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cardio pulm midterm > LECTURE 2: cardiac muscle dysfunction and failure > Flashcards

LECTURE 2: cardiac muscle dysfunction and failure Flashcards

1
Q

what is the most common cause of pulmonary congestion and edema

A

HF

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2
Q

if someone has a L sided HF would problem would most likely arise ?

A

lung

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3
Q

increased arterial pressure form hypertension causes what on the LV

A

increases work

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4
Q

hypertension causes what effect on afterload?

A

increased

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5
Q

what happens to the LV during hypertension

A

enlarges and hypertrophies

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6
Q

during HTN , the LV enlarges and hypertrophies so then there is an ____ energy expenditure of the mm fibers of the heart

A

increased

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7
Q

ECG measure what

A

ejection fraction

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8
Q

Doppler measures what

A

blood flow

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9
Q

what is the second most common causes of CMD

A

coronary artery disease

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10
Q

what is coronary artery disease

A

ischemia due to restriction of blood flow

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11
Q

if someone has CAD what happens at the ischemia areas of the ventricle ?

A

scar formation

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12
Q

in CAD if someone has scare formation at the ischemia areas of the ventricle what happens to the compliance ? filling ? and contractility?

A

poor compliance
decrease filling and contractility

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13
Q

if there is a decreased contractility then there is an _____ ejection fraction

A

decreased

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14
Q

someone who has CAD has the possibility of developing _____ ____ during to increased ___ released

A

cardiac arrhythmias due to increase Ca+ released

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15
Q

what is irreversible myocardial necrosis

A

myocardial infarction

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16
Q

if someone has high levels of CK-MB or troponin I what can we suspect

A

acute myocardial infarction

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17
Q

if you are reading a ECG and you see ST elevation what can we suspect

A

acute myocardial infarction

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18
Q

Can cardiac arrhythmias causes sudden cardiac arrest even with someone with a normal heart ?

A

yes

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19
Q

what is abnormal rate and contraction of atria or ventricles

A

cardiac arrhythmias

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20
Q

if someone has cardiac arrthymias that means there is an altered sequence of _____ and it does not allow for proper ____ and ____ of blood from their respective chambers

A

contraction
filling
ejection

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21
Q

is the conduction system affected in cardiac arrthmias ?

A

yes

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22
Q

if someone has cardiac arrhythmias then they have a ____ cardiac output

A

reduced

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23
Q

cardiac arrhythmias can assess what types

A

sick sinus body syndrome
prolonged supraventricular tachycardia
ventricular tachycardia

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24
Q

rapid atrial fibrillation or flutter is an example of what

A

prolonged supra ventricular tachycardia

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25
Q

which cardiac arrhythmias are deadly

A

ventricular tachycardia and fibrillation

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26
Q

what contributes / exacerbates to CMD due to fluid overload

A

renal insufficiency

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27
Q

one of the main focuses with someone with renal insufficiency is to maintain what

A

electrolyte balance of Na+ and K+ levels

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28
Q

what is azotemia

A

severe renal insufficiency

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29
Q

azotemia is a high blood content of what compounds

A

urea and creatinine

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30
Q

what is causes by decreased glomerular filtration rate and decreased blood flow

A

renal insufficiency

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31
Q

someone with severe renal insufficiency has an _____ SNS to increase what

A

increased and BP

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32
Q

someone with severe renal insufficiency has increase what

A

BUN
creatinine
water
sodium retention

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33
Q

explain the RAAS system

A

when BP falls renin comes from the kidneys and angiotensinogen is released from the liver and then they react together to form angiotensin 1 and then ACE is released from the lungs and acts on angiotensin 1 to form angiotensin 2 which then stimulates vascontriction of the blood vessels and also acts on adrenal glad to stimulate release of aldosterone to act on the kidneys to stimulate reabsoprtion of water and salt

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34
Q

what is the disease of the heart mm itself leading to HF

A

cardiomyopathy

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35
Q

what does cardiomyopathy impair in the heart

A

contractility and/or relaxation

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36
Q

what are primary causes of cardiomyopathy

A

idiopathic mechanisms

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37
Q

secondary cardiomyopathy is causes due to

A

prolonged HTN
MI
metabolic disorder : DM , thyroid disease
heart valve problems
cardiac arrthymias

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38
Q

what are the 3 types of cardiomyopathies

A

dilated
hypertrophic
restrictive

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39
Q

dilated cardiomyopathy causes what type of EF

A

reduced

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40
Q

cardial mm for dilated cardiomyopathy can be due to what

A

metabolic
toxic
infection
genetic

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41
Q

what is known as myocardial mitochondrial dysfunction

A

dilated cardiomyopathy

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42
Q

what type of dysfunction is dilated CM

A

systolic dysfunction

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43
Q

someone with dilated CM has a heart that is a ___ effective pump

A

less

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44
Q

someone with DCM has a ___ EF

A

decreased

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45
Q

someone with DCM has an _____ left ventricular end diastolic volume

A

increased

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46
Q

someone with DMC and an increased LV EDV causes what to the cardiac mm fibers

A

for them to dilate and stretch

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47
Q

why is there decreased contractility of the heart mm fibers with someone with DCM

