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Y2S1 CARDIO. > Systemic effects of cardiovascular disease > Flashcards

Systemic effects of cardiovascular disease Flashcards

1
Q

Define cardiac failure

A

Failure of the heart to pump sufficient
blood, and deliver sufficient oxygen, to satisfy
metabolic demands]resulting in under perfusion which may cause fluid retention and increased BV

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2
Q

• Acute heart failure

A

– rapid onset of symptoms, often with definable cause e.g. myocardial infarction

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3
Q

• Chronic heart failure

A

– slow onset of symptoms, associated with, for

example, ischaemic or valvular heart disease

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4
Q

• Acute-on-chronic heart failure

A

– chronic failure becomes decompensated by an acute event

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5
Q

Systolic failure

A
  • Failure of the pump to move blood in systole
  • Reduced ejection fraction
  • Reduced ventricular contraction
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6
Q

Systolic failure causes

A
  • Myocardial ischaemia
  • Myocardial infarction
  • Myocardial scarring
  • Myocarditis
  • Drugs eg alcohol, anti-cancer cytotoxics, cocaine
  • Muscular disorders eg DMD
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7
Q

systolic failure effects

A
  • Reduced cardiac output
  • Feedback to atria and right side of heart
  • Pulmonary oedema then
  • Peripheal oedema

support is used to treat

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8
Q

Diastolic failure

A
  • Failure of ventricular wall to relax
  • Restrictive, stiff ventricle
  • Reduced ventricular filling leads to reduced blood for systole •Elevated end diastolic pressure
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9
Q

causes of diastolic failure

A

•Scarring plus most causes of systolic •Infiltrative disease eg amyloid

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10
Q

effects of diastolic failure

A
  • None
  • Pulmonary and peripheral oedema •Response to exercise
  • Tachycardia and pulmonary acute oedema

treatment is to reduce the conduction of the AV node

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11
Q

right ventricular heart failure

A

effects the systemic

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12
Q

left ventricular heart failure

A

effects the pulmonary

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13
Q

Left ventricular failure

A
  • Particularly resulting from hypertensive and ischaemic heart failure
  • Causes pulmonary oedema, with associated
  • symptoms
  • Leads to pulmonary hypertension and, eventually, right ventricular failure
  • Combined left and right ventricular failure often called ‘congestive’ cardiac failure
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14
Q

Right ventricular failure common causes

A
  • Secondary to left ventricular failure
  • Related to intrinsic lung disease
  • ‘Cor pulmonale’ due to pulmonary hypertension
  • Primary pulmonary hypertension
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15
Q

Clinical features pf heart failure

A

• “Forward” failure
– Reduced perfusion of tissues
– Tends to be more associated with advanced failure
• “Backward” failure
– Due to increased venous pressures
– Dominated by fluid retention and tissue congestion

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16
Q

Key features of the clinical examination inpatients with heart failure

A

• Appearance -alertness, nutritional status, weight
• Pulse rate -rhythm, and character
• Blood pressure -systolic, diastolic, pulse
pressure
• Fluid overload -jugular venous pressure
• Peripheral oedema -(ankles and sacrum),
hepatomegaly, ascites
• Respiratory rate, crackles, effusion (transudate)
• Apex displacement, gallop rhythm, third heart sound, flow murmurs suggesting valvular dysfunction

17
Q

B-natriuretic protein

A

one of of the natriuretic peptide hormone family, produced by ventricular muscle. It is a stress response protein that increases in heart failure.

18
Q

other types of BNP

A
  • ANP produced in atrial muscle
  • CNP from large blood vessels
  • DNP present in blood probably originates from heart
19
Q

roles of BNP

A
  • Vessel dilatation
  • Natriuresis
  • Modulation angiotensin and aldosterone
  • Reduction in blood pressure
20
Q

Systemic hypertension

A

• Classification
– Primary vs secondary (based on cause)
– Benign vs malignant (based on clinical presentation)
– (be aware of the previous use of the term “essential” hypertension)

21
Q

definition of systemic hypertension

A

– Persistent raised blood pressure above 140/90 mmHg (Framingham,Multiple Risk Factor Intervention Trial –both suggest systolic pressure more important in determining cardiovascular risk)

22
Q

• Optimal BP

A

120/80 mm Hg
– Normal <130/<85 mm Hg
– High normal 130-139/85-89 mm Hg (labelled ‘pre- hypertension’ in the USA)

23
Q

• Hypertension and grades

A

– Mild hypertension Grade 1 140-159/90-99 mm Hg
– Moderate hypertension Grade 2 160-179/100-109 mm Hg
– Severe hypertension Grade 3 180/110 mm Hg

24
Q

• Isolated systolic hypertension

A

– Grade 1 140-159/<90 mm Hg

– Grade 2 160/<90 mm Hg

25
Q

Causes of secondary hypertension

A
  • Renal disease
  • Endocrine disease
  • Others
  • Drugs and toxins,
26
Q

Describe the end-organ effects of systemic hypertension - essential

A

• Slow changes in vessels and heart with chronic end-organ dysfunction

27
Q

Describe the end-organ effects of systemic hypertension - malignant/accelerated

A

• Rapid changes in vessels with acute end- organ dysfunction

28
Q

effects of systemic hypertension on the heart

A 
• Left ventricular hypertrophy
– Fibrosis
– Arrhythmias
• Coronary artery atheroma
– Ischaemic heart disease
• Cardiac failure
29
Q

effects of systemic hypertension on the kidney

A

• Nephrosclerosis
– Drop-out’ of nephrons due to vascular narrowing
– Proteinuria
– Haematuria
• Chronicrenalfailure
• Acuterenalfailure associated with malignant hypertension

30
Q

effects of systemic hypertension on the brain

A

Atherosclerosis Ischaemia and TIA Infarct Haemorrhage

31
Q

Describe the causes of pulmonary hypertension

A

• Increased pulmonary vascular resistance
• Diffuse lung disease, for example COPD
• Elevated left atrial pressure e.g. left ventricular failure, mitral valve stenosis
• Recurrent pulmonary emboli
• Primary pulmonary hypertension (unknown
cause) - genetics
• Left-right shunts e.g. ASD, VSD

32
Q

Describe the end-organ effects of pulmonary hypertension

A
  • Pulmonary arteries
  • Heart
  • Treat underlying cause, give symptomatic relief, transplant

Y2S1 CARDIO. (47 decks)

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