Systemic Effects of Cardiovascular Disease Flashcards
Define Cardiac Failure
Failure of heart to pump sufficient blood and deliver sufficient oxygen to satisfy metabolic demands. This results in under-perfusion which may cause fluid retention and increased blood volume.
Define Acute heart failure
Rapid onset of symptoms, often with definable cause like an MI
Define chronic heart failure
Slow onset of symptoms, associated with ischaemic or valvular heart disease.
Define Acute-on-chronic heart failure
Chronic failure becomes decompensated by an acute event
Describe features of systolic cardiac failure
Reduced systolic fraction and reduced ventricular contraction resulting in failure to pump blood in systole. This leads to reduced CO, pulmonary and peripheral oedema. Caused by myocardial ischaemia, infarction or scarring, myocarditis or drugs.
Describe features diastolic cardiac failure
Caused by failure of ventricular wall to relax leading to reduced ventricular filling leading to reduced blood for systole. It causes pulmonary and peripheral oedema and tachycardia when exercising. It is caused by scarring and similar causes that cause systolic failure. Also caused by infiltrative disease.
What are some of the causes of left and right ventricular failure?
- Coronary heart disease,
- Hypertension,
- Cardiomyopathies (congenital or acquired),
- Drugs (BBs, cocaine),
- Toxins
- Endocrine (eg, diabetes mellitus)
- Nutritional (eg, obesity)
- Infiltrative (eg, sarcoidosis or amyloidosis)
- Others such as infections, end-stage renal failure etc
What is Cachexia?
Extreme weight loss and muscle wasting due to chronic conditions like cancer
Describe features of left ventricular failure
- Particularly results from hypertensive and ischaemic HF.
- Causes pulmonary oedema which can lead to pulmonary hypertension and eventually RV failure.
What is congestive heart failure?
Combined left and right ventricular failure
Describe features of right ventricular failure
Caused by; LV failure, lung disease, pulmonary hypertension and can cause pitting oedema, and congestion in the liver as there is pooling of blood in hepatic vein.
What are the key features of clinical examinations of inpatients with heart failure?
- Appearance -Alertness, weight, nutritional status.
- Pulse rate -Rate and Rhythm.
- Fluid overload -JVP
- Peripheral oedema -Ascities and hepatomegaly.
- Resp rate
Describe features of forwards and backwards failure
Forwards - Reduced perfusion of tissues and tends to be associated with more advanced failure.
Backwards - Due to increased venous pressure caused by fluid retention and fluid congestion.
What is the B-natriuretic protein?
Hormone produced by ventricular muscle that occurs as a stress response protein which increases in HF
What does BNP do?
Causes vessel dilation, natriuresis, modulation of angiotensin and aldosterone, reduction in BP
Define hypertension?
Persistent raised blood pressure over 140/90mmHg
Hypertension is a major risk factor for what?
CV disease, ischaemic HD, accelerated atherosclerosis, Alzheimer type dementia
What are the causes of secondary hypertension?
- Renal disease (most common cause, eg, polyarteritis nodsa)
- Endocrine (eg, cushings disease)
- Others, such as coarctation or pre-eclampsia
- Drugs/toxins - Alcohol, liquorice
Describe the effects of end-organ effects of systemic hypertension
Primary/essential - Slow changes in vessels and heart with chronic end-organ dysfunction.
Accelerated - Rapid changes in vessels with acute end-organ dysfunction.
What is nephrosclerosis and what is it associated with?
It is hardening of vessel walls of small arteries and arterioles which can cause proteinuria or haematuria. Associated with chronic renal failure or acute renal failure with accelerated hypertension.
What occurs in the brain due to hypertension?
Atherosclerosis, ischaemia, transient ischaemic attacks, infarction and haemorrhage.
What are the causes of pulmonary hypertension?
Increased pulmonary vascular resistance, diffuse lung disease, elevated left atrial pressure, recurrent pulmonary emboli, primary pulmonary hypertension or left to right shunts (ASD, VSD)
What are the end-organ effects due to pulmonary hypertension?
Atherosclerosis in pulmonary arteries which can cause thrombus and emboli, and heart issue
Describe what thrombus is
Activation of blood coagulation within a vessel. Differs from clots as clots form extravascular
What is an embolus?
Presence of anything in circulation that interferes with blood stream.
What is Virchow’s triad
3 factors that are critically important in the development of venous thrombosis:
1) Alteration of vessel wall.
2) Alteration of blood flow.
3) Altered coagulability of blood.