A

due to overstretch

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48
Q

hypertrophic cardiomyopathies has a ____ EF

A

preserved

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49
Q

hypertrophic CM causes an _____ heart

A

enlarged

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50
Q

what type of dysfunction is a hypertrophic CM

A

diastolic dysfunction

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51
Q

what does it mean if there is a diastolic dysfunction

A

impaired filling of the ventricles during diastole

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52
Q

someone with HCM has a diastolic dysfunction which does not allow the myocardium to do what

A

relax to allow filling

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53
Q

HCM causes an _____ left atrial , pulmonary artery , and pulmonary capillary pressure

A

increased

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54
Q

what are causes for HCM

A

genetic or prolonged HTN

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55
Q

who is HCM a common cause for sudden cardiac arrest

A

young athletes

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56
Q

can HCM lead to fatal arrhythmias

A

yes

57
Q

which CM is considered to be myocardial fibrosis

A

restrictive cardiomyopathies

58
Q

someone with restrictive CM has a defect in what

A

myocardial relaxation

59
Q

what kind of dysfunction is RCM

A

diastolic

60
Q

what Causes these things
• Cardiac amyloidosis
• Diseases of the heart lining (endocardium), such as endomyocardial fibrosis
• Iron overload (hemochromatosis)
• Sarcoidosis
• Scarring after radiation or chemotherapy • Scleroderma
• Tumors of the heart

A

RCM

61
Q

what is it called when the heart contracts more forcefully to expel the cardiac output

A

heart valve abnormalities

62
Q

what does heart valve abnormalities induce

A

myocardial hypertrophy

63
Q

what can be caused by mitral valve prolapse

A

valvular insufficiency

64
Q

blocked valves are called what

A

valvar stenosis

65
Q

what causes regurgitation of the blood to fill the atria and ventricles forcefully

A

valvular incompetence

66
Q

valvular incompetence causes myocardial ____ and _____

A

dilation and hypertrophy

67
Q

mitral valve prolapse leads to what

A

shortness of breath and S3 heart sounds

68
Q

valvular incompetence produces ___ due to impaired relaxation of myocardium

A

CMD

69
Q

atrioventricualr valve incompetency affects what valves

A

mitral and tricuspid

70
Q

what incompetency dilates the left atria

A

mitral

71
Q

triscupsid valve incompetency dilates what

A

right atria

72
Q

ventricular valve incompetency affects what

A

aortic and pulmonic

73
Q

aortic valve incompetency dilates what

A

LV

74
Q

which incompetency dilates the RV

A

pulmonic valve

75
Q

active valve dysfunction leads to __ CO due to what

A

Decreased CO due to regurgitant blood

76
Q

acute valve dysfunction can produce ____ edema

A

pulmonary

77
Q

what is it called if there is fluid that may compress that heart

A

pericardial effusion

78
Q

what is defined as inflammation of the pericardium due to injury or infection

A

parcarditis

79
Q

what is charactized as elevated intracardiac pressures , progressively limited ventricular diastolic filling , and reduced stroke volume?

A

cardiac tamponade

80
Q

what produced cardiac tamponade

A

increased intrapericardial pressure from pericardial effusion

81
Q

what is CMD from elevated pulmonary artery pressure

A

pulmonary embolism

82
Q

pulmonary embolism causes ___ right ventricular demand

A

increased

83
Q

does elevated pulmonary artery pressure causes disease lung tissue and decreased lung surface to perfusion ratio

A

yes

84
Q

if right pulmonary embolism progresses to left ventricular failure what does that do to the coronary blood flow

A

decreases it

85
Q

pulmonary embolism may causes ____ infarction due to decreased right ventricular blood flow

A

lung

86
Q

pulmonary embolism causes ___ pulmonary hypertension which further increase the work for the ___ ventricular and causes ____

A

increased
right
hypertrophy

87
Q

Pulmonary hypertension causes a ____ right ventricular SV thus ____ the LV SV and CO

A

decrease 2x

88
Q

what is pulmonary hypertension defined as

A

mean pulmonary arterial pressure

89
Q

when is mPAP considered abnormal

A

if someone has primary PH and mPAP is >20 or someone with COPD >20

90
Q

what is the development of PH in COPD causes by

A

hypoxia

91
Q

hypoxia is associated with an ___ in pulmonary vascular resistance

A

increased

92
Q

The World Health Organization (WHO)
• Group __ - Pulmonary arterial hypertension (PAH)
• Group ___ - Pulmonary hypertension due to left-sided heart disease
• Group ___ - Pulmonary hypertension due to lung diseases and/or hypoxia
• Group ___ - Chronic thromboembolic pulmonary hypertension (CTEPH)
• Group __ - Pulmonary hypertension with unclear or multifactorial etiologies:

A

1-5

93
Q

if pressure increases in the pulmonary arteries what odes it causes the right ventricular to do

A

pump harder to provide blood to the lungs for oxygenation

94
Q

if someone has PH it can lead to increase girth ventricular work which can lead to what

A

hypertrophy
cor pulmonale (r side HF)

