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CVS A > Session 9 > Flashcards

Session 9 Flashcards

1
Q

Define heart failure

A

Chronic failure of the heart to provide sufficient output to meet the body’s requirements.

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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

What is the normal cardiac output?

A

5l/min

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4
Q

What is the normal stroke volume?

A

75ml/beat

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5
Q

What is the normal LV ESV?

A

75 ml

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6
Q

What is the normal LV EDV?

A

150 ml

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7
Q

What factors affect cardiac output?

A

Heart rate, LV preload, after load and myocardial contractility.

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8
Q

What is LV preload?

A

The same as venous capacity

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9
Q

What is after load?

A

Arctic and peripheral impedance

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10
Q

What pathophysiology is happening in heart failure?

A

The heart can no longer produce the same amount of force or cardiac output for a given level of filling.

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11
Q

Can heart failure occur on both sides?

A

Yes

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12
Q

In what situation can right sides heart failure occur on its own?

A

In the case of chronic lung disease

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13
Q

What is the most common cause of right sided heart failure?

A

Left sided heart failure

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14
Q

What is congestive heart failure?

A

This is when both ventricles of the heart are affected

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15
Q

What characterises left ventricular systolic dysfunction?

A

Dilation of the left ventricle and vasoconstriciton

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16
Q

Give some features of left ventricular systolic dysfunction

A

Inc LV capacity
Dec LV cardiac output
Thinning of the myocardial wall
Mitral valve incompetence

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17
Q

Describe some structural heart changes that occur in heart failure

A

Loss of muscle
Uncoordinated or abnormal myocardial contraction
Changes to ECM
Change of cellular structure and function

18
Q

What changes might occur to the ECM in heart failure?

A

Inc in collagen

Slippage of myocardial fibre orientation

19
Q

What cellulars structure and function changes might occur in heart failure?

A

Myocytolysis and vacuolation of cells. Myocyte hypertrophy. SR dysfunction and changes tot he calcium availability.

20
Q

What are the two main euro-hormonal systems involved with heart failure?

A

Sympathetic nervous system and RAAS

21
Q

Why are RAAS and he sympathetic nervous system activated in heart failure?

A

In order to try and help maintain cardiac output

22
Q

What are the main affects of the activation of the sympathetic nervous system?

A

Inc HR and contractility, Cause vasoconstriction and activate RAAS.

23
Q

How does heart failure cause activation of RAAS?

A

Drop in blood pressure (which happen in HF) stimulates renin release from the kidneys

24
Q

What does renin do?

A

It is an enzyme that catalyses the conversion of angiotensinogen to angiotensin I. Angiotensin I is converted to angiotensin II by the ACE enzyme.

25
Q

What effects does angiotensin II have?

A

Powerful vasoconstrictor that promotes release of aldosterone from adrenal cortex.

26
Q

What are the effects of aldosterone?

A

Causes salt and water retention in the kidneys hence increases blood volume

27
Q

Why are ACE inhibitors used in the treatment of heart failure?

A

Have an indirect vasodilatory and diuretic effect.

28
Q

What effects does nitric oxide have?

A

Potent vasodilator produced by endothelial cells vie NO synthase. NO syntheses may be blunted in HF therefore loss of vasodilation balance

29
Q

What effects do bradykinin have in heart failure?

A

Promotes natriuresis abd vasodilation. Also simulates the production of PGs

30
Q

What is oedema?

A

Oedema is the excessive volume of fluid within tissues

31
Q

What are the two types of oedema?

A

Interstitial or intracellular

32
Q

What type of oedema does left sided heart failure cause?

A

Pulmonary oedema

33
Q

What type of oedema does right sided heart failure cause?

A

Peripheral oedema

34
Q

What effect does heart failure have on vascular endothelium?

A

Increase in arterial peripheral resistance. Alterations in vascular tone exacerbate the clinical deterioration leading to skeletal muscle changes.

35
Q

What effects does heart failure have on skeletal muscle?

A

Reduced blood flow to skeletal muscle therefore reduction in skeletal muscle mass.

36
Q

What renal effects does early HF have?

A

GFR is maintained by haemodynamic changes at the glomerulus. Inc Na2+/H2O retention due to euro-hormonal activation

37
Q

What renal effects does severe HF have?

A

Renal blood flow falls leading to reduced GFR and a subsequent rise in serum urea and creatinine.

38
Q

What is heart failure with preserved ejection fraction?

A

This is when the amount of blood pumped from the heart’s left ventricle with each beat remains greater than 50%.

39
Q

Describe what is happening in HFpEF?

A

Normal LV function. Reduced LV compliance and impaired myocardial

40
Q

In clinical practice, what can heart failure be divided into?

A
  • Left sided heart failure
  • Right sided heart failure
  • Biventricular (congestive) HF
  • LVSD (pump failure)
  • HFpEF (failure of LV relaxation)
41
Q

What are the symptoms of left sided heart failure?

A

Fatigue, orthopnoae, tachycardia, cardiomegaly, pulmonary oedema

42
Q

What are the symptoms of right sided heart failure?

A

Fatigue, dyspnoea, anorexia, nausea, inc JVP, pitting oedema, ascites and pleural effusion

CVS A (18 decks)

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