Heart Faliure and Circulatory Shock

Question 1

High-output vs. low-output failure

Answer 1

High-output failure: The heart pumps too much blood, but still doesn’t meet the body’s needs. This can happen due to conditions like anemia or hyperthyroidism.
Low-output failure: The heart can’t pump enough blood because the heart is too weak, often due to heart attacks or high blood pressure in the lungs.

Question 2

Systolic vs. diastolic failure

Answer 2

Systolic failure: The heart can’t pump enough blood out to the body.
Diastolic failure: The heart has trouble filling up with enough blood because it becomes stiff.

Question 3

Right-sided heart failure SYMPTOMS

Answer 3

Causes congestion in peripheral tissues (the rest of the body). Symptoms include:
Swelling (edema) in legs and belly (ascites).
Liver congestion leading to liver dysfunction.
Digestive problems like anorexia and weight loss.

Question 4

Left-sided heart failure

Answer 4

Causes pulmonary congestion (fluid buildup in the lungs) and decreased cardiac output. Symptoms include:
Shortness of breath, especially when lying down (orthopnea).
Cough with frothy sputum.
Poor blood flow to the body, causing fatigue and blue skin (cyanosis) due to lack of oxygen.

Question 5

Manifestations of Heart Failure

Answer 5

Effects of impaired pumping
• Effects of decreased renal blood flow →
RAA pathway
• Effects of the sympathetic nervous
system
• Fluid Retention and Edema
• Dyspnea
• Fatigue, Weakness, and Cognitive
Impairment
• Cachexia and Malnutrition
• Cyanosis
• Arrhythmias and Sudden Cardiac Death

Question 6

Effects of impaired pumping

Answer 6

The heart can’t pump blood properly, leading to reduced blood flow to the body and organs.

Question 7

When the kidneys don’t get enough blood, they activate the …..

Answer 7

Renin-Angiotensin-Aldosterone (RAA) pathway, which causes the body to retain water and salt, leading to increased blood pressure.

Question 8

Effects of the sympathetic nervous system: The body releases stress hormones like adrenaline …

Answer 8

to try and increase heart rate and blood pressure to make up for the heart’s weakness, but this can strain the heart even more.

Question 9

Fluid Retention and Edema

Answer 9

The body holds onto extra fluid, which leads to swelling (edema) in the legs, ankles, and belly.

Question 10

fluid buildup in the lungs

Answer 10

Dyspnea: This is shortness of breath, especially during physical activity or while lying down

Question 11

weight loss…….. muscle wasting……..

Answer 11

Malnutrition, cachexia

Question 12

Cyanosis

Answer 12

The skin, lips, or fingernails may turn blue because the body isn’t getting enough oxygen-rich blood.

Question 13

The heart’s stroke volume

Answer 13

amount of blood pumped with each beat) increases as more blood fills the heart (end-diastolic volume)

Question 14

Venous Return and Stretching

Answer 14

When more blood returns to the heart (increased venous return), the heart chambers fill with more blood. Muscle fibers strech leading to a stronger contraction

Question 15

What is the cause of Ischemia(lack of oxygen)?

Answer 15

Increased stretching of the heart muscle raises ventricular wall tension, which increases oxygen consumption by the heart.

Question 16

Preload

Answer 16

refers to the volume of blood that stretches the heart at the end of diastole (when the heart is filled with blood before contracting). More preload leads to more stretch, which can increase the force of the next contraction.

Question 17

How the sympathetic nervous system initially helps to
maintain perfusion of the various body organs?

Answer 17

1-direct stimulation of heart rate.
2-cardiac contractility.
3-regulation of vascular tone.
4-enhancement of renal sodium and water retention.

Question 18

What happpens during the last stages of heart failure?

Answer 18

both cardiac sympathetic tone (fight/flight) and
catecholamine (epinephrine and norepinephrine)
levels are elevated

Question 19

increase in sympathetic activity can lead to?

Answer 19

tachycardia, vasoconstriction, and cardiac
arrhythmias.

Question 20

tachycardia

Answer 20

increased heart rate

Question 21

narrowed blood vessels

Answer 21

vasoconstriction

Question 22

arrhythmias

Answer 22

irregular heartbeats

Question 23

What actions will be taken by the body if the blood flow to the kidneys is reduced?

Answer 23

the body activates the renin-angiotensin-aldosterone (RAA) system, which makes the body hold on to even more salt and water, leading to more fluid buildup, worsening heart failure.

Question 24

body releases more adrenaline (epinephrine) and norepinephrine

Answer 24

try to compensate for the failing heart. This leads to increased heart rate (tachycardia), narrowed blood vessels (vasoconstriction), and can cause irregular heartbeats (arrhythmias).

Question 25

Decreased Blood Flow to Kidneys

Answer 25

When the kidneys don’t get enough blood, they release renin, which leads to the production of angiotensin II.

Question 26

Effects of Angiotensin II

Answer 26

-Vasoconstriction (narrowing of blood vessels).
-Increase norepinephrine levels.
-Stimulation of aldosterone production.
-increase levels of antidiuretic hormone(ADH)

Question 27

stimulation of aldosterone production

Answer 27

increase tubular
reabsorption of sodium and increase in water retention (which makes the kidneys retain sodium and water, increasing fluid in the body.)

Question 28

Increases levels of antidiuretic hormone (ADH)

Answer 28

vasoconstriction and stops the body from excreting water. (Water inhibitor)

Question 29

What happened in the long run of a heart failure (sustained expression of aldosterone)

Answer 29

stimulate fibroblast
and collagen deposition, resulting in ventricular hypertrophy as
well as fibrosis within the vasculature and myocardium(Aldosterone can cause the heart and blood vessels to become stiff and thick by increasing fibrosis (scar tissue), leading to ventricular hypertrophy (enlarged heart) and reduced flexibility of blood vessels.)

Question 30

Although ventricular hypertrophy improves the
work performance of the heart, it is also an
important

Answer 30

risk factor for subsequent cardiac
morbidity and mortality.

Question 31

Inappropriate hypertrophy and remodeling can
result in…

Answer 31

changes in structure (i.e., muscle mass,
chamber dilation) and cardiac function (i.e.,
impaired systolic or diastolic function) that often
lead to further pump dysfunction and hemodynamic
overload.

Question 32

Endothelins release from:

Answer 32

Endothelia cells, cardiac myocytes

Question 33

Endothines cause:

Answer 33

Vasoconstrictors{cause blood vessel to narrow}, induce vascular smooth
muscle cell proliferation{Blood vessel muscle cells to grow and multiply} and cardiac myocyte hypertrophy{heart muscle cells grow bigger}
and fibrosis{scar tissue to form in the heart};.

Question 34

Increased pressure in the veins

Answer 34

Blood accumulating in the pulmonary veins and left atrium

Question 35

Fluid in the lungs

Answer 35

When the pressure increase the fluid of the capillary leaks to the alveoli that fluid will make the lungs stiffer and harder to breath