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N351: Pathophysiology I > Module 8 > Flashcards

Module 8 Flashcards

1
Q

What two diseases are highly associated with heart failure?

A

Hypertension

Diabetes

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2
Q

Incidences/Prevalence/Cost of Heart Failure

A

10 per 1000 over 65

Men > Women

POC > Caucasian

Diabetes > Other Comorbidities

875,000 patients yearly over 65

about 42,000 deaths, and contributes to 225,000 more

Cost: almost 18 billion yearly

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3
Q

In regard to heart failure we need to us ____ care

A

preventative

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4
Q

Number 1 Cause of Heart Failure (HF)?

A

Atherosclerosis

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5
Q

Atherosclerosis

A

fibrofatty plaque building up in the arteries causing the lumen to narrow

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6
Q

What basically occurs with heart failure?

A

The heart as a pump is impaired –> Left Ventricular problems –> Decreased contractility, lack of blood pumped for metabolic demands

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7
Q

What are the results of heart failure?

A
  1. Circulatory Congestion (Blood Backup)
  2. Circulatory Overload (High blood volume)
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8
Q

What are HF intrinsic causes?

A

Causes of HF within / having to do with the heart itself

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9
Q

What are some intrinsic causes of HF?

A
  1. CAD
  2. AMI (Myocardial Infarction)
  3. Cardiomyopathy
  4. Myocarditis
  5. Congenital Heart Defects
  6. Aortic or Mitral Valve Disease
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10
Q

Ischemic Heart Disease (CAD)

A

Interrupted cardiovascular blood flow –> so ischemia and hypoxia occurs for the heart

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11
Q

Myocarditis

A

Viral or Bacteria Heart Muscle Inflammation

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12
Q

What are some secondary causes of HF?

A

COPD
Pulmonary Embolism
Hyperthyroidism
A-V Fistulas
HTN
Excess Blood Volume
Metabolic or Respiratory Acidosis
Drug Toxicities
Dysrhythmias

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13
Q

Pulmonary Embolism

A

Blood clot in the lungs leading to acute right sided heart failure (due to higher pressure force)

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14
Q

How does HTN lead to heart failure?

A

HTN –> Increased Afterload (pressure) –> Left Ventricle Hypertrophy –> Muscle is flabby and can pump less blood –> Dilated Enlarged Heart leads to inefficient pumping

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15
Q

A-V Fistula

A

Missing capillaries leads to bad nutrient exchange

can lead to heart failure

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16
Q

What causes excess blood volume before HF?

A

The RAA and ADH systems

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17
Q

How does metabolic or respiratory acidosis lead to HF

A

acidotic conditions lead to anaerobic metabolism and also lead to less contractility of the heart

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18
Q

Ventricular Fibrillation

A

Ventricle quivering from uncoordinated electrical signaling

Since its dysrhythmia, can lead to HF

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19
Q

What is the speed of HF pathogenesis?

A

Acute or Insidious

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20
Q

Heart Failure is associated with ___ ___

A

myocardial weakness

*This weakness can be due to comorbidities like nutrition, etc

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21
Q

During heart failure, _____ systems are actually making the heart weaker.

A

compensatory

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22
Q

In HF, decreased contractility leads to ..

A

decreased Cardiac Output with venous return being the same or increasing

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23
Q

How does the body react to decreased CO?

A
  1. SNS reflex activity –> Increased HR
  2. Renin Release –> Increased TPR and Blood Volume
  3. Anaerobic metabolism
  4. Increased O2 extraction by peripheral cells
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24
Q

What is the sympathetic response to heart failure?

A

HF = Decreased CO –> Decreased BP –> Activate SNS –> Increase in HR and Contraction Force w/ arteriole vasoconstriction

More work for a hurting heart!

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25
Q

What is the RAA system response to HF?

A

HF = Decreased CO –> Decreased Renal Perfusion/Kidney Flow Rate –> RAA System activate to release Renin –> Increased blood volume and TPR (increased preload and afterload)

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26
Q

What occurs to myocardial O2 needs in HF?

A

Increased HTN, HR, or Ventricular Enlargement occurs WITHOUT increasing consumption (since the cells grow but vessels do not)

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27
Q

What is the ANF response to HF?

A

Atrial stretch from increased preload due to RAA, but the RAA still sees kidney low blood flow. So, ANF release is stimulated which leads to sodium and water being retained –> vasoconstriction –> even worse preload

28
Q

Frank-Starling Law and Heart Failure

A

The RAA system continuously stretches fiber length –> increased blood volume causes the heart to dilate leading to impaired contraction from fibers being stretched out

29
Q

What are some causes of Left Heart Failure?

A
  1. AMI (Acute Myocardial Infarction)
  2. Systemic HTN
  3. Aortic Stenosis or Insufficiency
  4. Cardiomyopathy
30
Q

Aortic Stenosis

A

Calcified aortic outlets occur leading to impaired opening, so the ventricle must push harder to get blood out

31
Q

Aortic Insufficiency

A

Valve leaflets will not stay closed leading to backflow into the left ventricle AND increased ESV

32
Q

Why does Systemic HTN lead to left heart failure?

A

It increases afterload

33
Q

What are the effects of left heart failure?

