Heart Failure I - Pathophysiology Flashcards
T or F: HF is largely a disease of the Aged
True, median age is 75
General definition of HF
The inability of the heart pump to pump blood forward at a sufficient rate to meet the metabolic demand of the body (forward failure), or the ability to do so only if the cardiac filling pressures are abnormally high (backward failure)
Key requirement component of HF
Poor forward blood flow (decreased CO)
T or F: Backward buildup of pressure is almost always present as well
Ture, results in congestion (increased filling pressure)
What relationship states that the more the LV is filled, the more it will contract
Frank-Starling’s law
Increased Preload for the same inotropic states results in what?
Increased SV (this, increased CO)
What are the determinant agents of inotropy?
- Catecholaminergic/adrenergic
- Calcium
T or F: Inotropy produces increased SV for the same level of preload
Ture
What are the major types of HF
- Systolic and Diastolic
- Left sided vs. Right sided
What are the hallmarks of systolic HF?
- Decreased ejection fraction (HFeEF, LVSD)
- Ventricular enlargement (Dilated Cardiomyopathy)
- A problem with the squeeze
What measures are decreased in systolic HF?
Loss of inotropy= low SV and lower generated systolic BP
List Primary causes of systolic HF
- Direct destruction of heart muscle cells (MI)
- Overstressed heart muscle
- Volume overloaded heart muscle
What are the hallmarks of Diastolic HF?
- Normal ejection fraction (HFpEF)
- Ventricular wall thickening (LVH)
- Impaired filling
What measures are different in diastolic HF?
lower SV
Primary causes of diastolic HF?
- High afterload/pressure overload
- Myocardial thickening/fibrosis
- External compression
Normal systemic vs pulmonary bp
- Systemic: 120/80 mmHg
- Pulmonary: 22/10 mmHg
T or F: R ventricle does less work
True
Consequences of R Sided HF
- Decreased circulating blood flow (forward RV HF)
- increased venous pressures (Backwards RV HF)
Primary causes of R sided HF
- L HF
- Lung disease/pulmonary HTN/RV pressure overload (car pulmonale when primary lung disease causes HF)
- RV volume overload
- Damage to the RV myocardium
T or F: HF forms clinically coexist
True, systolic dysfunction is typically accompanied by diastolic dysfunction and vice verse
What is the underlying problem with HF?
reduced CO
List the compensatory responses to HF
- neurohumoral activation
- Frank-Starling (increased preload)
- Ventricular hypertrophy and dilation
What 2 regulation systems are activated by HF?
- Adrenergic activation
- Renin-angiotensin system
