MedComplex-CardioVascular2 Flashcards
What is Congestive Heart Failure? Failure of the heart ________.
as a pump
What is the leading discharge diagnosis in hospitalized pt’s over 65 years of age?
Congestive heart failure
CHF is a very common condition with a poor prognosis, with a mortality of more than ___% in less than FIVE years.
50% holy Shit!
CHF is the underlying or contributing cause of death of an estimated ________ individuals annually in the U.S. and for which about _______ patients are currently being treated.
300,000…2 million
The heart has an amazing capacity to adjust its activity to meet the body’s varying needs and acts to maintain ______ pressure and perfusion of vital organs.
arterial
In CHF: The output declines during ____, and markedly increases during ______ by the use of the Cardiac Reserve.
sleep…exercise
Persons with CHF, even at rest, must use their cardiac ______.
reserve
WHAT ARE THE THREE COMPENSATORY MECHANISMS used to prevent CHF?
1.Increased Sympathetic Stimulation 2.Fluid Retention 3.Cardiac Muscle Hypertrophy
CHF Comp. Mech #1: Increased Sympathetic Stimulation-Increases both the heart rate and myocardial contractility by release of _________.
Norepinephrine
CHF Comp. Mech #1: Increased Sympathetic Stimulation- In severe CHF, the hearts metabolic needs increase with the increased sympathetic stimulation, leading to myocardial ischemia and _______ when the coronary blood flow is not adequate to meet the hearts needs.
Angina
CHF Comp. Mech #2: Fluid Retention - As cardiac output starts to fall to a point where renal blood flow is decreased, the _____ is activated, increasing the ______ and _____ retention.
RAS…sodium and water
CHF Comp. Mech #2: Fluid Retention - The fluid retained by the _______ causes a progressive increase in the vascular volume with an accompanying increase in ______ return to the heart, leading to increased filling and stretching of the myocardium (chamber dilation)
kidneys…venous
CHF Comp. Mech #2: Fluid Retention - The increased _____ or dilation helps to sustain cardiac performance by enhancing contractility.
preload
CHF Comp. Mech #2: Fluid Retention - The increase in vascular volume, as failure progresses, leads to _____.
edema
CHF Comp. Mech #3: Cardiac Muscle Hypertrophy- It is a compensatory response of the myocardium to increased _______ work.
mechanical
CHF Comp. Mech #3: Cardiac Muscle Hypertrophy- Volume-__________ ventricles develop hypertrophy accompanied by dilation with increased ventricular diameters.
overloaded
CHF Comp. Mech #3: Cardiac Muscle Hypertrophy- The hearts usually range up to about _____ grams.
600g (normal about 300f, 450m)
CHF-the myocardial hypertrophy, along with the increased SNS stimulation, may lead to _______ or angina of the heart
ischemia
Pathophys of CHF-Characterized by diminished cardiac output (________ failure) or damming back of blood in the venous system (_______ failure), or both.
forward…backward
Pathophys of CHF - ______ failure impairs movement of blood into the vessels emerging from the heart.
forward
Pathophys of CHF- Backward failure allows blood to accumulate in the vessels or heart chambers located behind the failing ______ and results in congestion of the pulmonary and venous system circulation.
ventricles
LEFT Heart Failure-Pathophysiology - Most often caused by ischemic heart disease, ____, aortic and mitral valve disease, and non-ischemic myocardial disease (myocarditis)
HYPERTENSION
LEFT Heart Failure-Pathophysiology - The morphologic and clinical effects primarily results from progressive damming of blood within the _______ circulation and the consequences of diminished peripheral blood flow.
pulmonary
LEFT Heart Failure-Pathophysiology - The left ______ is usually hypertrophied with massive chamber dilation, with secondary enlargement of the left ______.
ventricle…atrium
LEFT Heart Failure-Pathophysiology -The enlargement may cause _________ with blood stasis and possible _______ formation with the chance of emboli.
atrial fibrillation…thrombis
Left Heart Failure-Lung Findings: Increased pressure in the ________ is transmitted retrograde to the capillaries and arteries, resulting in pulmonary congestion and edema with heavy, wet lungs.
pulmonary veins
Left Heart Failure-Lung Findings: There is edematous widening of the alveolar _______ and accumulation of edematous fluid in the alveolar spaces.
septae
Left Heart Failure-Lung Findings: When iron-containing hemoglobin from erythrocytes leak from the congested capillaries into the alveoli, the RBC’s are phagocytized by alveolar macrophages and are converted to ________ within the edematous fluid.
hemosiderin
Left Heart Failure-Lung Findings: The accumulated fluid causes cough, fatigue, limb weakness, and ______ (breathlessness) on exertion, along with orthopnea which is dyspnea on lying down, relieved by sitting or standing.
dyspnea
Which side of the heart having congestive heart failure will we see hemosiderin-laden macrophages?
