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Pathophysiology > Hypertension II > Flashcards

Hypertension II Flashcards

1
Q

How does increasing EDV under control condition affect stroke volume?

A

Increase SV

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2
Q

If you keep EDV the same, but allow for sympathetic stimulation, why will SV increase?

A

Increased contractility

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3
Q

True or False: If you were to continously increase EDV + sympathetic stimulation, stroke volume increases

A

True

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4
Q

Inhibition of sympathetics causes a reduction of ____ at rest and when EDV is increased

A

contractility

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5
Q

How is SV calculated using ESV and EDV?

A

ESV-EDV = SV

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6
Q

Which determinants of cardiac performance is depicted here?
A. Afterload
B. Preload
C. Contractility

A

B. Pre-load

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7
Q

True or False: Pre load is changing in this image

A

False - it preload remains CONSTANT

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8
Q

ESPVR (end systolic pressure ratio) assesses:

A

contractility

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9
Q

True or False: EDV is a marker for preload

A

True

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10
Q

Why does stroke volume increase here?

A

Increased contractility

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11
Q

End Systolic Volume is a marker for ___. Therefore, changes in ESV suggest changes in ____

A

afterload

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12
Q

If you see do not changes in EDV or ESV, you could assume changes in ____

A

contractility

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13
Q

There is an increased slope of ESPVR-2 vs. ESPVR-1. What does this indicate?

A

Increased contractility

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14
Q

Which type of HF and accompanying feature is shown?
A. Systolic HF; decreased contractility
B. Systolic HF; decreased compliance
C. Diastolic HF; decreased contractility
D. Diastolic HF; decreased compliance

A

A. Systolic HF; decreased contractility

Note: Decreased in slope of ESPVR (end systolic volume)

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15
Q

How does diastolic HF affect compliance?

A

It decreases compliance, as shown

  • Slight decreased in EDV
  • Increase in End Diastolic Pressure
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16
Q

Is decreased in ESV or ESP a good thing? Why?

A

No - reduced pressure means reduced flow and reduced CO

  • Expelling less blood from
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17
Q

Why do people with systolic HF have a slight increase in EDV?

A

They expel less blood, so they have more left over

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18
Q

True or False: Reduced filling of the heart is seen with disastolic CHF

A

True

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19
Q

Decreased in EDV is associated with ____ while increased EDV is associated with ___

A

Decreased EDV = Diastolic HF

Increased EDV = Systolic HF

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20
Q

True or False: Decreased EDV and EDP are seen in Systolic HF

A

False - Diastolic

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21
Q

Which type of HF impairs venous return, adding resistance, therefore reducing preload?

A

Diastolic HF

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22
Q

HFrEF (HF with reduced EF) is associated with ___ dysfunction
A. Systolic
B. Diastolic

A

A. Systolic

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23
Q

In systolic dysfunction HF, do the ventricles pump out more or less blood than normal?

A

Less

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24
Q

Heart Failure with Preserved Ejection Fraction (HFpEF) is associated with _____ dysfunction
A. Systolic
B. Diastolic

A

B. Diastolic

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25
Q

True or False: If there is diastolic dysfunction, ventricles fill with more blood than normal

A

False - fill with LESS blood than normal

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26
Q

Impaired filling is characteristic of:
A. HFpEF
B. HFrEF

A

A. HFpEF

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27
Q

The underlying cause of myocardial depression results in ____ deficiencies

A

contractility

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28
Q

How is cardiac m. affected by myocardial depression?

A

Unable to efficiently respond to increased in length (EDV) or load (afterload)

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29
Q

In heart failure, normal improvement of contractility in exercise is attenuated or
prevented due to reductions in:
1.
2.
3.

A
  • Cardiac NE stores
  • Beta-adrenergic receptor density
  • Catecholamine sensitivity
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30
Q

True or False: If you increase contractility in a normal person, there will be an increased of ventricular performance at rest and during exercise due to SNS stimulation.

What will not change?

A

True

  • EDV will not change
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31
Q

Why does a patient with CHF have ~ normal CO and performance at rest?

A

Frank-Starling mechanism

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32
Q

Why might one with CHF experience dyspnea while trying to exercise?

A

High pulmonary capillary pressure
caused by high EDV/EDP

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33
Q

HF is classified based on:

A

Ejection Fraction
Limitations in physical activity
Structural disease/symptoms

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34
Q

What are the five etiologies of CHF?

A
  1. Hemodynamic overload
  2. CAD
  3. Cardiomyopathy
  4. Hypertrophy – diastolic dysfunction
  5. Electrophysiological
    (Tachy- or brady arrhythmias)
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35
Q

As HF progresses, there is an increase in EDV that leads to ___ in EF and SV

36
Q

Arterial hypertension could increased ___, leading to HF

Aortic valve regurgitation can increase ___, leading to HF

A

pressure; volume

37
Q

True or False: ETOH, Diabetes, Viral Myocarditis can lead to HF

38
Q

Advanced aortic stenosis and uncontrolled HTN will reduced EF and ___ afterload (systolic dysfunction)

39
Q

CAD, Aortic/Mitral Regurgitation, and cardiomyopathies impair ____, leading to reduced EF (systolic dysfunction)
A. Afterload
B. Preload
C. Contractility

A

C. Contractility

40
Q

Dilated cardiomyopathy is an example of what type of hypertrophy?

A

Eccentric Hypertrophy

41
Q

Which 5 factors impair diastolic filling, leading to HF with preserved EF (diastolic dysfunction)?

