Heart Failure I - patho Flashcards

1
Q

Heart failure involves ____ failure and _____ failure

A

forward failure (low flow)

and backward failure (congestion)
- typically in response to low flow

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2
Q

forward failure

A

Heart failure is the inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body

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3
Q

backward failure

A

ability to do so only if the cardiac filling pressures are abnormally high

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4
Q

what controls CO?

What controls SV?

A

HR x SV

SV controlled by:
Inotropy of the ventricles (+)
Preload of the ventricles (+)
Afterload of the ventricles (-)

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5
Q

Sum up Frank-starlin curve in 1 sentence

A

If you stretch the heart out more in diastole, it will contract more in systole.

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6
Q

Determinants of Inotropy

A

Catecholaminergic/adrenergic stimulation

Calcium

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7
Q

Describe the following axis for PV loops:
x-axis
y-axis
unlabled axis

A

x: volume inside the ventricles
y: pressure inside the ventricles

unlabeled axis: time

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8
Q

Major divisions of HF

A

systolic HF
Diastolic HF
Left-sided
Right-sided

  • note: systolic is usually accompanied by diastolic dysfunction and vice versa
  • and LV failure often causes RV failure
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9
Q

Types of ventricular remodeling and what type of HF does it typically result in?

A

Hypertrophied heart
- diastolic HF

Dilated heart
- systolic HF

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10
Q

A weak/damaged myocardium = what type of HF?

A

Systolic failure due to loss of contractility

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11
Q

Systolic dysfunction
what is it a problem in?
what is the hallmark?

A

A problem with squeeze
- ↓contraction / ↓ inotropy

Hallmark is:
1. Decreased ejection fraction
“HF with reduced ejection fraction” = HFrEF
“left ventricular systolic dysfunction” = LVSD

  1. Ventricular enlargement
    “dilated cardiomyopathy” = DCM
  • note: these are all the same terms. multiple names
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12
Q

3 primary causes of systolic heart failure

A
  1. direct destruction of heart muscle cells
  2. overstressed heart muscle
  3. volume overloaded heart muscle
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13
Q

Diastolic dysfunction
what is it a problem in?
what is the hallmark?

A

Impaired filling
- ↓lusitropy / decrease in relaxation

Hallmark is 
1. Normal ejection fraction
“HF with preserved ejection fraction” = HFpEF
“preserved systolic function” = PSF
2. Ventricular wall thickening
“left ventricular hypertrophy” = LVH
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14
Q

Right-sided heart failure

  • what is it
  • what does it cause
A

Stresses to the RV can cause it to fail to adequately pump blood through the lungs, which causes
↓ circulating blood flow (forward RV HF)
↑ venous pressures (backward RV HF)

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15
Q

HFrEF

HFpEF

A

Heart failure with reduced ejection fraction
- systolic HF

heart failure with preserved ejection fraction
- diastolic HF

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16
Q

↓ LV filling leads to ↓ CO

  • what two structures senses this?
  • how do they compensate?
A

Juxtaglomerular apparatus in kidney senses lower flow
–> Renin-
Angiotensin-Aldosterone (RAAS) activation

Carotid sinus / aortic baroreceptors sense lower pressure
–> Autonomic nervous system / adrenergic activation

17
Q

What does RAAS activation result in?

What about ANS/adrenergic activation?

A

RAAS: ↑ Sodium retention (↑ volume) + vasoconstriction

ANS/adrenergic activation: ↑ HR

  • note: this is good short term compensatory mechanism, but is a double edge sword –> HF without intervention in the long run
18
Q

How is SV preserved?

What adverse side effects can result from ↑ volume?

A

STROKE VOLUME PRESERVED BY INCREASED
END-DIASTOLIC FILLING / PRESSURE (↑ contractility + preload)

↓ LV squeeze (systolic HF)
AND/OR ↑ stiffness (diastolic HF)

Supranormal filling pressures