A

Forward Effects AND Backward Effects

34
Q

Backward Effects of L Heart Failure

A

EF is very low in the L ventricle, so blood backs up into the atrium, pulmonary veins, and lung capillary bed –> Volume in lungs is too high leading to Pulmonary Edema

35
Q

Forward Effects of L Heart Failure

A

Decreased Systolic Volume occurs in the Left Ventricle due to backup making it so not enough blood gets into the body

Stroke Volume Low –> Decreased BP –> Activated RAA and SNS response –> increased HR, Vasoconstriction, and Blood Volume

36
Q

Aldosterone directs..

A

sodium, and water follows

37
Q

What are some of the forward and backward effects of left heart failure?

A

Forward: Decreased blood supply to brain, kidneys, extremities

Backward: Pulmonary Edema

38
Q

Right Heart Failure

A

When the right ventricles output to the pulmonary artery decreases leading to the systemic veins becoming congested

39
Q

Major Cause of Right Heart Failure?

A

Major cause is Left Ventricular Failure because of excessive pressure in the pulmonary capillary bed

40
Q

What are some other causes of RHF?

A

COPD

Pulmonary Embolus

Rt. Ventricular Infarction (RCA)

“Cor Pulmonale” d/t lung disease

41
Q

___ leads to ___ HF, but ___ never leads to ___ HF

A

Left Right Right Left

42
Q

Effects of Right Heart Failure?

A
  1. Increased Pressure and Volume to the liver (leading to impaired liver function)
  2. Increased pressure in peritoneal vessels leading to leaking into the peritoneal cavity causing Ascites
  3. Increased capillary pressure leading to peripheral edema, and less perfusion occurring
43
Q

Manifestations of R Heart Failure?

A
  1. Pitting Edema (Sacrum, Feet, Legs)
  2. Pleural Effusions (d/t LHR)
  3. Jugular Venous Distention
  4. Early Satiety
  5. Respiratory system (d/t lung disease)
  6. Hepatomegaly, Ascites, Decreased Drug Metabolism (Distended Liver)
  7. Hypoalbuminemia d/t Hepatomegaly and decreased production
44
Q

Right sided heart failure with adventitious lung sounds means…

A

That it is due to lung disease

*Pure RHF does not have these sounds

45
Q

Most people end up with ____ failure

A

biventricular

46
Q

Biventricular Perfusion

A

Bilateral Ventricular Failure usually beginning with Left Sided Heart Failure

Has manifestations of both and leads to inability to perfuse body tissues

47
Q

Right HF leads to …

A

Blood going back into the body / staying there

48
Q

Left HF leads to …

A

Blood backing up into the lungs

49
Q

Biventricular HF leads to ..

A

blood moving forward and backing up with inadequate perfusion for the body

50
Q

Most common HF?

A

Biventricular Failure

51
Q

Systolic Dysfunction

A

Decreased contractility due to myocardium damage (usually from repeated MI)

Also called “Classic” Heart Failure

Failure from distention and thin ventricular walls leads to an extremely LOW EF

52
Q

HFrEF

A

Heart Failure reduced Ejection Fraction

new name for systolic dysfunction

53
Q

Typical Heart Failure

A

Systolic Dysfunction

54
Q

Diastolic Dysfunction

A

Newer concept

Chambers get hypertrophied NOT dilated, meaning a normal EF can occur, but in reality there was not enough blood in the small chamber to begin with

Normal silhouette on CXR and normal EF, but smaller chamber volume amount

55
Q

Diastolic Dysfunction is usually seen in ..

A

hypertrophic cardiomyopathies

56
Q

Who typically gets diastolic dysfunction?

A

Elderly women with HTN that go in and out of pulmonary edema quickly

57
Q

The problem with diastolic dysfunction is one of…

A

decreased compliance of the LV ; it does not fill well (with atrial contraction)

58
Q

Typical Ventricular ejection is ___ to ___ %

A

55 to 70 %

59
Q

Systolic Dysfunction is treated with …

A

a Diuretic (to get rid of volume)

60
Q

Diastolic Dysfunction is treated with …

A

Negative Chronotrope (to slow down the heart) and a Positive Inotrope (to get the best contraction possible)

61
Q

Cardiomyopathy

A

group of myocardial diseases that affect the pumping ability of the heart not caused by valve or coronary artery disease (usually muscle)

62
Q

Idiopathic Cardiomyopathy

A

no known origin

63
Q

Congestive or Dilated Cardiomyopathy

A

usually of unknown etiology, but may be associated with hyperthyroidism, ROHism, childbirth, DM, drug toxicity

64
Q

Restrictive Cardiomyopathy

A

amyloidosis, hemosiderosis (excess iron) - Myocardium becomes infiltrated with abnormal substances causing extensive fibrosis

65
Q

Hypertrophic Cardiomyopathy

A

also called “Idiopathic Hypertrophic Subaortic Stenosis”

Genetic abnormality of protein synthesis –> hypertrophy of septum causing obstruction of outflow of blood

66
Q

Hepatojugular Reflex (HJR)

A

Pressing on the liver and seeing that the jugular fills with blood - meaning there is liver edema

N351: Pathophysiology I (11 decks)

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