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Cardiopulmonary > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

What is the most common cause of congestive heart failure?

A

-Cardiac Muscle Dysfunction

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2
Q

What does cardiac muscle dysfunction present with?

A

-impaired aerobic capacity and endurance, with cardiovascular pump dysfunction or failure

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3
Q

How does hypertension cause cardiac muscle dysfunction?

A

-increased arterial pressure leads to LV hypertrophy; leads to over stretched contractile fibers and an ineffective pump

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4
Q

What is the second most common cause of cardiac muscle dysfunction?

A

-Coronary Artery Disease

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5
Q

What can occur post CABG that can cause cardiac muscle dysfunction?

A

-post perfusion pump syndrome

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6
Q

Atrial fibrillation can cause what?

A

-Ventricular tachycardia

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7
Q

How can renal insufficiency cause cardiac muscle dysfunction?

A

-it can cause fluid overload= increase BP

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8
Q

What is the primary cause of cardiomyopathy that leads to cardiac muscle dysfunction?

A

-myocardium being replaced by fatty or scar tissue and beings to lose the ability to receive and transmit impulses

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9
Q

What protein is produced in bone marrow that can be deposited in the heart and lead to cardiomyopathy and eventually CMD?

A

-Amyloid

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10
Q

What type of cardiomyopathy referred to the myocardium being stretched causing it to pump ineffectively?

A

-Dilated cardiomyopathy

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11
Q

Dilated cardiomyopathy normally effects what heart chamber?

A

-The LV

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12
Q

Dilated cardiomyopathy also causes a decrease in what?

A

-Mitochondria

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13
Q

Dilated Cardiomyopathy will cause what two things to be elevated?

A

-End Diastolic volume and end diastolic pressure; further dilated the ventricle and decreasing contractility

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14
Q

Decreased energy associated with dilated cardiomyopathy causes what to be decreased?

A

-Stroke Volume (leads to increased HR to compensate)

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15
Q

Excessive nonfunctional cardiac muscle associated with a hypertophic cardiomyopathy can cause what dysfunction?

A

-stiffening of valves

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16
Q

What type of cardiomyopathy is associated with decreased myocardial compliance and decreased stretching of the myocardium leading to decreased end dialstolic volume?

A

-Restrictive Cardiomyopathy

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17
Q

A blocked valve will cause the heart to do what?

A

-Contract more forcefully

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18
Q

Heart valve dysfunctions are associated with what two types of cardiomyopathy?

A

-dilation and hypertrophy

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19
Q

Cardiac tamponade can cause elevated intracardiac pressures causing what?

A

-limited diastolic filling and causes a reduced stroke volume

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20
Q

What can pericarditic cause?

A

-Percardial effusion (elevated fluid levels in the pericardial sac)

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21
Q

What can cause CMD in the right ventricle?

A

-Pulmonary embolism

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22
Q

How can a pulmonary embolism cause CMD of the right ventricle?

A

-IT increased pulmonary pressures, and overworks the RV

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23
Q

Pulmonary pressures greater than what is considered hypertensive?

A

-25 mmHg

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24
Q

For COPD patients, pulmonary pressures greater than what are considered hypertensive?

A

-20 mmHG

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25
Q

Increased pulmonary pressures lead to what?

A

-RV hypertrophy

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26
Q

Spinal cord injuries to what segment typically cause CMD?

A

-Cervical

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27
Q

Why do C-spine SCIs cause CMD?

A

-It can cause an imblanace in sympathetic and parasympathetic stimulation

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28
Q

What are the two most common congenital heart abnormalities?

A

-bicuspid valve abnormality, and leaflet abnormalities associated with mitral valve prolapse

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29
Q

Who does aging cause a decreased cardiac output?

A

-altering contraction and relaxation of cardiac muscle

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30
Q

Decreased vascular elasticity associated with aging will have what effect on the cardiovascular system?

A

-Increased BP

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31
Q

LV hypertrophy associated with aging have what effect on the heart?

A

-Decreased ventricular compliance

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32
Q

Decreased adrenergic responsiveness associated with aging will have what effect on the cardiovascular system?

A

-Decreased exercise HR

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33
Q

Decreases in the rate of calcium pumped by the sarcoplasmic reticulum associated with aging will have what effect on the heart?

A

-Prolonged times for relaxation

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34
Q

Prolonged time to peak contraction force of cardiac muscle contraction associated with aging will have what effect on the heart?

