Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Cardiology-Exam 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

________ ________ is the FINAL common pathway of many cardiac diseases

A

Heart Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Early compensatory mechanisms to myocardial insults include……….. and are initially protective but become maladaptive with time

A

Inc. preload and wall thickness (SNS and RAAS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

clinical syndrome characterized largely by fluid retention leading to pathologically elevated filling pressure; worsened by physiologic compensation with SNS and RAAS; decreased contractility, stroke volume, and increased preload

A

Heart Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Heart failure can be caused by… (4 total)

A

Impaired contractility (ischemia, dilation)
Inc. afterload (HTN, AS)
Inc. volume (valve insufficiency)
Impaired ventricular filling (hypertrophy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most common cause of heart failure

A

Myocardial infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Two main physiologic adaptations to decreased stroke volume are…….

A

Inc. preload (Frank-Starling)

Inc. wall thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When contractility is impaired, a higher _________ is required to increase stroke volume

A

preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Increased preload leads to increased stroke volume up to a point (True or False)

A

True. (plateaus to where no increase in pressure affects stroke volume)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Increased left atrial pressure can result in…

A

pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is preload regulated (3 total)

A 
Venous tone (sympathetic activity via baroreceptors)
Blood volume (Sympathetic, RAAS, ADH)
Body position
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Norepinephrine application to the kidney causes…

A 
Renin release
Fluid retention (inc. preload)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cardiovascular response to chronic beta-adrenergic receptor stimulation

A 
Downregulation of receptors
Energy starvation
Cardiomyocyte death
Ventricular arrhythmias
Fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dec. perfusion stimulates sympathetic outflow, causing……. which worsens disease progression

A

Cardiac activity–> myocardial toxicity and arrhythmias

Renal activity–> vasoconstriction and fluid retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Renal response to reduced stroke volume

A

Reduced stroke volume—> reduced effective arterial blood volume—> increased renin and aldosterone—> increased blood volume and vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does heart failure disrupt the negative feedback loop of the renin-angiotensin system?

A

Gradual decrease in cardiac output, and thus renal perfusion, perpetually stimulates renin release (as futile as a dog chasing it’s own tail)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does the SNS and RAAS increase preload?

A

Inc. circulating volume

Inc. venous return

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Natriuretic peptides that counteract maladaptive neurohormones (help reduce blood volume and promotes vasodilation)

A

ANP (atrial natriuretic peptide)

BNP (brain natriuretic peptide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Determinants of afterload (3 total)

A

Systemic vascular resistance
Aortic compliance
Aortic valve resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Concentric hypertrophy (pathologic) will progress to what over years of chronic stressors

A

Eccentric hypertrophy (dilation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common phenotype for heart failure

A

Cardiac dilation (eccentric hypertrophy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Two main modes of heart failure

A

Ischemia

Hypertrophic (concentric to eccentric)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Fibrosis impairs the heart’s ability to (contract/relax/both)

A

Both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Morphologic features of ventricular remodeling

A

Hypertrophic myocytes
Dead myocytes
Fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When stroke volume decreases, ______ will increase in an attempt to preserve MAP

