LECTURE 2: cardiac muscle dysfunction and failure Flashcards
what is the most common cause of pulmonary congestion and edema
HF
if someone has a L sided HF would problem would most likely arise ?
lung
increased arterial pressure form hypertension causes what on the LV
increases work
hypertension causes what effect on afterload?
increased
what happens to the LV during hypertension
enlarges and hypertrophies
during HTN , the LV enlarges and hypertrophies so then there is an ____ energy expenditure of the mm fibers of the heart
increased
ECG measure what
ejection fraction
Doppler measures what
blood flow
what is the second most common causes of CMD
coronary artery disease
what is coronary artery disease
ischemia due to restriction of blood flow
if someone has CAD what happens at the ischemia areas of the ventricle ?
scar formation
in CAD if someone has scare formation at the ischemia areas of the ventricle what happens to the compliance ? filling ? and contractility?
poor compliance
decrease filling and contractility
if there is a decreased contractility then there is an _____ ejection fraction
decreased
someone who has CAD has the possibility of developing _____ ____ during to increased ___ released
cardiac arrhythmias due to increase Ca+ released
what is irreversible myocardial necrosis
myocardial infarction
if someone has high levels of CK-MB or troponin I what can we suspect
acute myocardial infarction
if you are reading a ECG and you see ST elevation what can we suspect
acute myocardial infarction
Can cardiac arrhythmias causes sudden cardiac arrest even with someone with a normal heart ?
yes
what is abnormal rate and contraction of atria or ventricles
cardiac arrhythmias
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
contraction
filling
ejection
is the conduction system affected in cardiac arrthmias ?
yes
if someone has cardiac arrhythmias then they have a ____ cardiac output
reduced
cardiac arrhythmias can assess what types
sick sinus body syndrome
prolonged supraventricular tachycardia
ventricular tachycardia
rapid atrial fibrillation or flutter is an example of what
prolonged supra ventricular tachycardia
which cardiac arrhythmias are deadly
ventricular tachycardia and fibrillation
what contributes / exacerbates to CMD due to fluid overload
renal insufficiency
one of the main focuses with someone with renal insufficiency is to maintain what
electrolyte balance of Na+ and K+ levels
what is azotemia
severe renal insufficiency
azotemia is a high blood content of what compounds
urea and creatinine
what is causes by decreased glomerular filtration rate and decreased blood flow
renal insufficiency
someone with severe renal insufficiency has an _____ SNS to increase what
increased and BP
someone with severe renal insufficiency has increase what
BUN
creatinine
water
sodium retention
explain the RAAS system
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
what is the disease of the heart mm itself leading to HF
cardiomyopathy
what does cardiomyopathy impair in the heart
contractility and/or relaxation
what are primary causes of cardiomyopathy
idiopathic mechanisms
secondary cardiomyopathy is causes due to
prolonged HTN
MI
metabolic disorder : DM , thyroid disease
heart valve problems
cardiac arrthymias
what are the 3 types of cardiomyopathies
dilated
hypertrophic
restrictive
dilated cardiomyopathy causes what type of EF
reduced
cardial mm for dilated cardiomyopathy can be due to what
metabolic
toxic
infection
genetic
what is known as myocardial mitochondrial dysfunction
dilated cardiomyopathy
what type of dysfunction is dilated CM
systolic dysfunction
someone with dilated CM has a heart that is a ___ effective pump
less
someone with DCM has a ___ EF
decreased
someone with DCM has an _____ left ventricular end diastolic volume
increased
someone with DMC and an increased LV EDV causes what to the cardiac mm fibers
for them to dilate and stretch
why is there decreased contractility of the heart mm fibers with someone with DCM
due to overstretch
hypertrophic cardiomyopathies has a ____ EF
preserved
hypertrophic CM causes an _____ heart
enlarged
what type of dysfunction is a hypertrophic CM
diastolic dysfunction
what does it mean if there is a diastolic dysfunction
impaired filling of the ventricles during diastole
someone with HCM has a diastolic dysfunction which does not allow the myocardium to do what
relax to allow filling
HCM causes an _____ left atrial , pulmonary artery , and pulmonary capillary pressure
increased
what are causes for HCM
genetic or prolonged HTN
who is HCM a common cause for sudden cardiac arrest
young athletes
can HCM lead to fatal arrhythmias
yes
which CM is considered to be myocardial fibrosis
restrictive cardiomyopathies
someone with restrictive CM has a defect in what
myocardial relaxation
what kind of dysfunction is RCM
diastolic
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
RCM
what is it called when the heart contracts more forcefully to expel the cardiac output
heart valve abnormalities
what does heart valve abnormalities induce
myocardial hypertrophy
what can be caused by mitral valve prolapse
valvular insufficiency
blocked valves are called what
valvar stenosis
what causes regurgitation of the blood to fill the atria and ventricles forcefully
valvular incompetence
valvular incompetence causes myocardial ____ and _____
dilation and hypertrophy
mitral valve prolapse leads to what
shortness of breath and S3 heart sounds
valvular incompetence produces ___ due to impaired relaxation of myocardium
CMD
atrioventricualr valve incompetency affects what valves
mitral and tricuspid
what incompetency dilates the left atria
mitral
triscupsid valve incompetency dilates what
right atria
ventricular valve incompetency affects what
aortic and pulmonic
aortic valve incompetency dilates what
LV
which incompetency dilates the RV
pulmonic valve
active valve dysfunction leads to __ CO due to what
Decreased CO due to regurgitant blood
acute valve dysfunction can produce ____ edema
pulmonary
what is it called if there is fluid that may compress that heart
pericardial effusion
what is defined as inflammation of the pericardium due to injury or infection
parcarditis
what is charactized as elevated intracardiac pressures , progressively limited ventricular diastolic filling , and reduced stroke volume?
