Hypertension II Flashcards
How does increasing EDV under control condition affect stroke volume?
Increase SV
If you keep EDV the same, but allow for sympathetic stimulation, why will SV increase?
Increased contractility
True or False: If you were to continously increase EDV + sympathetic stimulation, stroke volume increases
True
Inhibition of sympathetics causes a reduction of ____ at rest and when EDV is increased
contractility
How is SV calculated using ESV and EDV?
ESV-EDV = SV
Which determinants of cardiac performance is depicted here?
A. Afterload
B. Preload
C. Contractility
B. Pre-load
True or False: Pre load is changing in this image
False - it preload remains CONSTANT
ESPVR (end systolic pressure ratio) assesses:
contractility
True or False: EDV is a marker for preload
True
Why does stroke volume increase here?
Increased contractility
End Systolic Volume is a marker for ___. Therefore, changes in ESV suggest changes in ____
afterload
If you see do not changes in EDV or ESV, you could assume changes in ____
contractility
There is an increased slope of ESPVR-2 vs. ESPVR-1. What does this indicate?
Increased contractility
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. Systolic HF; decreased contractility
Note: Decreased in slope of ESPVR (end systolic volume)
How does diastolic HF affect compliance?
It decreases compliance, as shown
- Slight decreased in EDV
- Increase in End Diastolic Pressure
Is decreased in ESV or ESP a good thing? Why?
No - reduced pressure means reduced flow and reduced CO
- Expelling less blood from
Why do people with systolic HF have a slight increase in EDV?
They expel less blood, so they have more left over
True or False: Reduced filling of the heart is seen with disastolic CHF
True
Decreased in EDV is associated with ____ while increased EDV is associated with ___
Decreased EDV = Diastolic HF
Increased EDV = Systolic HF
True or False: Decreased EDV and EDP are seen in Systolic HF
False - Diastolic
Which type of HF impairs venous return, adding resistance, therefore reducing preload?
Diastolic HF
HFrEF (HF with reduced EF) is associated with ___ dysfunction
A. Systolic
B. Diastolic
A. Systolic
In systolic dysfunction HF, do the ventricles pump out more or less blood than normal?
Less
Heart Failure with Preserved Ejection Fraction (HFpEF) is associated with _____ dysfunction
A. Systolic
B. Diastolic
B. Diastolic
True or False: If there is diastolic dysfunction, ventricles fill with more blood than normal
False - fill with LESS blood than normal
Impaired filling is characteristic of:
A. HFpEF
B. HFrEF
A. HFpEF
The underlying cause of myocardial depression results in ____ deficiencies
contractility
How is cardiac m. affected by myocardial depression?
Unable to efficiently respond to increased in length (EDV) or load (afterload)
In heart failure, normal improvement of contractility in exercise is attenuated or
prevented due to reductions in:
1.
2.
3.
- Cardiac NE stores
- Beta-adrenergic receptor density
- Catecholamine sensitivity
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?
True
- EDV will not change
Why does a patient with CHF have ~ normal CO and performance at rest?
Frank-Starling mechanism
Why might one with CHF experience dyspnea while trying to exercise?
High pulmonary capillary pressure
caused by high EDV/EDP
HF is classified based on:
Ejection Fraction
Limitations in physical activity
Structural disease/symptoms
What are the five etiologies of CHF?
- Hemodynamic overload
- CAD
- Cardiomyopathy
- Hypertrophy – diastolic dysfunction
- Electrophysiological
(Tachy- or brady arrhythmias)
As HF progresses, there is an increase in EDV that leads to ___ in EF and SV
decrease
Arterial hypertension could increased ___, leading to HF
Aortic valve regurgitation can increase ___, leading to HF
pressure; volume
True or False: ETOH, Diabetes, Viral Myocarditis can lead to HF
True
Advanced aortic stenosis and uncontrolled HTN will reduced EF and ___ afterload (systolic dysfunction)
Increase
CAD, Aortic/Mitral Regurgitation, and cardiomyopathies impair ____, leading to reduced EF (systolic dysfunction)
A. Afterload
B. Preload
C. Contractility
C. Contractility
Dilated cardiomyopathy is an example of what type of hypertrophy?
Eccentric Hypertrophy
Which 5 factors impair diastolic filling, leading to HF with preserved EF (diastolic dysfunction)?
