Module 5: Heart Failure - Schober (Weeks 7 & 8) Flashcards
Definition:
- Where the heart can’t meet the demands of the body
- Unable to pump enough blood to meet the body’s demands
Heart Failure
Definition:
Phase of the cardiac cycle where blood is pumped out of the heart
Systole
Definition:
- Heart muscles can’t pump with enough force
- Weak and smaller muscles
- Less blood is ejected with each contraction
Systolic Heart Failure
Definition:
- Is a filling problem
- Less blood filling up the ventricles
- Muscles are larger (takes up space)
Diastolic Heart Failure
(T/F) It is possible to have isolated heart failure
True
- Left side tends to be affected first, leading to a right side failure
Right Side Congestion:
Fluid buildup in __________
body
Left Side Congestion:
Fluid buildup in __________
Lungs
Definition:
The total amount of blood that the heart is able to pump every minute, usually given in liters of blood per minute
Cardiac Output [CO]
Cardiac Output: Definition
amount of blood pumped out every Beat
Stroke volume
Cardiac Output: Definition
Beats per minutes
Heart Rate
Stroke volume x Heart Rate =
Cardiac Output [CO]
(T/F) Heart failure is considered a primary disease
False, it is considered a Secondary Disease
List some clinical signs of Heart Failure:
- Weakness
- Tachypnea
- Labored breathing
(T/F) Heart failure is a disease
False, Heart failure is not a disease, it is a pathophysiologic state or clinical syndrome
Heart failure is a pathophysiologic state or clinical syndrome characterized by:
- A cardiac (or index) lesion leading to cardiac dysfunction, disease progression, and finally cardiac failure
- Decrease Cardiac output leading to arterial underfilling
- Neurohormonal activation
- Activation of the cytokine cascade with the release of pro-inflammatory cytokines
- Renal retention of N and water
- Increase Venous pressure
- Fluid accumulation causing congestive heart failure (CHF)
- Heart failure is ALWAYS associated with clinical signs
Definition:
- Global term
- Any type of cardiac abnormality. May ultimately lead to heart failure or CHF
Heart disease
(Ex. Loud Heart murmur)
Definition:
Heart pumps an inadequate volume of blood or blood pumped is maldistributed leading to clinical signs
Heart failure
(Ex. Exercise intolerance)
Definition:
Describes impaired cardiac function leading to elevated venous and capillary pressures and clinical signs
Congestive heart failure
(Ex. Tachypnea Collapse)
Definition:
Describes a state of impaired cardiac function not (yet) associated with clinical signs (need diagnostic tests for detection) – a relatively non-specific term
Failing heart
Pathophysiology of Ventricular Dysfunction:
Decreased myocardial inotropy (contractility)
Pump Failure (systolic dysfunction)
Pathophysiology of Ventricular Dysfunction:
- Decreased myocardial lusitropy and increased chamber stiffness
- Impaired ventricular filling or normal ventricular filling only with increased filling pressure
Filling failure (diastolic dysfunction)
Pathophysiology of Ventricular Dysfunction:
- Increased myocardial workload
- Pressure overload: Ventricle pumps at increased pressure to eject
- Volume overload: Ventricle pumps a greater than normal volume of blood with each beat
Ventricular overload
Pathophysiology of Ventricular Dysfunction:
Electrical disturbance (rate & rhythm)
Arrhythmia
Definition:
Is a condition in which the left ventricle, the heart’s main pumping chamber, is enlarged (dilated). As the chamber gets bigger, its thick muscular wall stretches, becoming thinner and weaker. This affects the heart’s ability to pump enough oxygen-rich blood to the rest of the body.
