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CVS > Session 9 > Flashcards

Session 9 Flashcards

1
Q

What is heart failure?

A

A state in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

Failure of the pump action of the heart

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2
Q

What is the primary cause of systolic heart failure?

A

ISCHAEMIC HEART DISEASE

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3
Q

Apart from ischaemic heart disease, what are some other causes of heart failure?

A 
Hypertension 
Dilated cardiomyopathy 
Valve disease
Pericardial disease
Arrhythmias - e.g. persistent tachycardia 
High-output heart failure
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4
Q

What happens in high-output heart failure?

A

Heart can’t keep up with the amount of cardiac output the body needs

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5
Q

How can arrhythmias (persistent tachycardia) cause heart failure?

A

Persistent tachycardia —> Changes in structure of the heart —> Failure of pump action —> Heart failure

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6
Q

How is heart failure progression classified by the NYHA functional classification?

A

Class I - Class IV

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7
Q

In which classes of the NYHA functional classification of heart failure is there no symptoms at rest?

A

Classes I-III (class IV may have symptoms at rest)

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8
Q

Heart failure is classified by the NYHA functional classification based on the occurrence/absence of symptoms due to different levels of…

A

Physical activity

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9
Q

What is the typical…

I) cardiac output 
II) stroke volume
III) LV ESV
IV) LV EDV 
V) Ejection fraction
A

5 litres/min

75 ml/beat

75 ml

150 ml

50% +

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10
Q

State 4 factors influencing cardiac output

A

Heart Rate
Venous Capacity (LV preload)
Aortic & Peripheral Impedance (afterload)
Myocardial Contractility

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11
Q

How can heart rate affect cardiac output?

A

Increasing heart rate, increases cardiac output up until a certain point

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12
Q

What functional and structural changes are seen in left ventricular systolic dysfunction?

A

Increased LV capacity —> Reduced LV cardiac output

Thinning of the myocardial wall (fibrosis/necrosis)
LV dilated

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13
Q

How can left ventricular systolic dysfunction affect the mitral valve?

A

LV dilation leads to cusps of valves being pulled apart and incompetence of the mitral valve

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14
Q

Describe the structural heart changes seen in heart failure (3)

A

Loss of muscle
Changes to the ECM (increased type III collagen)
Change of cell structure/function (e.g. Myocyte hypertrophy)

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15
Q

How can the structural heart changes seen in heart failure affect myocardial contraction?

A

Results in uncoordinated/abnormal myocardial contraction

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16
Q

Describe the ventricular remodelling that occurs in…

I) diastolic heart failure
II) systolic heart failure

A

Hypertrophied heart

Dilated heart

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17
Q

Describe the ventricular remodelling seen after acute infarction

A

Global remodelling and scarring to protect damaged areas

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18
Q

Describe the early role of the sympathetic nervous system (baroreceptor-mediated response) in heart failure

A

Works to improve cardiac output by increased contractility, HR (tachycardia) and arterial and venous vasoconstriction

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19
Q

What long term deleterious effects can activation of the sympathetic nervous system in heart failure have?

A

B-adrenoceptors become down-regulated/uncoupled
Noradrenaline induces cardiac hypertrophy, apoptosis and necrosis via a-adrenoreceptors
Noradrenaline induces up-regulation of the RAAS

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20
Q

State long term deleterious effects of activation of the sympathetic nervous system in heart failure, with regards to the increased noradrenaline levels

A

Induces cardiac hypertrophy, myocyte apoptosis, myocyte necrosis via a-adrenoreceptors

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21
Q

How can sympathetic nervous stimulation (in the long term) seen in heart failure affect the variability of the heart rate

A

Reduction in heart rate variability

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22
Q

Where is angiotensinogen produced?

A

Liver

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23
Q

Angiotensinogen is clever to _______________ by the action of __________

A

Angiotensin I

Renin

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24
Q

Angiotensin I is clever to __________________ by the action of ___________________

A

Angiotensin II

ACE - angiotensin converting enzyme

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25
Q

Angiotensin I and II can both be used to produce angiotensin III by the action of…

A

NEP

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26
Q

Angiotensin II carries out its effects via which receptors?

A 
AT1 receptors (type 1)
AT2 receptors (type 2)
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27
Q

Which receptors does angiotensin III act on?

A

Type 2 receptors

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28
Q

Which angiotensin II receptors lead to more beneficial effects for a patient?

A

Type 2 receptors

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29
Q

What effect can activation of the angiotensin II receptors have?

A

Vasodilator effect by increasing NO levels

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30
Q

Nitric oxide is a powerful _________________

A

Vasodilator

31
Q

Name three deleterious effects of angiotensin II binding to type 1 receptors

A

Vasoconstriction —> Increased afterload —> Decreased CO —> Stroke/Hypertension

LV hypertrophy —> Fibrosis/Remodelling —> HF/MI

Aldosterone release —> Increased salt/water retention —> Renal failure

32
Q

Angiotensin II results in the release of ____________ which results in increased salt/water retention

A

Aldosterone

33
Q

Why is the RAAS commonly activated in heart failure?

A

Reduced renal blood flow (perfusion pressure) in the kidneys

34
Q

Atrial natriuretic peptides respond to _________ due to increased ____________

A

Stretch

Volume

35
Q

What effect do natriuretic hormones have? (4)

A

Constricts afferent arterioles
VASODILATOR of efferent arterioles
Decreases Na+ reabsorption in the collecting duct
Inhibits secretion of renin/aldosterone

36
Q

Where is brain natriuretic peptide produced? Where is atrial natriuretic peptide produced?