95
Q

what causes a pathological decreases in cardiac output

A

congestive heart failure

96
Q

CHF is a __ ventricular failure leading to ____ congestion

A

left
pulmonary

97
Q

For example, left-sided HF is frequently the result of left ventricular insult (e.g., myocardial infarction, hypertension, aortic valve disease), which causes fluid to accumulate behind the left ventricle ([LV], left atrium, pulmonary veins, pulmonary capillaries, lungs). If the left-sided failure is severe, there is progressive accumulation beyond the lungs, leading to pulmonary hypertension (PH) and subsequently as right-sided failure. 7 Thus right-sided HF may occur because of left-sided HF or because of right ventricular failure (e.g., secondary to PH, pulmonary embolus, right ventricular infarction). In either case, fluid backs up behind the right ventricle and produces the accumulation of fluid in the liver, abdomen, and bilateral ankles and hands.

A

just know

98
Q

what is the result of low cardiac output at rest or during exertion

A

HF with reduced ejection fraction

99
Q

what usually results from impaired relaxation of the LV and passive LV compliance resulting in stiffness and increased diastolic pressure

A

HF with preserved EF

100
Q

The impaired contraction of the ventricles during systole that produces an inefficient expulsion of blood (low stroke volume) is termed what

A

systolic HF

101
Q

The impaired filling and inability of the ventricles to accept the blood ejected from the atria during rest or diastole is termed what

A

diastolic HF

102
Q

LV failure will lead to ___ congestion

A

pulmonary

103
Q

someone with CHF will have ____ edema due to _____ pulmonary capillary pressure

A

pulmonary
increased

104
Q

If BNP is increased what can we predict

A

CHF

105
Q

if someone has right CHF where is fluid backed up into

A

right atrium / periphery

106
Q

Left CHF causes fluid build up into what

A

lungs

107
Q

what type of EF does someone with a systolic dysfunction have

A

reduced

108
Q

what type of EF does someone with a diastolic dysfunction have

A

preserved

109
Q

how does Sympathetic nerve impulses affected the myocardial contractility

A

positively

110
Q

how does Circulating epinephrine affected the myocardial contractility

A

positively

111
Q

how does the use of digitalis and lanoxin effected the myocardial contractility

A

positively

112
Q

what type of pharmacological agent is digitalis

A

positive iontropic which increased contractility

113
Q

how does the loss of myocardial cell affect the myocardial contractility

A

bad

114
Q

how does Pharmacologic depressants (Beta Blockers) affect the myocardial contractility

A

neg

115
Q

what is hypercapina

A

increased CO2 and decreased O2

116
Q

how does anoxia affect the myocardial contractility

A

neg

117
Q

what is the overall affect of the RAAS system

A

increase CO and BP by sodium and water retention

118
Q

why is there a decreased pulmonary function in CHF

A

fluid build up

119
Q

which stage of fluid accumulation in the pulmonary system is liquid build up compromises small airways of lung. Ventilation / perfusion mismatch. Produces hypoxemia and tachypnea

A

2

120
Q

which stage of fluid accumulation in the pulmonary system is increased lymph flow w/o net gain in interstitial fluid. Gas exchange is improved. Increased lymph flow increases liquid into the lung

A

1

121
Q

which stage of fluid accumulation in the pulmonary system is pulmonary edema increases, increased pulmonary capillary wedge pressure that floods the alveoli. Compromises gas exchange. Produces severe hypercapnea and hypoxemia

A

3

122
Q

what kinf of receptor is myocardial iontrophy and chontropyy

A

beta 1

123
Q

what type of receptor is vasodilation of capillary beds and bronchdilation

A

beta 2

124
Q

what type of receptors is vasoconstriction of vascular beds of GI, kidney and brain

A

alpha 1

125
Q

which type of receptors is arterial vasodilation

A

alpha 2

126
Q

which receptor wants to increase HR and force of contraction

A

beta 1

127
Q

which receptor is more of a relaxer

A

beta 2

128
Q

which receptor is a positive iontropic ? negative?

A

alpha 1
alpha 2

129
Q

if you down regular beta 1 then waht happens to myocardial contractile force and heart rate

A

decreased

130
Q

what is the purpose of beta blockers

A

slows heart rate and lowers BP

131
Q

hematologic function and CHF is due to deacreased ___ concentration in the blood due to either right or left heard failure

A

oxygen

132
Q

if diastolic is less than 40 then what does that indicate

A

HF

133
Q

hematologic function and CHF causes an ____ red blood cell production from ___ ____ which then produces _____

A

increase
bone marrow polycythemia

134
Q

what is anemia

A

low hematocrit/ hemoglobin

135
Q

which way does anemia shift the SaOz curve

A

to the right

136
Q

how can u exercise a patient with skeletal muscle activity and CHF w/o cardiomyopathy

A

low/moderate intensity for longer periods

137
Q

how should you exercise your patient with skeletal mm activity and CHF with cardiomyopathy

A

aerobic but for a little

138
Q

dysfunctional heart relies on what as a primary fuel source

A

glucose

139
Q

what does CHF do for pancreatic function

A

impairs insulin ferreting and glucose tolerance

cardio pulm midterm (11 decks)

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