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DPT732: MAP II > MAPIISG1 - Cardiac Muscle Dysfunction/Heart Failure > Flashcards

MAPIISG1 - Cardiac Muscle Dysfunction/Heart Failure Flashcards

1
Q

What is Cardiac Muscle Dysfunction / Heart Failure?

A

pathophysiological state in which abnormality of cardiac function is responsible for failure of heart to pump blood at a rate sufficient to meet metabolic demands of body

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2
Q

What are clinical manifestations of heart failure?

A

Exercise intolerance, SOB, chronic fatigue, decline in functional status, QOL (quality of life)

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3
Q

What are the Etiologies (causes) of heart failure?

A

Intrinsic myocardial disease: CAD –> CHD or coronary myopathy due to virus, infection, congenital)

Myocardial damage: chemotherapy, radiation, drugs

Excess workload: HTN, aortic stenosis

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4
Q

What are measurements of heart function?

A
  1. Ejection Fraction (LVEF): normal 55-75%
  2. What is Cardiac Output (blood moved in 1 minute : normal 4-8L/min
  3. LVEDV (or LVEDP)
  4. Ecocardiogram
  5. Exercise Stress Test
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5
Q

Pathophysiology of heart failure - abnormal stroke volume due to (3)

A
  1. Impaired ventricular filling
  2. Increase afterload
  3. impaired ventricular filling
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6
Q

What is increase in afterload?

A

resistance encoutered by blood ejected during systole; due to increase in arterial resistance leads to increase in myocardial O2 consumption and decrease stroke volume

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7
Q

What affect does increase in afterload have on stroke volume of a normal heart?

A

increase in afterload has little effect on SV

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8
Q

What is impaired contractility?

A

due to decrease in intercellular Ca2+ –> decrease in force of contractility and stroke volume

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9
Q

What are the three types of cardiomyopathy?

A

Dialted: heart chamber enlarges, muscle fibers stretch
Hypertopic: heart walls thicken, espcially in LV; some athelets
Restrictive: hypertropic and ventricle walls stiffen resulting in loss of flexibility

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10
Q

What are the 4 types of Systolic dysfunction?

A
  1. Loss of contractility
  2. Dilated ventricle
  3. Increase LVEDV
  4. Decreased LVEF
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11
Q

What is 1 type of Diastolic dysfunction?

A
  1. Impaired filling due to hypertrophy or decreased filling, may result from HTN or aortic stenosis
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12
Q

Classify the type of Heart Failure: Dialated Cardiomyopathy

  • LVEDP: Increase or Decrease
  • Force of Muscle Contraction: Increase or Decrease
  • Systolic or Diastolic
A

Classify the type of Heart Failure: Dialated Cardiomyopathy

  • LVEDP: Increase
  • Force of Muscle Contraction: Decrease
  • Systolic
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13
Q

Classify the type of Heart Failure: Restrictive Cardiomyopathy

  • LVEDP: Increase or Decrease
  • Force of Muscle Contraction: Increase or Decrease
  • Systolic or Diastolic
A

Classify the type of Heart Failure: Restrictive Cardiomyopathy

  • LVEDP: Decrease
  • Force of Muscle Contraction: Increase
  • Diastolic
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14
Q

What causes right-sided heart failure?

A

increase in pulmonary resistance

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15
Q

What are symptoms of Right-sided heart failure?

A

Venous Congestion

  • peripheral pitting edema
  • weight gain
  • hepatomeglary
  • jugular venous distension
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16
Q

What causes left-sided heart failure?

A

loss of myocardial tissue (decrease in force of contraction and increase in afterload)

17
Q

What are symptoms of Left-sided heart failure?

A
  1. Dyspnea: rales/crackles, pulmonary edema
  2. Orthopnea: SOB > lying down vs. sitting up
  3. Paroxysmal nocturnal dyspnea
  4. S3 heart sound
  5. Excessive weight gain (>2lbs/day)
  6. Decrease in exercise tolerance
18
Q

How do neromal neurohormonal compensatory mechansims tend to exacerbate HF?

A
  • Purpose of NCMs (SNS stimulation, RAAS) is to maintain levels of CO, BP that allow for adequate perfusion of brain, heart
  • Body senses decrease in cardiac output, but blood pressure isn’t able to identify cause as HF so compensatory adaptations decompensate heart function
19
Q

What is a diagnostic marker of heart failure?

A

B-type natriuretic peptide (BNP) if CO decreased, BNP increases

BNP >100pg/ml is diagnostic for chronic heart failure

20
Q

What are the New York Heart Association Classification of HF?

A

Class I: no limitation of physical activity
Class II: slight limitation of physical activity; dyspnea, fatigue with moderate PA
Class III: dyspnea with minimal physical activity
Class IV: symptoms at rest

21
Q

Control of HF - How is preload corrected?

A

Control of salt and water retention - low sodium diet or diuretics

22
Q

Control of HF - How is contractility improved

A

Increase FOC:
Digitalis (Glycosides)
Ionotropic Meds (Digoxin)

Decrease Workload:
Ace Inhibitors (decease afterload)
B-blockers (decrease HR)
pacemaker
Diuretics (decrease volume)
23
Q

Control of HF - How is Afterload improved?

A

reduce peripheral resistance
lower blood pressure
ACE inhibitors (decrease afterload)

24
Q

What is the HF triple cocktail?

A

Medications to decrease cardiac workload

ACE Inhibitors
Diuretics
Beta-blockers

25
Q

What do Ace Inhibitors do?

A

decrease afterload

26
Q

What do Diuretics do?

A

decrease volume

27
Q

What do Beta- blockers do?

A

decrease HR (via limit SNS to heart)

28
Q

What is the correlation between measures of HF (LVEF) and exercise capacity?

A

poor

29
Q

What are three measurements of exercise capacity?

A

VO2 peak:

30
Q

What effect does exercise training have on HF patients?

A

improves survival, improved exercise tolerance causes a reduction in symptoms and improved quality of life

31
Q

What is the Bad News with reponse to exercise in patients with HF?

A

Decrease CO due to decrease in SV

Decrease in skeletal muscle blood flow, function of autonomic control

Decrease in skeletal muscle metabolic response

32
Q

What is the Good News with response to exercise in patients with HF

A

exercise training reverses those deficits, especially peripheral abnormailities - skeletal muscle blood flow/autonomic function, skeletal metabolic response

DPT732: MAP II (14 decks)

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