A

-Prolonged times of contraction

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35
Q

Decreased myocardial twitch force associated with aging will have what effect on the myocardium?

A

-reduction in contraction velocity

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36
Q

Decreased rate of ATPase hydrolysis associated with aging will have what effect on the myocardium?

A

-Reduction in shortening velocity

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37
Q

Decreased myosin ATPase activity associated with aging will have what effect on the myocardium?

A

-reduction in shortening velocity

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38
Q

Diastolic dysfunction associated with aging will have what effect on the heart?

A

-impaired ventricular filling with potential to increase cardiac preload and CHF

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39
Q

Decreased lean body mass associated with aging can cause what effects on the cardiovascular system?

A

-decreased muscle strength and peak oxygen consumption

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40
Q

What is the most common manifestation of heart failure?

A

-Pulmonary edema

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41
Q

What is the most common cause of pulmonary edema?

A

-LV failure

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42
Q

How can Heart failure affect the brain?

A

-It will increase sympathetic stimulation

43
Q

How can heart failure effect the liver?

A

-it can cause hypoperfusion and venous congestion-leading to cirrhosis

44
Q

Heart failure can cause what dysfunction in the MSK system?

A

-atrophy (it decreased nutrition and ultimately a reduction in exercise tolerance

45
Q

What 7 things effect the stretch of cardiac muscle (frank starling mechanism)?

A
  • Atrial contribution to ventricular filling
  • Total blood volume
  • body position
  • intrathoracic pressure
  • intrapericardial pressure
  • venous tone
  • pumping action of skeletal muscle
46
Q

What two chemicals are release fom arterial and cardiac myocytes in response to stretch?

A

-ANP and BNP

47
Q

What are the effects of ANP and BNP?

A

-they decrease chemicals to reduce fluid volume

48
Q

Increased levels of BNP are associated with what 3 conditions?

A

-Heart disease, heart failure, and acute coronary syndrome

49
Q

ANP produced by atrial stretch receptors reaches the kidneys to have what effect?

A

-Increases diureses to decrease fluid volume

50
Q

Decreased in CO increase sympathetic stimulation, this activates the RAS system to increase production of what?

A

-ADH

51
Q

The activation of the RAS system will lead to what changes?

A

-increased ADH which inturn increases venous return and increases preload (produces greater CO)

52
Q

What negative effects can an increase of ADH cause?

A

-An increase of peripheral edema

53
Q

Pulmonary dysfunction can stem from what two sources?

A

-Cardiogenic or noncardiogenic

54
Q

What occurs in stage I of LV failure that cuases pulmonary edema?

A

-intersitial edema results from elevated capillary pressures (13-18 mmHg), which forces fluid plasme into the interstitial area

55
Q

What occurs in stage two pulmonary edema caused by LV failure?

A

-early alveolar edema occurs when capillary hydrostatic pressure is significantly elevated (18-28 mmHg), causing fluid to cross the alveolar membrane

56
Q

in stage III pulomnary edema caused by LV failure, what occurs?

A

-Complete alveolar flood occurs when pressure reach > 28 mmHGm and can possibly flood large airways

57
Q

What capillary pressures are associated with stage I pulmonary edema?

A

-13-18 mmHg

58
Q

What capillary pressures are associated with stage II pulmonary edema?

A

-18-28 mmHg

59
Q

What capillary pressures are associated with stage III pulmonary edema?

A

->28 mmHg

60
Q

Alpha-1 adrenergic receptors have what effects on the heart?

A

-Increase ionotrophic effects (increased contractility)

61
Q

Alpha 2 adrenergic receptors activate the inhibitory G protein that has what effects on the heart?

A

-Decrease ionotrophic effects (decreased contractility)

62
Q

Beta-1 adrenergic receptors have what effects on the heart?

A
  • stimulates increased HR and contractility
63
Q

Beta-2 adrenergic receptors have what effects on the cardiopulmonary system?

A

-promotes vasodilation and muscle relaxation of bronchial tracts

64
Q

What G protein sends stimulatory signals to the catalytic unit to increased myocardial contraction?

A

-Gs

65
Q

What G protein sends inhibitory signals to the catalytic unit to decreased myocardial contraction?

A

-G1

66
Q

What is the catalytic unit made of?

A

-Adenylate cyclase

67
Q

What sympathetic complex begins to fail with CHF?

A

-RCG complex

68
Q

Why does the RCG complex begin to fail with CHF?

