Heart Failure and Circulatory Shock

Question 1

What are natriuretic peptides?

Answer 1

Healthy, stretch induced peptides that promote sodium and potassium excretion, inhibit renin and block angiotensin 2 activity, and inhibit norepinephrine secretion.

Question 2

What are the three compensatory mechanisms for heart failure that we discussed?

Answer 2

• Myocardial hypertrophy
• Sympathetic reflexes
• Renin-angiotensin-aldosterone system

Question 3

How does myocardial hypertrophy act as a compensatory mechanism for heart failure?

Answer 3

?

Question 4

How do sympathetic reflexes act as compensatory mechanisms for heart failure?

Answer 4

?

Question 5

How does the renin-angiotensin-aldosterone system act as a compensatory mechanism for heart failure?

Answer 5

Kidneys increase blood pressure and blood volume in an attempt to increase preloading.

Question 6

What is the end stage of most heart pathologies?

Answer 6

Heart failure

Question 7

Describe symmetrical myocardial hypertrophy

Answer 7

“Athlete’s Heart”. Myocardial wall hypertrophies and ventricle grows proportionally.

Question 8

Describe concentric myocardial hypertrophy

Answer 8

Wall thickens at the expense of ventricular volume.

Question 9

Describe eccentric myocardial hypertrophy

Answer 9

Wall thins, and the volume of the ventricle grows in an attempt to increase preload.

Question 10

T/F: Lower ejection fraction increases the risk for sudden cardiac death and 5 year mortality rate.

Answer 10

TRUE.

Question 11

T/F: Congestive heart failure is synonymous with left ventricular dysfunction.

Answer 11

FALSE. You can have LVD without congestion.

Question 12

What are some symptoms of left sided heart failure?

Answer 12

• Exertion dyspnea,
• Orthopnea (difficulty breathing laying flat, measured in pillows)
• Paroxysmal nocturnal dyspnea
• Cyanosis (blueish discoloration)
• -Elevation of pressure in pulmonary circulation.

Question 13

What is paroxysmal nocturnal dyspnea?

Answer 13

Sudden nighttime difficulty breathing brought on by increased veinous return to heart during laying down causing increased preload and O2 demand of the heart.

Question 14

What are some symptoms of right sided heart failure?

Answer 14

• Fatigue
• Dependent edema
• Distention of jugular veins
• Liver engorgement
• Ascites
• Anorexia and GI distress
• Cyanosis
• Elevated peripheral pressure.

Question 15

What is right sided heart failure?

Answer 15

Fluid buildup in right atrium, goes into systemic circulation causing dependent edema.

Question 16

What is cor pulmonale

Answer 16

-enlargement of the right side of the heart as a result of lung dysfunction.

Question 17

What are the most common drug treatments of CHF?

Answer 17

Diuretics, ACE inhibitors/ARBs, Beta blockers.

Question 18

How does an Intra-aortic balloon pump work?

Answer 18

???Inflates with diastole, deflates in systole. Increases aortic pressure during diastole which increases blood flow. Decreases BP during systole, eases blood flow out of heart.

Question 19

T/F: IABP’s are permanent.

Answer 19

FALSE

Question 20

T/F: LVAD’s are permanent.

Answer 20

TRUE, they can be.

Question 21

Which is smaller, an impella or an LVAD?

Answer 21

Impella, but it’s temporary.

Question 22

What symptoms do R and L sided heart failure share?

Answer 22

• Cyanosis
• Pulmonary symptoms
• Fluid retention and edema
• Altered physical activity tolerance
• General muscle wasting
• Malnutrition

Question 23

What are the four types of circulatory shock?

Answer 23

• Cardiogenic: ventricles not functioning properly. Decreased ventricular function, decreased cardiac output, hypoxia.
• Hypovolemic: low blood volume, decreased BP, decreased O2 delivery ability.
• Obstructive: Blood flow restricted by great vessels in heart, decreased loading/output, decreased O2 carrying capacity.
• Vasodilatory: decreased BP, no pressure gradients. Poor preload and