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Cardio Exam 4 > Heart Failure - The condition > Flashcards

Heart Failure - The condition Flashcards

1
Q

At the end of systole, ventricular relaxation begins suddenly,
which results in rapidly decreasing _____

A

intraventricular pressures

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2
Q

The degree of tension on the muscle walls of the ventricles
when they begin to contract

A

Preload

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3
Q

LV dilation, hypertrophy, and changes in
cardiac compliance modify ____

A

preload.

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4
Q

____- The load or pressure against which the ventricles (especially the left ventricle) exert their contractile force and must
overcome in order to eject the stroke volume

A

Afterload

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5
Q

The fraction of the End-Diastolic Volume that is ejected is called the _____

A

Ejection Fraction

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6
Q

The actual volume of blood that
is ejected during ventricular
contraction is called the _____

A

Stroke
Output Volume (stroke volume)

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7
Q

_____ is the amount of blood (the volume) that the heart ejects with each ventricular contraction

A

Stroke volume

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8
Q

The End-Diastolic Volume minus the End-Systolic Volume

A

Stroke volume

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9
Q

Explain what preload means in the myocardial cells

A

The stretching in turn causes the muscle to contract with increased
force because the actin and myosin filaments are brought to a more
optimal degree of overlap for force generation.

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10
Q

Frank-Starling Mechanism = ____

A

The greater the heart muscle is stretched
during filling, the greater the force and volume of contraction

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11
Q

_____ is the volume ejected by each ventricle in 1 minute

A

Cardiac Output

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12
Q

Cardiac Output (CO) is the product of ____

A

Heart Rate and Stroke Volume
○ In other words, CO = HR x SV

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13
Q

There are four main factors that affect the CO

A

○ Heart Rate
○ Contractility
○ Preload
○ Afterload

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14
Q

Cardiac causes of Heart failure:

A

○ Myocardial damage- Myocardial infarction, myocarditis, cardiomyopathy
○ Valvular disorders- Especially aortic/mitral valve stenosis/regurgitation
○ Arrhythmias- Bradyarrhythmias and tachyarrhythmias
○ Conduction defects- Especially AV blocks and LBBB
○ Reduced substrate availability- Ischemia with CAD
○ Infiltrative or matrix disorders- Amyloidosis, hemochromatosis, chronic fibrosis

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15
Q

Systemic causes of Heart failure:

A

○ Increased demand for Cardiac Output- Anemia, hyperthyroidism, Paget disease
○ Increased Afterload- Aortic stenosis and systemic hypertension

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16
Q

____-sided heart failure is more common than ____-sided

A

Left; right

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17
Q

Left-sided heart failure common causes

A

○ Most commonly caused by ischemic heart disease and/or hypertension.
○ Other important causes
include mitral or aortic valve
disease, cardiomyopathy, and
congenital heart disorders.
CARDIO-FAIL-3,4

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18
Q

Etiology of right-sided heart failure

A

○ Most commonly caused by left-sided heart failure.
■ Commonly seen along with left heart failure (biventricular).
■ Most heart failure patients have signs/symptoms of both.
○ Other important causes
include pulmonary
hypertension (Cor
Pulmonale), pulmonary
emboli, RV infarction,
valvular disease, and
congenital heart disorders

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19
Q

There are four main systems that respond in various ways when the
body encounters decreased Cardiac Output secondary to the
developing Heart Failure. These include:

A

○ Cardiac Response
○ Hemodynamic Response
○ Renal Response
○ Neurohormonal Response

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20
Q

Reduced CO with lower SBP in HF triggers arterial baroreflexes, leading to___

A

■ This triggers a neuronal response via the Autonomic Nervous
System that increases sympathetic tone and decreases
parasympathetic tone- VASOCONSTRICTION.
■ Heart rate and myocardial contractility also increase,
venoconstriction occurs, and Na and H2O are retained.

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21
Q

Renal Response to cardiac dysfunction

A

○ Cardiac dysfunction results in decreased renal blood flow / GFR.
○ This activates the Renin-Angiotensin-Aldosterone System (RAAS).
■ The end result of this massive hormonal cascade is Na and H2O
retention, increased intravascular volume, and increased BP

22
Q

Angiotensin II worsens HF by causing ____

A

vasoconstriction, stressing the heart

23
Q

Angiotensin II triggers ADH secretion (Vasopressin), which _____

A

increases water reabsorption, thereby increasing preload and stressing the heart

24
Q

Angiotensin II also increases sympathetic activity on the heart (triggers
norepinephrine release), which likely contributes to _____

A

cardiac remodeling

25
Q

Angiotensin II also increases Aldosterone production, which not only
enhances Na reabsorption, but also encourages ____

A

cardiac remodeling.

