of right ventricle is reduced: Right ventricle does not pump as efficiently as a healthy heart

40
Q

What is the impact if right sided HF?

A

Accumulation (congestion) of blood in RV, RA and in the systemic circulation resulting in systemic S&S.

41
Q

T/F Right sided HF results in systemic pathologies

A

True

42
Q

S&S of Right sided HF:

A
  1. Abdominal blotting/swelling/ascites (abdominal swelling)
  2. Kidney failure
  3. Jugular vein distension (JVD) – congestion back up
  4. Weight gain
  5. Dependent edema (when gravity can influence blood flow)
  6. Increased frequency of deep vein thrombi and PE’s
43
Q

Cor pulmonale is another name for what sided HF?

A

Right sided HF

44
Q

What is congestive HF? (CHF)

A
  • Right sided failure ultimately meets up with left sided failure
  • 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
45
Q

T/F CHF is type of HF most commonly seen in clinical practice

A

True

46
Q

Evolution of clinical stages of CHF:

Normal -

A
  • no symptoms
  • normal exercise
  • normal LV fxn
47
Q

Evolution of clinical stages of CHF:

Asymptomatic LV Dysfunction -

A
  • no symptoms
  • normal exercise
  • abnormal LV fxn
48
Q

Evolution of clinical stages of CHF:

Compensated CHF -

A
  • no symptoms
  • decrease exercise
  • abnormal LV fnx
49
Q

Evolution of clinical stages of CHF:

Decompensated CHF -

A
  • symptoms
  • decrease exercise
  • abnormal LV Fxn
50
Q

Evolution of clinical stages of CHF:

Refractory CHF -

A
  • symptoms not controlled with treatment
51
Q

HF: NYHA HF Classification

Class 1 -

A

Class 1: No limitation of physical activity and no symptoms with physical activity

52
Q

HF: NYHA HF Classification

Class 2 -

A

class 2: slight limitation of physical activity/comfortable at rest and physical activity causes symptoms

53
Q

HF: NYHA HF Classification

Class 3 -

A

class 3: marked limitation of physical activity/comfortable at rest and less than ordinary activity causes symptoms

54
Q

HF: NYHA HF Classification

Class 4 -

A

class 4: severe limitation and discomfort with physical activity and symptoms present at rest

55
Q

Staging HF:

Stage A -

A

People at high risk for developing HF in the future but no functional or structural heart disorder. Pre-heart failure

56
Q

Staging HF:

Stage B -

A

a structural heart disorder but no symptoms at any stage.

57
Q

Staging HF:

Stage C -

A

previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment.

58
Q

Staging HF:

Stage D -

A

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

59
Q

What is acute HF? Will see sudden onset of what S&S?

A

Acute HF: HF symptoms appear suddenly or a rapid worsening of existing symptoms of heart failure occurs
- Sudden onset of dyspnea and limb and LE swelling

60
Q

What is the 5 lb. rule in regard to acute HF?

A

5 lb. rule: 5 lb. increase in body weight in 24 hrs.

61
Q

What is systolic HF (HRrEF)?

A

Left ventricular contractility is reduced in turn reducing EF (left or right HF) and O2 delivery to the periphery

62
Q

What does HRrEF stand for?

A

heart failure with reduced ejection fraction

63
Q

What is the typical characteristic of HF?

A

↓LV function is typically characteristic of HF

64
Q

What is diastolic HF (HFpEF)?

A
  • ventricle pumps out same % of blood as normal, but the amount may be lower than normal
  • ventricles lose ability to relax normally -> stiffer and less compliant -> heart chambers can’t fill normally during diastole -> Global loss of cardiac, vascular and peripheral reserve
65
Q

T/F Patient with diastolic HF (HFpEF) often have pulmonary HTN and exercises intolerance.

A

True

66
Q

What should patient with diastolic HF (HFpEF) do in regard to physical activity?

A

These patients should be achieving or exceeding the guideline-recommended doses of physical activity

67
Q

T/F Systolic HF or HFrEF seen in more women than men

A

False. more men than women

68
Q

What chronic comorbidities seen with Systolic HF or HFrEF and Diastolic HF or HFpEF?

A
  1. HTN
  2. Type 2 diabetes
  3. obesity
  4. renal disease
69
Q

T/F Cardiac remodeling can never be positive.

A

False,

  • Aerobic exercise- Mild to moderate dilation & mild to moderate in LV wall thickness
  • Resistance exercise -mild to moderate in LV wall thickness
  • “Athlete’s Heart”
70
Q

HF is recognized as what type of disease rather than simply a heart disease?

A

neuroendocrine disease

71
Q

T/F Expect a lengthy and diverse drug list for your patients who have diagnosed HF

A

True

72
Q

What type of medications will patient with HF be taking?

A 
Diuretics
Beta blockers
ACE inhibitors/ARB
Calcium channel blockers
Vasodilators
Positive ionotropes
73
Q

Describe why Heart failure is not exclusive a “cardio-centric” disease:

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
74
Q

What is a key intervention for patients with HF?

A

Exercise training

Pathophys (16 decks)

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