42
Q

True or False: CAD, HTN, Diabetes, Age, and Obesity are risk factors for HF

43
Q

____: A consequence of heart failure, in which problems occur from REDUCED CO and fall in ARTERIAL PRESSURE

____:

A

Forward Failure

Backwards Failure

44
Q

True or False: In Backward Failure, tissues become underperfused, which leads to hypoxia and
altered metabolism

A

False - Forward Failure!

45
Q

____: A consequence of heart failure, in which
problems result from REDUCED ability to transfer blood
from the VENOUS to the ARTERIAL circulation
A. Forward Failure
B. Backward Failure

A

B. Backward Failure

46
Q

Which Failure leads to pulmonary and systemic congestion?
A. Forward Failure
B. Backward Failure

A

B. Backward Failure

47
Q

Which type of HF?

A

Concentric HF
- Increased LV pressure

48
Q

True or False: Right HF is associated with lung edema

A

False - left lung pressure

49
Q

True or False: There is right ventricle hypertrophy in Right HF, which increased afterload

50
Q

True or False: Venous pressure increased in left heart failure

A

False - right HF

51
Q

Peripheral Edema is associated with:
A. Left HF
B. Right HF

A

B. Right HF

52
Q

***How does the Frank-Starling mechanism sustain cardiac performance (SV)?

A

Increases preload
Increases CO

53
Q

Which three neurohumoral mechanisms are activated to defend BP?

A
  1. Sympathetic
    - Vaso/venoconstriction
    - Increased HR
  2. RAAS
  3. Vasopressin
54
Q

Is contractility reduced in HF (LV)?

A

Yes - reduced slow from 1 to 3

55
Q

Why is there exponential increased in preload reserve?

A

Because it has a limit

56
Q

One way for compensating for cardiac failure is increasing ____

57
Q

Increased EDV will increase ____

58
Q

True or False: Chronic stimulation of SNS is a compensatory mechanism in HF

A

True
- plasma NE correlated with extent of ventricular dysfunction
- basal levels can predict survival probability

59
Q

How does ANP affect preload and afterload?

60
Q

True or False: Chamber dilation, wall thickening, or reduction in wall tension is a compensatory mechanism in CHF

61
Q

True or False: Pressure overload increases LV pressure, left ventricular mass index, and left ventricle wall thickness significantly. By contrast, volume overload increases all of the above as well, but to a lesser extent.

62
Q

What causes arterial mechanoreceptor unloading?

A

Decreased ventricular work, SV, and CO

63
Q

What is the affect of arterial mechanoreceptor unloading?

A

Affects hypothalamus => increased ADH => increased TPR => change pressure gradient

64
Q

What causes RUQ discomfort in HF?

A

Liver congestion

65
Q

___ is the primary symptom of heart failure

A

Fatigue (exertional)

66
Q

What causes peripheral edema in CHF?

A

Elevated venous pressure

67
Q

Is peripheral edema associated with left or right HF?

68
Q

How does peripheral edema in R HF affect venous, capillary, and right atrial pressure?

A

Increases venous, capillary, and right atrial pressure

69
Q

Left HF leads to ___ edema

70
Q

True or False: Sweating and tachy, as seen in HF, are due to increased PNS activity

A

False - SNS activity

71
Q

What causes clinical manifestation of hepatomegaly, jugular venous distention, and peripheral edema?

A

Venous congestion

72
Q

True or False: Elevated troponin suggests cardiac injury

73
Q

Which of the following increases with high atrial and ventricular filling pressures?
A. CRP
B. BNP
C. CBC

74
Q

Which of the following may be slightly elevated with acute myocardial
infarction?
A. CRP
B. BNP
C. CBC

A

A. CRP
- note: not cardiac specific!

75
Q

Which imaging is the most useful test for identification of ejection fraction?
A. Electrocardiogram
B. Chest X-Ray
C.2DEchocardiography/Doppler

A

C. 2D-Echocardiography/Doppler

76
Q

Which drug class reduce blood volume?
A. ACE Inhibitors
B. Aldosterone Receptor Antagonists
C. Diuretics

A

B. Aldosterone Receptor Antagonists

77
Q

Which drug classes reduces systemic and pulmonary congestion?
A. ACE Inhibitors
B. Aldosterone Receptor Antagonists
C. Diuretics

A

C. Diuretics

78
Q

Which drug class reduces preload and afterload AND has beneficial effects on remodeling?
A. ACE Inhibitors
B. Aldosterone Receptor Antagonists
C. Diuretics

A

A. ACE Inhibitors

79
Q

Which drug class reduces inflammatory cytokine production, decreases frequency of ventricular premature beats, and has beneficial effects on ventricular remodeling?
A. ACE Inhibitors
B. Aldosterone Receptor Antagonists
C. Diuretics
D. Beta-adrenergic receptor antagonists

A

D. Beta-adrenergic receptor antagonists

80
Q

True or False: Venous Vasodilators will decrease preload and pulmonary congestion while Arteriolar Vasodilators decrease systemic vascular resistance/afterload

81
Q

Dopamine, Dobutamine and PDE Inhibitors are ____

82
Q

How do Intropes affect CO, SV, and F-S Curve?

A
  • Shift FS up
  • Increase CO/SV
83
Q

How does Nesiritide decreased afterload and preload?

A

Vasodilation

85
Q

Benefit of exercise training?

A

Increased maximal exercise tolerance

Pathophysiology (26 decks)

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