26
Q

Neurohormonal Response

A

○ Brain (B-Type) Natriuretic Peptide (BNP) is released from the stretched
ventricles and can enhance renal excretion of Na.
■ However, in patients with HF, the effect is blunted by decreased renal
perfusion and receptor downregulation (from chronic stimulation)
○ Because of the intense Sympathetic activation that occurs in response to
decreased cardiac output, Beta-1 adrenergic receptors on the heart are
downregulated over time, which further impairs myocyte contractility
and heart rate management

27
Q

Systolic vs. Diastolic heart failure

A

● In Systolic Dysfunction, the ventricle contracts poorly and empties inadequately, which leads to increased diastolic volume/pressure and reduced ejection fraction
● In Diastolic Dysfunction, ventricular filling is
impaired due to impaired ventricular relaxation, which results in reduced end-diastolic volume and increased end-diastolic pressure

28
Q

Left-Sided HF Presentation

A

■ Dyspnea (due to pulmonary venous congestion)
■ Fatigue (due to low cardiac output)
■ As HF worsens, the dyspnea can occur at rest, even at night (often causing nocturnal cough)
■ Orthopnea - Dyspnea that occurs shortly after lying flat and is relieved promptly by sitting up (common as HF advances)

29
Q

Common signs of left heart failure on exam include:

A

■ Diffuse, sustained, laterally displaced PMI
■ S3 gallop- Very common in HF - Due to rapid ventricular
filling and poor ventricular function (“Sloshing-in”)
● Think volume overload
■ S4 gallop- Less common - Due to increased ventricular wall resistance and decreased compliance (“A-Stiff-Wall”)
■ Basilar crackles/rales (with pulmonary edema)
■ Basilar dullness to percussion (if pleural effusion)

30
Q

Right-Sided HF Presentation: patient history

A

○ In right heart failure, patients most commonly report…
■ Lower extremity edema (due to systemic venous congestion)
■ Fatigue (due to low cardiac output)
○ Sometimes patients report a sensation of fullness in the abdomen
or neck, again due to systemic venous congestion.
○ Hepatic congestion can cause RUQ abdominal pain.
○ Stomach and intestinal congestion can cause anorexia and a
sensation of abdominal bloating

31
Q

Physical Exam Findings: Right-sided HF

A

■ Peripheral pitting edema in lower extremities
■ Enlarged and sometimes pulsatile liver
● With hepatojugular reflux
■ Abdominal swelling / Ascites
■ Jugular Venous Distention
■ Possible S3 along right sternal border
■ Possible RV lift/heave

32
Q

Clinical suspicion for heart failure should be high in patients with a
history of _____

A

MI, HTN, or Valvular Disorders
○ Suspicion should be moderate in any patient who is elderly and/or
has diabetes mellitus

33
Q

When there is clinical suspicion of Heart Failure, diagnostic studies to order include:

A

○ Chest X-ray, EKG, and Echocardiogram
○ Other than Serum BNP, blood tests are not used for diagnosis

34
Q

Chest X-ray in heart failure can reveal several findings

A

○ Enlarged cardiac silhouette due to Cardiomegaly
○ Pleural effusion(s)- Will be transudative
○ Pulmonary edema (especially during exacerbations)
○ Findings suggestive of chronic pulmonary venous congestion
■ Kerley B lines

35
Q

Echo use in Heart Failure

A

Echocardiography can help to evaluate the chamber dimensions, valvular function, ejection fraction, wall motion abnormalities,
and LV hypertrophy

36
Q

Serum BNP Levels are generally ____ in heart failure

A

high

37
Q

____ is released from the ventricular walls during ventricular
stretching, which happens with volume overload.

A

BNP

38
Q

____ is an inactive polypeptide that
is created when BNP is cleaved during breakdown

A

N-Terminal Pro-BNP (NT-Pro-BNP)

39
Q

_____ findings are not diagnostic of heart failure, but many abnormal
findings can be suggestive of underlying disease processes.

A

EKG

40
Q

Free water retention is disproportionately higher, so a _____ often develops in HF, especially in the scenario of volume overload

A

hypervolemic hyponatremia

41
Q

A sudden worsening of chronic heart failure, known as an exacerbation,
can occur when _____

A

something changes in the normal routine that places increased demand on the already weakened heart

42
Q

How does “Congestive Heart Failure” develop?

A

● A sudden worsening of chronic heart failure, known as an exacerbation, can occur when something changes in the normal routine that places increased demand on the already weakened heart
● Cardiac-related elevation of pulmonary and/or systemic venous pressures may then result in organ congestion

43
Q

Medication Non-Adherence in Heart failure exacerbation

A

○ A common cause of exacerbations is when patients with diagnosed
heart failure simply do not take their medication as prescribed.
○ Could be due to confusion, misreading labels, side effects, cost, etc

44
Q

Causes of heart failure exacerbation

A

● Medication Non-Adherence
● Excessive Dietary Sodium Intake

45
Q

Other important triggers of exacerbations include:

A

○ Alcohol consumption
○ Infections, like pneumonia
○ Uncontrolled hypertension
○ Increased metabolic demand (Anemia, Hyperthyroidism)
○ Arrhythmias and MI

46
Q

American College of Cardiology / American Heart Association
(ACC/AHA) classifies heart failure into____

A

4 stages: A, B, C, and D
○ Stage A and B are “at risk of HF,” while C and D have HF

47
Q

Common signs of left heart failure with vitals and inspection:

A

■ Tachycardia
■ Hypotension
■ Respiratory distress
■ Cyanosis
■ Confusion/agitation (due to hypoxia/
hypoperfusion)

48
Q

Sometimes we estimate the degree of orthopnea by learning _____

A

how
many pillows the patient sleeps on at night to address the
orthopnea that occurs with lying flat.

49
Q

Both Orthopnea and PND occur due to _____

A

pulmonary congestion

50
Q

_____ - Dyspnea that occurs shortly after lying flat and is relieved promptly by sitting up (common as HF advances)

A

Orthopnea

Cardio Exam 4 (5 decks)

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