Dilated Cardiomyopathy (DCM)
** FILLER CARD **
** The following cards are from C15 **
Sympathetic Stimulation:
Mechanism => Increase sympathetic neuronal activity (beta & alpha)
Consequence =>
Increase HR, contractility, vasoconstriction
Sympathetic Stimulation:
Mechanism => Renin release
Consequence =>
RAAS activation
Sympathetic Stimulation:
Mechanism => Myocardial cell injury
Consequence =>
Hypertrophy, necrosis, fibrosis
Sympathetic Stimulation:
Mechanism => Altered electrical activity
Consequence =>
Arrhythmias, sudden death
Sympathetic Stimulation:
Mechanism => Increase AVN conduction
Consequence =>
Increase ventricular rate in Afib
Sympathetic Stimulation:
Mechanism => Desensitization/uncoupling/down-regulation of beta-receptors
Consequence =>
Decrease inotropic and chronotropic response to exercise
(T/F) Plasma NorEpi with chronic HF correlates to prognosis
True
(T/F) The higher NorEpi with chronic HF the better the outcome
False, worse the outcome
Effects of the sympathetic nervous system on the cardiovascular system:
- These increase heart rate, contractility, and speed of conduction
Beta 1 & Beta 2
Effects of the sympathetic nervous system on the cardiovascular system:
- Stimulation leads to vasodilation
Beta 2
Effects of the sympathetic nervous system on the cardiovascular system:
- Stimulation causes vasoconstriction
Alpha 1
Definition:
Allows blood from the right side of the heart to flow to the aorta, one of the largest arteries, and back out into the body without going through the lungs
ductus arteriosus (DA)
Effects of the sympathetic nervous system on the cardiovascular system:
- Dopaminergic, vasodilation
DA
Pair the following:
1. Heart: a. alpha 1 > beta 2 > DA
2. Vessels: b. Beta 1»_space; Beta 2»_space; alpha 1
- b. Beta 1 > > Beta 2 > > alpha 1
- a. alpha 1 > beta 2 > DA
Autonomic Receptors – Heart & Vessels
- Chronic stimulation leads to __________ of cardiac beta 1 receptor in blood vessels (arteries + veins): Vasoconstriction
down-regulation
- the process of reducing or suppressing a response to a stimulus
Arterial Vasoconstriction:
Pale mucous membranes are a consequence of what?
Acute neurohormonal activation with in-tense vasoconstriction
Blood Pressure in Heart Failure (ABP = CO x Vascular resistance):
Should systemic vasoconstriction in heart failure lead to hypertension?
Never, we will never see systemic hypertension in a patient with heart failure
- BP is often low normal due to compensatory mechanisms
- Low CO < 80 mmHg often a sign of “cardiogenic shock”
Renin-Angiotensin-Aldosterone System (RAAS):
- Vasoconstriction (intrinsic, strongest in the body)
- increase Arginine vasopressin (AVP) and NE release
- increase Na+ (and H2O) retention & increase Thirst
- increase Hypertrophy (vessels, heart)
Angiotensin II
List some Cons of Systemic Vasoconstriction:
- Causes redistribution of blood AWAY from skeletal muscle
- decrease Exercise capacity - increase LV afterload (afterload “mismatch”) = too much afterload for an already failing ventricle
- decrease Stroke volume - Neurohormones -> Cardio toxic
- Vanoconstriction -> decrease Capacitance to transport interstitial fluid (edema fluid) to the kidneys
(T/F) Heart failure is associated with Na+ and H2O retention increasing preload & venous pressures
True
Secretion of Vasopressin (AVP) in CHF:
What is a poor prognostic indicator in Heart Failure?
Hyponatremia
- the sodium level in the blood is below normal
List the Short-term benefits of Cardiac remodeling:
- increase Stroke volume
- decrease Wall stress
(but if chronic, it causes: arrhythmias, Dilation, Dysfunction, and valve leakage)
Definition:
Is the process of functional recovery, electrical stabilization, and reduction of chamber size due to therapeutic interventions
Reverse Remodeling
Although very beneficial as an immediate response to injury, chronic ______________ & ______________ are the ultimate drivers of disease progression and death
neurohormonal activation, remodeling
Hemodynamics relates to:
- Pressure
- Volume
- Flow
- Resistance to flow
Increase hydrostatic pressure due to pulmonary vein congestion from left heart failure
Pathogenesis of Pulmonary Edema
Definition:
“Collection of a large amount of free fluid in the pleural space”
- usually a sign of left, right, and bi-ventricular heart failure
- Most common in cats
Pleural effusion
Signs and Symptoms of CHF:
- Signs of pulmonary venous congestion
- Labored breathing
- Tachypnea (abnormally rapid breathing)
- Pulmonary crackles
- Cough (not very specific)
- Distant heart sounds
- Weakness
- Collapse
- Anorexia
- Cyanosis
Left-sided CHF
Signs and Symptoms of CHF:
- Signs of systemic venous congestion
- Jugular vein distension (is a finding, not a sign)
- Abdominal distension with a fluid wave (ascites)
- Hepatomegaly
- Splenomegaly
- Anorexia
- Subcutaneous swelling (large animals)
- (Cardiac) cachexia
- Dilation of superficial veins
Right-sided CHF
(T/F) Pleural effusion can be both a sign of I-CHF & r-CHF
True
What statement concerning heart failure is correct?