True or False: CAD, HTN, Diabetes, Age, and Obesity are risk factors for HF
True
____: A consequence of heart failure, in which problems occur from REDUCED CO and fall in ARTERIAL PRESSURE
____:
Forward Failure
Backwards Failure
True or False: In Backward Failure, tissues become underperfused, which leads to hypoxia and
altered metabolism
False - Forward Failure!
____: 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
B. Backward Failure
Which Failure leads to pulmonary and systemic congestion?
A. Forward Failure
B. Backward Failure
B. Backward Failure
Which type of HF?
Concentric HF
- Increased LV pressure
True or False: Right HF is associated with lung edema
False - left lung pressure
True or False: There is right ventricle hypertrophy in Right HF, which increased afterload
True
True or False: Venous pressure increased in left heart failure
False - right HF
Peripheral Edema is associated with:
A. Left HF
B. Right HF
B. Right HF
***How does the Frank-Starling mechanism sustain cardiac performance (SV)?
Increases preload
Increases CO
Which three neurohumoral mechanisms are activated to defend BP?
- Sympathetic
- Vaso/venoconstriction
- Increased HR - RAAS
- Vasopressin
Is contractility reduced in HF (LV)?
Yes - reduced slow from 1 to 3
Why is there exponential increased in preload reserve?
Because it has a limit
One way for compensating for cardiac failure is increasing ____
preload
Increased EDV will increase ____
preload
True or False: Chronic stimulation of SNS is a compensatory mechanism in HF
True
- plasma NE correlated with extent of ventricular dysfunction
- basal levels can predict survival probability
How does ANP affect preload and afterload?
Reduces
True or False: Chamber dilation, wall thickening, or reduction in wall tension is a compensatory mechanism in CHF
True
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.
True
What causes arterial mechanoreceptor unloading?
Decreased ventricular work, SV, and CO
What is the affect of arterial mechanoreceptor unloading?
Affects hypothalamus => increased ADH => increased TPR => change pressure gradient
What causes RUQ discomfort in HF?
Liver congestion
___ is the primary symptom of heart failure
Fatigue (exertional)
What causes peripheral edema in CHF?
Elevated venous pressure
Is peripheral edema associated with left or right HF?
Right HF
How does peripheral edema in R HF affect venous, capillary, and right atrial pressure?
Increases venous, capillary, and right atrial pressure
Left HF leads to ___ edema
pulmonary
True or False: Sweating and tachy, as seen in HF, are due to increased PNS activity
False - SNS activity
What causes clinical manifestation of hepatomegaly, jugular venous distention, and peripheral edema?
Venous congestion
True or False: Elevated troponin suggests cardiac injury
True
Which of the following increases with high atrial and ventricular filling pressures?
A. CRP
B. BNP
C. CBC
B. BNP
Which of the following may be slightly elevated with acute myocardial
infarction?
A. CRP
B. BNP
C. CBC
A. CRP
- note: not cardiac specific!
Which imaging is the most useful test for identification of ejection fraction?
A. Electrocardiogram
B. Chest X-Ray
C.2DEchocardiography/Doppler
C. 2D-Echocardiography/Doppler
Which drug class reduce blood volume?
A. ACE Inhibitors
B. Aldosterone Receptor Antagonists
C. Diuretics
B. Aldosterone Receptor Antagonists
Which drug classes reduces systemic and pulmonary congestion?
A. ACE Inhibitors
B. Aldosterone Receptor Antagonists
C. Diuretics
C. Diuretics
Which drug class reduces preload and afterload AND has beneficial effects on remodeling?
A. ACE Inhibitors
B. Aldosterone Receptor Antagonists
C. Diuretics
A. ACE Inhibitors
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
D. Beta-adrenergic receptor antagonists
True or False: Venous Vasodilators will decrease preload and pulmonary congestion while Arteriolar Vasodilators decrease systemic vascular resistance/afterload
True
Dopamine, Dobutamine and PDE Inhibitors are ____
Inotropes
How do Intropes affect CO, SV, and F-S Curve?
- Shift FS up
- Increase CO/SV
How does Nesiritide decreased afterload and preload?
Vasodilation
ok
Benefit of exercise training?
Increased maximal exercise tolerance