A

Ventricular myocytes (in the brain also)

Atrial myocytes

37
Q

Natriuretic peptides work to lower the blood pressure and work carried out by the heart by reducing…

A

The volume of blood

38
Q

What can be used as a sensitive marker for heart failure?

A

Natriuretic hormones

39
Q

Name two things that can result in hyponatraemia (water in excess of Na+ retention) in normal conditions

A

Increased water intake (thirst)

Action of ADH on V2 receptors in collecting duct

40
Q

ADH acts on which receptors in which part of the kidney?

A

V2 receptors

Collecting duct

41
Q

Normally hyponatraemia _________ ADH release but ADH is ______________ in heart failure

A

Inhibits

Increased

42
Q

How can the increased ADH seen in heart failure affect water retention and cardiac output?

A

Increased water retention

Increased systemic resistance —> Reduced cardiac output

43
Q

Endothelial is secreted by…

A

Vascular endothelial cells

44
Q

What effects does endothelin released from vascular endothelial cells have?

By which mechanism does endothelin communicate with vascular endothelial cells?

A

VASOCONSTRICTOR effect

Autocrine activity
Activating the RAAS

45
Q

Describe the changes in levels of endothelin you may see in a patient with heart failure

A

Increased endothelin in HF

46
Q

What effect can prostaglandins E2 and I2 have? What are they stimulated by?

A

VASODILATORS on afferent renal arterioles

Noradrenaline/RAAS

47
Q

Nitric oxide is a potent ________________ produced by ________________ cells by the action of…

A

Vasodilator

Endothelial

Nitric oxide synthase

48
Q

How can NO synthase be affected in heart failure? What effect does this have?

A

Reduced activity in heart failure

Loss of vasodilation

49
Q

What does bradykinin promote? (2)

A

Natriuresis

Vasodilation

50
Q

Bradykinin stimulates the production of…

A

Prostaglandins

51
Q

Describe the levels of tumour necrosis factor seen in heart failure. What effect can these have on the heart?

A

Increased in HF

Represses myocardial function

52
Q

What symptom is a tell-tale sign of heart failure?

A

Oedema

53
Q

What is oedema?

A

Excessive volume of fluid within the tissues in the interstitium an intracellularly

54
Q

Net filtration pressure = …

A

Hydrostatic pressure - osmotic pressure

55
Q

How does heart failure affect net filtration pressure and cause oedema?

A

Increased capillary hydrostatic pressure —> Increased net filtration pressure

More fluid into the interstitium

56
Q

How is skeletal muscle blood flow affected in heart failure? What consequence can this have on skeletal muscle mass? What symptoms can this result in?

A

Reduced

Reduction in skeletal muscle mass

Fatigue
Exercise intolerance

57
Q

Diastolic HF is a less common form of heart failure. What is another name for it? In which patients is it more common?

A

Heart Failure with Preserved Ejection Fraction

Elderly + Women

58
Q

In diastolic heart failure there is ___________ LV function with ______________ remodelling

A

Normal

Concentric

59
Q

What happens in heart failure with preserved ejection fraction?

A

Reduced LV compliance and impaired myocardial relaxation. Impaired diastolic LV filling. LV filling becomes dependent on high LA pressure. RV dysfunction can result from high LA/PA pressure.

60
Q

What can result from the high LA/PA pressures seen in diastolic heart failure?

A

RV dysfunction

61
Q

In diastolic heart failure, LV filling becomes dependent on…

A

High LA pressure

62
Q

Describe what happens to cardiomyocytes in diastolic heart failure. What causes a reduced LV compliance in diastolic HF?

A

Thicker and shorter cardiomyocytes - impaired relaxation

Increased deposition of collagen

63
Q

In diastolic HF there is impaired…

A

Diastolic LV filling

64
Q

State 4 common symptoms of left sided heart failure

A 
Fatigue 
Exertional dyspnoea 
Orthopnea 
Paroxysmal nocturnal dyspnoea 
Tachycardia 
Cyanosis
65
Q

What is dyspnoea?

What is orthopnea?

What is paroxysmal nocturnal dyspnoea?

A

Shortness of breath

Shortness of breath when lying flat

Attacks of shortness of breath at night

66
Q

What is the name given to failure of both sides of the heart (ventricles)?

A

Biventricular (congestive) cardiac failure

67
Q

Describe the term given to heart failure due to…

I) ‘pump failure’
II) ‘failure of LV relaxation)

A

Left ventricular systolic dysfunction

Heart failure with preserved ejection fraction

68
Q

Right sided heart failure is often secondary to…

Can also result from…

A

Left sided heart failure

Chronic lung disease, PE, pulmonary hypertension

69
Q

Right sided heart failure results in fluid accumulation in areas drained by systemic veins. State some symptoms of RSHF.

A 
Fatigue 
Dyspnoea 
Nausea 
Anorexia 
Weight Gain 
DEPENDENT PITTING OEDEMA 
Enlarged liver/spleen 
Visible jugular vein
70
Q

What is heart failure?

A

Where the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

71
Q

What is chronic heart failure?

A

Clinical syndrome caused by abnormality of the heart and recognised by a characteristic pattern of renal, neural and hormonal responses

72
Q

Heart failure incidence is ______________ while prevalence is ____________

A

Decreasing

Increasing

73
Q

Give an example of a mineralocorticoid receptor antagonist. How do they work?

A

Spironolactone

Acts as a competitive inhibitor for aldosterone receptors

CVS (8 decks)

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