a) Heart failure can only be correctly diagnosed via thoracic radiography
b) Heart failure is a clinical syndrome associated with clinical signs
c) Heart failure describes a state of impaired cardiac function not (yet) associated with clinical signs
d) Heart failure is a global term used for any type of cardiac abnormality
e) Heart failure is best characterized by a combination of a loud heart murmur, collapse, and low stroke volume
b) Heart failure is a clinical syndrome associated with clinical signs
Which of the following is NOT considered a cause of heart failure in the pathophysiology of ventricular dysfunction?
a) Abnormal diastolic function
b) Abnormal systolic function
c) Pressure and/or volume overload
d) Systemic hypotension
e) Tachy- and bradyarrhythmias
d) Systemic hypotension
Which of the following statements regarding heart failure is CORRECT?
a) Pressure overload causes eccentric ventricular hypertrophy
b) Systolic dysfunction can lead to heart failure due to reduced ventricular filling
c) Volume overload causes concentric ventricular hypertrophy
d) Tachyarrhythmias can lead to heart failure due to reduced ventricular filling, neurohormonal activation, ischemia, and increased cardiomyocyte death
e) Diastolic dysfunction can lead to heart failure due to increased left ventricular filling causing ventricular volume overload
d) Tachycarrhythmias can lead to heart failure due to reduced ventricular filling, neurohormonal activation, ischemia, and increased cardiomyocyte death
‘Loki’ is a 5-yr old Doberman with dilated cardiomyopathy and poor LV systolic function. Heart rate is regular at 180 bpm, rate of respiration increased at 52/min, mucus membranes are pale, and CRT is 3-4 sec. The dog is cachectic with mild ascites. All of the following neurohormonal systems are likely activated, EXCEPT:
a) Cytokine cascade
b) Renin-Angiotensin-Aldosterone system
c) Parasympathetic nervous system with increased vagal tone
d) Sympathetic nervous system with increased sympathetic tone
e) Arginine-Vasopressin (AVP) system
c) Parasympathetic nervous system with increased vagal tone
Definition:
- Accumulation of large amounts of free fluid in the abdomen
- Usually modified transudate
- May be almost pure plasma with as much a 80-90% protein as plasma
Ascites
The main compensatory mechanisms in heart failure
include, EXCEPT:
a) Tachycardia & increased cardiac contractility
b) Arteriolar vasoconstriction
c) Renal sodium and water retention
d) Cardiac remodeling
e) Reduced thirst, venodilation, and increased renal sodium and water excretion
e) Reduced thirst, ventilation, and increased renal sodium and water excretion
Which statement regarding systemic vasoconstriction due to heart failure is CORRECT?
a) Mucus membrane color will be deeply cyanotic
b) It is mediated via vascular beta-1 receptors
c) It is caused by activation of the SNS and RAAS and the secretion of endothelin
d) It relevantly increases cardiac preload
e) It leads to relevantly increased systemic (arterial) blood pressure
c) It is caused by activation of the SNS and RAAS and the secretion of endothelin
** FILLER CARD **
C18 Heart Failure Drugs
Impaired Systolic Function:
List the indications for use of positive inotropic drugs:
- Dilated cardiomyopathy (DCM)
- Heart failure
- Cardiogenic shock
- Acute & chronic CHF
- Critical care patients
- Septic shock
- General anesthesia
- Counteract negative inotropic action of anesthetics
- Drug & Drug over-dosages
- Chemotherapy (doxorubicin)
- Beta-adrenergic receptor blockers
Fill in the blank:
Any increase of Ca2+ will _____________ contractility
increase
- but also increase arrhythmogenicity (wants to be avoided)
Definition:
producing or tending to produce cardiac arrhythmia
Arrhythmogenicity
