Systemic Effects of Cardiovascular Disease

Question 1

Define Cardiac Failure

Answer 1

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.

Question 2

Define Acute heart failure

Answer 2

Rapid onset of symptoms, often with definable cause like an MI

Question 3

Define chronic heart failure

Answer 3

Slow onset of symptoms, associated with ischaemic or valvular heart disease.

Question 4

Define Acute-on-chronic heart failure

Answer 4

Chronic failure becomes decompensated by an acute event

Question 5

Describe features of systolic cardiac failure

Answer 5

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.

Question 6

Describe features diastolic cardiac failure

Answer 6

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.

Question 7

What are some of the causes of left and right ventricular failure?

Answer 7

• 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

Question 8

What is Cachexia?

Answer 8

Extreme weight loss and muscle wasting due to chronic conditions like cancer

Question 9

Describe features of left ventricular failure

Answer 9

• Particularly results from hypertensive and ischaemic HF.

- Causes pulmonary oedema which can lead to pulmonary hypertension and eventually RV failure.

Question 10

What is congestive heart failure?

Answer 10

Combined left and right ventricular failure

Question 11

Describe features of right ventricular failure

Answer 11

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.

Question 12

What are the key features of clinical examinations of inpatients with heart failure?

Answer 12

• Appearance -Alertness, weight, nutritional status.
• Pulse rate -Rate and Rhythm.
• Fluid overload -JVP
• Peripheral oedema -Ascities and hepatomegaly.
• Resp rate

Question 13

Describe features of forwards and backwards failure

Answer 13

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.

Question 14

What is the B-natriuretic protein?

Answer 14

Hormone produced by ventricular muscle that occurs as a stress response protein which increases in HF

Question 15

What does BNP do?

Answer 15

Causes vessel dilation, natriuresis, modulation of angiotensin and aldosterone, reduction in BP

Question 16

Define hypertension?

Answer 16

Persistent raised blood pressure over 140/90mmHg

Question 17

Hypertension is a major risk factor for what?

Answer 17

CV disease, ischaemic HD, accelerated atherosclerosis, Alzheimer type dementia

Question 18

What are the causes of secondary hypertension?

Answer 18

• Renal disease (most common cause, eg, polyarteritis nodsa)
• Endocrine (eg, cushings disease)
• Others, such as coarctation or pre-eclampsia
• Drugs/toxins - Alcohol, liquorice

Question 19

Describe the effects of end-organ effects of systemic hypertension

Answer 19

Primary/essential - Slow changes in vessels and heart with chronic end-organ dysfunction.
Accelerated - Rapid changes in vessels with acute end-organ dysfunction.

Question 20

What is nephrosclerosis and what is it associated with?

Answer 20

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.

Question 21

What occurs in the brain due to hypertension?

Answer 21

Atherosclerosis, ischaemia, transient ischaemic attacks, infarction and haemorrhage.

Question 22

What are the causes of pulmonary hypertension?

Answer 22

Increased pulmonary vascular resistance, diffuse lung disease, elevated left atrial pressure, recurrent pulmonary emboli, primary pulmonary hypertension or left to right shunts (ASD, VSD)

Question 23

What are the end-organ effects due to pulmonary hypertension?

Answer 23

Atherosclerosis in pulmonary arteries which can cause thrombus and emboli, and heart issue

Question 24

Describe what thrombus is

Answer 24

Activation of blood coagulation within a vessel. Differs from clots as clots form extravascular

Question 25

What is an embolus?

Answer 25

Presence of anything in circulation that interferes with blood stream.

Question 26

What is Virchow’s triad

Answer 26

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.