A

Systemic vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
The increase in __________ due to SNS and RAAs can further impair cardiac performance by decreasing stroke volume, beginning the maladaptive cycle
afterload (due to increased SVR)
26
Medications to _______ ________ are central to treating heart failure (opposed SNS and RAAS effects)
reduce afterload
27
You can have good systolic activity with diastolic dysfunction (True or False)
True
28
Dec. Contractility Dec. Stroke Volume Inc. stiffness
Systolic Dysfunction
29
Normal contractility Dec. stroke volume Inc. stiffness Diastolic Dysfunction
Diastolic Dysfunction
30
Why does the RAAS contribute to the worsening of heart failure?
The kidneys cannot tell the difference between poor perfusion due to dehydration vs. low cardiac output
31
Mean survival after a diagnosis of heart failure is...
5 years
32
Classification system for Heart Failure
NYHA Functional Class (I-IV)
33
Dyspnea that occurs while lying flat and is relieved by sitting upright
Orthopnea
34
What is nearly diagnostic of right-sided heart failure (besides dyspnea)
Jugular vein distention/pressure
35
The most common cause of right heart failure is ______ ______ ______
left heart failure
36
What can cause primary right-sided heart failure
``` Right ventricle infarction Pulmonic stenosis Tricuspid regurgitation CHF Arrhythmogenic RV Dysplasia ```
37
Most common presenting symptom of heart failure
Dyspnea on exertion
38
HFpEF
Heart Failure with Preserved Ejection Fraction
39
Heart failure always results in reduced ejection fraction (True or False)
False (40% have preserved Ejection Fraction)
40
Heart failure with preserved ejection fraction (HFpEF) is most commonly due to (diastolic/systolic) dysfunction
Diastolic dysfunction (doesn't fill adequately)
41
HFpEF can present with both left and right sided heart failure (True or False)
True; indistinguishable from HFrEF (unless you know the EF)
42
Blood tests to run to diagnose heart failure
Chemistry panel (renal, sodium, glucose) Liver function tests Troponin BNP
43
Heart sound/gallop from early diastolic filling into an overloaded ventricle; normal in children
S3
44
Heart sound/gallop that is normal to hear in children
S3
45
Heart sound/gallop from late diastolic filling; atrial "kick" into a stiff ventricle
S4
46
Chest X-ray findings indicative of pulmonary edema
``` Whitewashed lung (alveoli filled with fluid) Prominent upper-lung vessels (redistribute blood to viable alveoli in upper lung) ```
47
One of the best chemicals in the blood to diagnose heart failure; released almost exclusively from stretched cardiomyocytes
BNP (B-type Natriuretic Peptide)
48
How do ACE inhibitors and ARBs help heart failure?
Reverse remodeling to lower wall stress and oxygen demand (Dec. fluid) Dec. afterload, thus dec. oxygen demand and inc. stroke volume (Dec. SVR)
49
Contraindications for ACE inhibitors and ARBs
Angioedema Renal artery stenosis Advanced renal dysfunction
50
Excess ________ can cause cough and angioedema
Bradykinin (ACE breaks it down, so ACEi cause elevated levels)
51
aldosterone antagonists; block mineralocorticoid receptors systemically; indicated with Class II-IV heart failure, HTN or hyperaldosteronism; contraindicated for hyperkalemia
Spironolactone | Eplerenone
52
Aldosterone antagonists are indicated for what NYHA classes of heart failure?
Class II-IV
53
Aldosterone antagonists help prevent............ in the setting of heart failure
Cardiac/vascular fibrosis | LVH
54
Contraindications of beta-blockers
Bronchospasm Severe decompensated CHF Severe bradycardia AV block
55
Why might some men not like being on a beta-blocker?
an adverse effect is sexual dysfunction
56
old school cardiac medicine; inhibits Na export via Na/K ATPase, increasing internal Na conc. and Ca retention; made from foxglove extract; very narrow therapeutic window, so not used that often
Digitalis (Digoxin)
57
Why might Digitalis (Digoxin) not be the best choice for heart failure?
Narrow therapeutic window with toxicities like arrhythmias and seizures
58
Diuretics: __________ are typically used for HTN, but ___________ are used for heart failure
Thiazides; Loop diuretics (Furosemide)
59
Loop diuretics help heart failure by excreting fluid, improving symptoms and prolonging life (True or False)
False; help symptoms but don't prolong life
60
How do diuretics alleviate symptoms of heart failure?
Decrease fluid volume, thus decreasing preload
61
trial that sought to study the hypothesis that ISDN/hydralazine (BiDil) would provide a survival benefit for African American patients with HFrEF
A-HeFT
62
What complications kill heart failure patients?
SCD | Arrhythmias
63
ICDs are put in the left-upper chest and the lead is inserted into the ______________ vein and into the right atrium
Axillary/Subclavian
64
When do you want to put in an ICD?
EF <30% | NYHA Class I-III
65
difference in the timing of ventricular contractions in the heart; large differences in timing of contractions can reduce cardiac efficiency and is correlated with heart failure; can be seen on echo
Ventricular dyssynchrony
66
Treatment for ventricular dyssynchrony
Cardiac Resynchronization Therapy (biventricular pacemaker)
67
Placement of leads in biventricular pacemaker
On IVS and LV free wall
68
Only cure for heart failure
Heart transplant (but there is an organ donor shortage)
69
Device used to help heart failure patients; flow is directed from the apex of the LV to the ascending aorta
Left Ventricular Assist Devices
70
Drugs for HFpEF
No evidence-based drug to reduce mortality (treat predisposing conditions)
71
Heart failure is progressive, with periods of ___________
decompensation (ADHF)
72
ADHF
Acute Decompensated Heart Failure
73
Acute decompensated heart failure signs/symptoms can be divided into what categories
Cold (Shock): nausea, AMS, reduced capillary refill, hypotension, cold skin, narrow pulse pressure Wet: dyspnea/orthopnea, cough, peripheral edema, rales, JVD, hepatic congestion
74
Most patients with ADHF require.....
diuretics to relieve excess fluid retention
75
Patients with decompensated heart failure (hypoperfusion) need...
Diuretics Inotropes (dobutamine, milrinone) Vasodilators
76
Inotropes used in cardiogenic shock
Dobutamine | Milrinone
77
Why might routine use of IV inotropes (dobutamine) actually shorten life in regards to HF
Possibly increased intracellular calcium and arrhythmias
78
Cornerstone management of chronic heart failure
Neurohormonal antagonists (beta-blockers, ACEi and ARBs)
79
Two central goals for management of ADHF
``` Relieve congestion (diuretics; optimize preload) Adequate tissue perfusion (vasodilators, inotropes) ```
80
Dilated Cardiomyopathy causes
ABCCCD: Alcohol abuse, Beriberi, Coxsackie B myocarditis, chronic Cocaine use, Chagas disease, and Doxorubicin toxicity

Cardiology-Exam 2 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions