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PHCY 310 > L 53 HF background > Flashcards

L 53 HF background Flashcards

1
Q

Blood flow between the atria and ventricles is controlled by the …?

A

Atrioventricular valves

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2
Q

Flow out of the ventricles is controlled by the … and …?

A

Flow out of the ventricles is controlled by the pulmonary valve and aortic valve.

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3
Q

Dyspnoea/dyspnoeic?

A

Difficulty breathing

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4
Q

Tachycardia?

A

Rapid heart rate

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5
Q

Tachypnoea/tachypnoeic?

A

Rapid breathing

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6
Q

Patient: dyspnoeic, tachypnoeic, tachycardic, increased swelling of ankles and lower legs, fatigue, difficulty completing usual daily tasks.
Diagnosis:?

A

Heart failure!

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7
Q

In heart failure, cardiac output is reduced due to ..?

A

In heart failure, cardiac output is reduced due to impaired cardiac function

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8
Q

Name the types of heart failure?

A
  1. Systolic heart failure/reduced ejection fraction

2. Diastolic heart failure/prserved ejection fraction

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9
Q

Explain the 2 types of heart failure?

A

HFrEF: ejection fraction <40%, occurs in 2/3 of HF patients. Systolic
HFpEF: ejection fraction >50%, occurs in 1/3 of HF patients. Diastolic

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10
Q

How can you have HF with normal EF?

A

CO = HR x SV
EF = SV/EDV
In HF, if HR remains the same, but SV is reduced, EF will decrease.
BUT, if EDV is reduced (by reduced ventricular filling) then EF will appear normal, but CO will be reduced overall so patient will still have HF.

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11
Q

If SV is 50mL, and EDV is 140mL, then EF = ….

A

35%
EF = SV/EDV
50/140 = 0.357 x100 = 35%

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12
Q

If SV is 50 mL, but EDV is 90mL, then EF = …

A

56%
EF = SV/EDV
50/90=0.55 x 100 = 55%

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13
Q

What is congestive heart failure?

What is it also known as?

A

Congestion refers to the leakage of fluid into the lungs, liver and peripheries due to backflow.
AKA = Acute decompensated heart failure

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14
Q

Congestive heart failure
Lung symptoms are more common with … ventricular failure.
Systemic symptoms are more common with … ventricular failure?

A

Lung symptoms are more common with left ventricular failure. (Think L = left = lungs)
Systemic symptoms are more common with right ventricular failure

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15
Q

How does the heart compensate for a decrease in CO? x4

A
  • Increased preload via RAAS
  • Vasoconstriction via RAAS and increased vasopressin
  • Tachycardia and increased contractility via SNS
  • Ventricular hypertrophy and remodelling
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16
Q

What does vasopressin do?

A

Causes vasoconstriction

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17
Q

Why does the heart increase preload?
What effects does this have?
Get thinking!

A

Decreased CO = the kidneys think there is less volume passing through. Therefore they increase preload (volume)
Preload inc –> SV increases in ventricles –> congestion in a failing heart (backflow)

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18
Q

Tachycardia means there is …. for the ventricles to …

A

Tachycardia = less time for ventricles to fill.

Increases risk of arrhythmias

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19
Q

What are the impacts of increased preload? x2

A 
Increased SV and venous return (good)
Increased congestion (bad)
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20
Q

What are the impacts of increased vasoconstriction? x2

A 
Maintains BP and perfusion when CO decreases (good)
Increases afterload (bad)
21
Q

What are the impacts of increased contractility and tachycardia? x4

A
  • Increased HR and CO (good)

- Shortened diastolic filling time, B1 receptor downregulation, increased ventricular arrhythmias (bad)

22
Q

What are the impacts of ventricular hypertrophy and remodelling? x3

A 
Increased CO (good)
Decreased filling and contraction force, increased ventricular arrhythmias (bad)
23
Q

Risk factors of hart failure x8

A
  • IHD
  • Hypertension
  • Valvular defects
  • Obesity and T2DM
  • AF
  • Alcoholism
  • Use of amphetamines or anabolic steroids
  • some cancer chemotherapies
24
Q

3 classes of medicines implicated in HF

A

Negative inotropes
Cytotoxics
Sodium and H2O retention drugs

25
Q

Examples of negative inotropes x3

Example x1 of Na+ and H2O retention drugs

A

Negative inotropes: flecainide, B blockers, verapamil
H2O and Na+ retention: NSAIDs
Negative inotropic = decreased contraction

26
Q

Signs and symptoms of heart failure

A
  • Congestion (develops behind the failing ventricle. Patients with congestion often have both-sides HF)
  • Decreased organ perfusion (therefore decreased renal output, mental confusion - less nutrients/O2, cold extremities)
  • Tachycardia
27
Q

What symptoms come with left sided HF?