cardiac tamponade
what produced cardiac tamponade
increased intrapericardial pressure from pericardial effusion
what is CMD from elevated pulmonary artery pressure
pulmonary embolism
pulmonary embolism causes ___ right ventricular demand
increased
does elevated pulmonary artery pressure causes disease lung tissue and decreased lung surface to perfusion ratio
yes
if right pulmonary embolism progresses to left ventricular failure what does that do to the coronary blood flow
decreases it
pulmonary embolism may causes ____ infarction due to decreased right ventricular blood flow
lung
pulmonary embolism causes ___ pulmonary hypertension which further increase the work for the ___ ventricular and causes ____
increased
right
hypertrophy
Pulmonary hypertension causes a ____ right ventricular SV thus ____ the LV SV and CO
decrease 2x
what is pulmonary hypertension defined as
mean pulmonary arterial pressure
when is mPAP considered abnormal
if someone has primary PH and mPAP is >20 or someone with COPD >20
what is the development of PH in COPD causes by
hypoxia
hypoxia is associated with an ___ in pulmonary vascular resistance
increased
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:
1-5
if pressure increases in the pulmonary arteries what odes it causes the right ventricular to do
pump harder to provide blood to the lungs for oxygenation
if someone has PH it can lead to increase girth ventricular work which can lead to what
hypertrophy
cor pulmonale (r side HF)
what causes a pathological decreases in cardiac output
congestive heart failure
CHF is a __ ventricular failure leading to ____ congestion
left
pulmonary
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.
just know
what is the result of low cardiac output at rest or during exertion
HF with reduced ejection fraction
what usually results from impaired relaxation of the LV and passive LV compliance resulting in stiffness and increased diastolic pressure
HF with preserved EF
The impaired contraction of the ventricles during systole that produces an inefficient expulsion of blood (low stroke volume) is termed what
systolic HF
The impaired filling and inability of the ventricles to accept the blood ejected from the atria during rest or diastole is termed what
diastolic HF
LV failure will lead to ___ congestion
pulmonary
someone with CHF will have ____ edema due to _____ pulmonary capillary pressure
pulmonary
increased
If BNP is increased what can we predict
CHF
if someone has right CHF where is fluid backed up into
right atrium / periphery
Left CHF causes fluid build up into what
lungs
what type of EF does someone with a systolic dysfunction have
reduced
what type of EF does someone with a diastolic dysfunction have
preserved
how does Sympathetic nerve impulses affected the myocardial contractility
positively
how does Circulating epinephrine affected the myocardial contractility
positively
how does the use of digitalis and lanoxin effected the myocardial contractility
positively
what type of pharmacological agent is digitalis
positive iontropic which increased contractility
how does the loss of myocardial cell affect the myocardial contractility
bad
how does Pharmacologic depressants (Beta Blockers) affect the myocardial contractility
neg
what is hypercapina
increased CO2 and decreased O2
how does anoxia affect the myocardial contractility
neg
what is the overall affect of the RAAS system
increase CO and BP by sodium and water retention
why is there a decreased pulmonary function in CHF
fluid build up
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
2
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
1
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
3
what kinf of receptor is myocardial iontrophy and chontropyy
beta 1
what type of receptor is vasodilation of capillary beds and bronchdilation
beta 2
what type of receptors is vasoconstriction of vascular beds of GI, kidney and brain
alpha 1
which type of receptors is arterial vasodilation
alpha 2
which receptor wants to increase HR and force of contraction
beta 1
which receptor is more of a relaxer
beta 2
which receptor is a positive iontropic ? negative?
alpha 1
alpha 2
if you down regular beta 1 then waht happens to myocardial contractile force and heart rate
decreased
what is the purpose of beta blockers
slows heart rate and lowers BP
hematologic function and CHF is due to deacreased ___ concentration in the blood due to either right or left heard failure
oxygen
if diastolic is less than 40 then what does that indicate
HF
hematologic function and CHF causes an ____ red blood cell production from ___ ____ which then produces _____
increase
bone marrow polycythemia
what is anemia
low hematocrit/ hemoglobin
which way does anemia shift the SaOz curve
to the right
how can u exercise a patient with skeletal muscle activity and CHF w/o cardiomyopathy
low/moderate intensity for longer periods
how should you exercise your patient with skeletal mm activity and CHF with cardiomyopathy
aerobic but for a little
dysfunctional heart relies on what as a primary fuel source
glucose
what does CHF do for pancreatic function
impairs insulin ferreting and glucose tolerance
