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CVS > L18: Heart Failure > Flashcards

L18: Heart Failure Flashcards

1
Q

What is heart failure

A

The inability of the heart to supply adequate blood flow and therefore oxygen to peripheral tissue and organs

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2
Q

What are the symptoms of heart failure

A 
Weight gain
Shortness of breath
Increased swelling 
Trouble sleeping frequent cough 
Loss of appetite
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3
Q

What happens in the heart failure which tries to increase CO

A

Increase SNS
Increase volume loading
Hypertrophy

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4
Q

What are the common causes heart failure

A

Myocardial infarction

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5
Q

What is myocardial infarction

A

When a thrombus forms in the coronary artery

So the myocardium is perfumed by one artery

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6
Q

What occurs when there is no blood flow to a specific area of the muscles

A

Ischaemia

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7
Q

What is ischaemia

A

No blood flow

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8
Q

What happens to the tissue when there is ischaemia

A

Hypoxic
Hypercapnic
Acidotic
Nutrient depleted

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9
Q

What is the tissue at risk of if ischaemia occurs

A

Necrosis

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10
Q

What is necrosis

A

Tissue death

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11
Q

How does a thrombus develop in the coronary arteries

A

1) as we age we develop fatty plaques in the arteries
2) the plaque ruptures and releases substances to platelet activation
3) platelet forms a thrombus which completes block the coronary artery

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12
Q

What is the treatment for MI

A

Percutaneous coronary intervention (PCI)

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13
Q

What does a PCI involve

A

Inserting a catheter into the coronary artery which punctures the thrombus
Catheter inflates the ballon so vessel is stretched
A stent is fitted so the vessel remain open and blood flows

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14
Q

What happens to the tissues when we re-introduce blood flow via PCI

A

Tissue can die further due to sudden reperfussion

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15
Q

Do we have any interventions in place to stop the cell death after PCI

A

No

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16
Q

What are the other causes of heart failure

A

Hypertension

Contractile dysfunction

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17
Q

Why does hypertension cause heart inability to pump

A

Increases the afterload (pressure that the heart has to work against)

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18
Q

How does a contractile dysfunction lead to Heart failure

A

Cant pump

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19
Q

What happens to the starling curve in heart failure

A

Decreases

20
Q

Why does the starling curve decrease

A

We lose our inability to stretch sacromere and stretch to give a contraction to increase the SV

21
Q

Where are baroreceptors found in the body

A

Aortic arch

Carotid sinus

22
Q

What is the afferent nerve of the carotid sinus

A

CN9/ glossopharyngeal nerve

23
Q

What is the afferent nerve of the aortic arch

A

Vagus nerve /CN10

24
Q

If there is a fall in stroke volume due to a change in the starling curve what happens to the ABP

A

Abp= co X TPR
Abp= (SV X HR) X TPR
Decreases

25
Q

What happens to the afferent nerve activity of the baroreceptors when they detect a decrease in the ABP

A

Afferent activity decreases

26
Q

Where does the afferent nerve input into

A

The CNS to NTS

27
Q

What happens after inputting into the NTS

A

1) NTS inhibits the nucleus ambiguus so the PNS vagal activity to the SAN decreases
2) RVLM is activated which increases the sympathetic pre-ganglionic nerve to the SAN and heart rate increases
3) sympathetic activity also causes vasoconstriction
4) SNS also causes an increase in SV by increasing the contractility of the cardiac myocytes
5) SNS causes adrenaline release form the adrenal gland which increase the HR and SV

28
Q

What does an increase in SV and HR do

A

Increase cardiac output

29
Q

What is the consequence of the persistent activation of the SNS to the heart

A

Hypertrophy
Loss of adregenic sensitivity due to less beta receptors expressed
Dysfunction with calcium homeostasis

30
Q

How do we get a calcium homeostasis dysfunction due to the persistent activation of SNS

A

1) SNS leads to sarcoplasmic reticulum overload with calcium as it open voltage gated calcium channels
2) the overload of calcium causes calcium to lead during diastole
3) calcium becomes removed by the NA+/CA2+ exchanger
4) sodium is brought into the cell which causes depolarisation
5) we get a small contraction during the diastole interval and if it meets the threshold it leads to an ectopic AP
6) SNS also causes increases PKA activity which brings in calcium back to the sarcoplasmic reticulum by stimulating SERCA

31
Q

When there a reduced ABP what happens in the kidney

A

1) renin is released
2) renin coverts angiotensinogen to angiotensin 1
3) ACE converts angiotensin 1 to angiotensin 2
4) angiotensin 2 causes the release of aldosterone which brings in water by bringing in sodium and therefore water follows

32
Q

What does the effect of bringing in water do to the EDV

A

Increase it

33
Q

What effect does increase in EDV have to the SV

A

Increase it to maintain CO

34
Q

What happens to the SV in late stage heart failure

A

Decreases because we lose sacromeres which cannot stretch despite the increase in the EDV

35
Q

What happens when we get a mismatch in the left and right CO

A

Oedema

36
Q

Where can oedema occur

A

Pulmonary

Systemic

37
Q

In left heart failure where do we get the oedema

A

Pulmonary

38
Q

In right heart failure where do we get the oedema

A

Systemic

39
Q

Why do we get an oedema forming when there is an increased blood volume

A

An increase in blood volume increases the hydrostatic pressure in the capillaries
Fluid moves into the interstitial space to give oedema

40
Q

When we get pulmonary oedema what happens to diffusion of oxygen

A

Decreases due to an increases diffusion distance created by the fluid

41
Q

Which receptors does a decrease in oxygen stimulate

A

Peripheral chemoreceptors

42
Q

What is the treatment for pulmonary oedema

A

100% o2 supply
Diuretics
Ace inhibitors
AT1 receptor antagonist

43
Q

Why do we get hypertrophy of the heart

A

Due to an increase in blood pressure or SNS activity

44
Q

How can we lower BP

A

Give vasodilator

45
Q

How can we stop the stimulation of SNS

A

Beta blockers

CVS (19 decks)

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