A

-because of insensitivity of the heart to beta adrenergic stimulation

69
Q

What hematological conditions can CHF cause?

A

-Polycythemia, anemia, hemostasis or thrombocytopenia

70
Q

CHF patients without myopathy tend to have a decrease in what?

A

-Average diameter of type I and type II muscle fibers

71
Q

CHF patients with myopathy tend to experience what?

A

-type I and type II muscle fiber atrophy

72
Q

CHF patients may see a decrease in what up to 50%?

A

-Isometric maximal muscle strength

73
Q

What pancreatic functions can be compromised due to CHF?

A
  • reduced blood flow to panreas
  • impairs insulin secretion and causes glucose intolerance
  • Increased Acetyl-CoA
74
Q

Abnormalities in sympathetic neural function can cause dysfunction of the stomach and intestines causing what?

A

-Malnutrition and anorexia

75
Q

Patients with CHF may see what 3 blood abnormalities?

A
  • Decreased production of erythropoietin
  • decreased synthesis of 1,25-dihydroxyxholecalciferol
  • impaired intermediary metabolism
76
Q

What is the definition of CHF?

A

-a chronic, progressive condition affecting the ability of the heart to pump the blood and maintain adequate circulation of blood in the tissues resulting in heart failure

77
Q

What type of heart failure causes inefficient ejection of blood?

A

-Systolic heart failure

78
Q

What 2 things will systolic heart failure decrease?

A

-stroke volume and ejection fraction

79
Q

What will systolic heart failure increase?

A

-systolic volume

80
Q

Systolic heart failure leads to heart failure with what?

A

-reduced ejection fraction

81
Q

What type of heart failure impairs the ability of the heart to receive blood?

A

-Diastolic heart failure

82
Q

Diastolic heart failure leads to impairments in what two ventricular functions?

A

-filling and relaxation

83
Q

Diastolic heart failure leads to a rise in what?

A

-Diastolic pressure

84
Q

Daistolic heart failure leads to heart failure with preserved what?

A

-Ejection fraction

85
Q

What are some symptoms of left sided heart failure?

A

-dyspnes, dry cough, pulmonary rales, enlarged heart, pleural effusion, peripheral cyanosis, increased respiration

86
Q

Right sided heart failure will have what symptoms?

A

-Edema, bloating, increased central venous pressure, liver/spleen enlargement, peripheral cyanosis, increased right arterial pressure, peripheral effects

87
Q

Why does CHF cuase dyspnea?

A

-it cuases poor gas transport

88
Q

How can you combat orthopnea associated with CHF?

A

-Elevated the upper body while sleeping

89
Q

What heart sound is seen with CHF?

A

-S3

90
Q

What causes the S3 heart sound?

A

-a non-compliant left ventricle

91
Q

A 6 minute walk test score of less that 468 indicates what?

A

-poor short term survival

92
Q

What responses to exercises may we see with a patient with CMD or CHF?

A
  • rapid rise in HR with submaxive exercise
  • lower peak O2 consumption
  • decreased rise in systolic BP in response to exercise
  • Possible increased DPN
  • easily provoked Dyspnea, fatigue and possible angina
  • lower maximal workload
  • increased HR and contractility
93
Q

What outcome measure can be used to assess quality of life of patient with CHF?

A

-Minnesota living with HF questionnaire

94
Q

What condition is commonly associated with functional decline?

A

-depression

95
Q

What might we see in the lab results with a CHF patient?

A

-proteinuria, elevated unrine specific gravity, BUN, creatine levels, and decreased erythrocyte sedimentation rate

96
Q

What liver enzymes may be elevated in CHF patients?

A

-AST and bilirubin

97
Q

What will CHF do to PaO2 and O2 saturation?

A

-Decrease it

98
Q

What will CHf do to PaCO2 levels?

A

-increase it

99
Q

What radiologic rindings may you see in a CHF patient?

A

-Large heart, presence of pulmonary edema

100
Q

What dietary changes may be made for a CHF patient?

A

-Decreasing sodium and fluid intake

101
Q

When is a ICD implant indicated for a CHF patient?

A

-When EF is less than or equal to 35% and when mild to moderate symptoms are present

102
Q

What type of breathing techniques facilitate improved exercise tolerance?

A

-Diaphragmatic breathing

103
Q

what should you educate a CHF patient on?

A

-energy prevention

Cardiopulmonary (7 decks)

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