A

Lung issues: cough, dyspnoea, orthopnoea, tachypnoea

28
Q

Orthopnoea

A

Dyspnoea when lying flat

29
Q

What symptoms come with right sided HF?

A

Peripheral oedema (weight gain), hepatomegaly, fatigue, elevation of jugular venous distention

30
Q

What is hepatomegaly

A

An abnormal enlargement of the liver

31
Q

What is jugular venous distention?

What is it a measure of?

A

Increased pressure in the superior vena cava causing the jugular vein (side of neck) to bulge a lot more than it should.
An indirect measure of central venous pressure

32
Q

Diagnostic measures of heart failure x6

A
  • Elevated brain natriuretic peptide
  • ECG (myocardial ischaemia, AF, bradycardia, LVH)
  • Serum creatinine
  • Hb conc
  • CXR (looking for cardiomegaly, pulmonary congestion)
  • Echocardiogram
33
Q

What are the 4 stages of HF classification?

A

I, II, III, and IV
I being the lowest classification, and IV being the most serious classification (unable to carry on physical activity without discomfort, and symptoms present at rest)

34
Q

Serum creatinine is .. due to renal hypoperfusion.

CKD can cause …

A

Serum creatinine is INCREASED due to renal HYPOperfusion.

CKD can cause HYPERvolaemia

35
Q

Heart failure is a clinical syndrome characterised by a decrease in …

A

EF is usually decreased but can look normal in…
Heart failure is a clinical syndrome characterised by a decrease in CO
EF is usually decreased but can look normal in HFpEF

36
Q

Signs and symptoms of HF relate to … and …

A

Congestion and organ hypofusion

37
Q

Although … failure is common, … … eventually fail

A

Although left ventricular failure is common, both ventricles eventually fail

38
Q

HF is a complication of many diseases, notably … and …

A

HF is a complication of many diseases, notable IHD and HTN

39
Q

Compensatory mechanisms for HF include …

However, these eventually…

A

Preload increase, vasoconstriction, tachycardia, ventricular remodelling.
However these eventually make matters worse

40
Q

Which ventricle failure is more common?

What will most often cause the other ventricle to fail too?

A

Left ventricular failure is most common.

COPD/lung disease for a long time can cause right ventricle to fail too.

41
Q

Patients become tachycardic because their hearts are …

A

Their hearts are trying to compensate for a decreased cardiac output (from impaired squeezing function in HF)

42
Q

SV is a function of …

A

ESV and EDV

43
Q

Usually, what is the first organ to fail?

A

Kidneys

44
Q

HFrEF is known as gives a … ejection fraction, and HFpEF gives a … ejection fraction.

A

HFrEF is known as gives a low ejection fraction, and HFpEF gives a normal ejection fraction.

45
Q

HFrEF stands for …
HFpEF stands for …
What is EF?
How can you get 100% EF?

A

HFrEF stands for heart failure with reduced ejection fraction
HFpEF stands for heart failure with preserved ejection fraction.
Ejection fraction is a % of how much blood is pumped out with each contraction.
You can’t get 100% EF, there will always be a small amount of residual blood left.

46
Q

What could cause EDV to be lower?

A

Thickened ventricles means they don’t hold as much blood (more wall = less space) therefore EDV decreases

47
Q

In right ventricular heart failure, there is backflow into the ..
In left ventricular heart failure, there is backflow into the …?

A 
Right = backflow into lungs causing leakage into lungs
Left = backflow into vena cava causing pooling in legs
48
Q

Right sided HF is a complication of …

A

COPD

PHCY 310 (65 decks)

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