left sided heart failure (with macrophages in the lungs)
Left Heart Failure: The decreased cardiac output causes a reduction in _____ perfusion, activating the RAS, inducing retention of salt and water, expanding the blood volume, which contributes to the ________ edema.
renal…pulmonary
Left Heart Failure: In far-advanced CHF, the cerebral hypoxia may give rise to hypoxic ___________ with stupor, loss of consciousness, restlessness and possible coma.
encephalopathy
Right Heart Failure: WHAT IS THE NUMBER 1 REASON for right heart failure? (THIS WILL BE ON EXAM)
secondary consequence of left heart failure
Right heart failure causes congestion of the ________ and _______.
peripheral organs and extremities
Which side of congestive heart failure can lead to NUT-MEG liver?
right sided CHF
In nut-meg liver, the congestion is around which part of the histological anatomy of the liver?
central veins
Right Heart Failure: The failure leads to an elevated pressure in the _____ veins and it’s tributaries.
PORTAL
Right Heart Failure: The congestion produces a tense, enlarged spleen (congestive splenomegaly), with a weight up to _____ grams.
600g (normally 150-200g)
Right Heart Failure: Pressure in the abdominal veins may lead to the accumulation of fluid within the abdomen (_______)
ascites
Right Heart Failure: More pronounced in the ______ extremities and in the area over the sacrum.
LOWER
Right Heart Failure: There is also prominent ankle (pedal) and ________ edema. The external jugular vein becomes distended, visualized as _________.
pretibial…JVD (Jugular Veinous Distension)
RIGHT Heart Failure:Yes, ________ effusions (>1liter) may appear and can cause a partial atelectasis.
pleural
Causes of primary HTN: What % of HTN is classified as primary? What is the specific cause for this HTN?
90%…no specific cause
Causes of primary HTN: What are the 7 risk factors for primary HTN?
1.Old Age 2.Race 3.Stress 4.Genetics 5.Salt 6.Obesity 7. RAS malfxn
Causes of primary HTN: Race: Hypertension is more common and more severe in the _____ race-reason UNKOWN
black
Causes of primary HTN: Genetics: Hypertension is more frequently seen among members of the same families and persons with a positive family medical history are ____ times more likely to develop essential HTN. With the presence of OTHER risk factors, it becomes ___ times more likely.
2x…3-4x
Causes of primary HTN: Excess Salt Intake: does not cause HTN in all persons, nor does the reduction reduce the BP. May be due to increased vascular ________.
resistance
Causes of secondary HTN: What are the 7 underlying causes?
1.Pregnancy 2.Kidney Disease 3.Vascular Disorder (ArterioSclerosis) 4.PheoChromoCytoma 5.EtOH 6.MEDS 7.Brain Lesions
Causes of secondary HTN: WHAT IS THE MOST COMMON CAUSE OF SECONDARY HTN?
KIDNEY DISEASE. I DONT KNOW WHAT IM YELLING ABOUT!
Causes of secondary HTN: Pheochromocytoma: A tumor of the __________, produces and secretes Catecholamines (Norepinephrine and Epinephrine),
adrenal medulla
Causes of secondary HTN: Alcohol Consumption: Regular consumption of ______ or more drinks per day increases the risk.
three
Causes of secondary HTN: Medications: Such as oral _________, and certain nasal decongestants, may also increase the BP
oral contraceptives
________ HTN: is an ACCELERATED and potentially fatal form of Hypertension that develops in __-__% of patients with primary or secondary HTN.
MALIGNANT…5-10%
EXAM QUESTION: Malignant HTN It is a disease of middle-aged adults around the age of _____, WHICH GENDER?, particularly WHICH AGE,SEX,AND RACE??, as well as persons with previous chronic renal disease and toxemia of pregnancy.
40…males much more than females…YOUNG BLACK MEN
Malignant HTN: About HALF of the patients have an antecedent history of benign _______ and ________
hypertension and nephrosclerosis
Malignant HTN: Characterized by marked elevation in BP with DIASTOLIC pressures greater than ____mm Hg, encephalopathy, renal disorders, vascular changes, and papilledema
130mm
Malignant HTN: Related to injury to the _______ because of the high pressures causing leakage of plasma into the injured walls resulting in fibrinoid necrosis.
endothelium
Malignant HTN: the size of the kidneys vary with the duration of the disease. The cut surface reveals obscured corticomedullary junctions with small red _______ areas of hemorrhage.
punctate
What are the two most important features of hypertensive retinopathy?
1.AV Nicking 2.Cotton Wool Spots
HTN MEDS: _________ may be a side-effect of certain calcium channel blockers (________ or ________), leading to pain and difficulty chewing
Gingival Hyperplasia…. (Nifedipine or Procardia)
What are the four most affected tissues/organs in HTN?
1.Heart 2.Kidney 3.Vessles 4.Brain
