Systemic Effects of CVS Flashcards
What is the definition of cardiac failure?
- failure of heart to pump sufficient blood, deliver sufficient oxygen or satisfy metabolic demands
- results in under-perfusion which can cause fluid retention and increased blood volume
Describe acute heart failure
rapid onset of symptoms, often with definable cause
eg. MI
Describe chronic heart failure
slow onset of symptoms, associated with a disease such as ischaemic/valvular disease
Describe acute-on-chronic heart failure
chronic failure which becomes decompensated by an acute event
Describe systolic failure
- failure of pump to move blood in systole
- reduced ejection fraction
- reduced ventricular contraction
What are the causes of systolic failure?
- myocardial ischaemia/infarction/scarring
- myocarditis
- drugs
- muscular disorders
What are the effects of systolic failure?
- decreased CO
- feedback to atria and right side of heart
- pulmonary oedema then peripheral oedema
How would you treat systolic failure?
- supportive treatment unless there is an underlying cause you can treat/remove
- positive ionotrope/diuretics
Describe diastolic failure
- failure of ventricular wall to relax
- restrictive/stiff ventricle
- decreased ventricular filling, reduced blood
- elevated EDV
What causes diastolic failure?
- scarring
- same problems as systolic
- infiltrative disease
What are the effects of diastolic failure?
- none (can asymptomatic)
- pulmonary and peripheral oedema
- response to exercise (tachycardia, pulmonary acute oedema)
What is the treatment for diastolic failure?
reduce AV conduction
What are the primary effects of right heart failure?
- systemic effects
- blood coming through IVC and SVC backs up
- venous pressure increases
- fluid is pushed out venous system and not reabsorbed
- congestion
- ankle and sacral oedema
What are the primary effects of left heart failure?
- pulmonary effects
- backup of blood and increased pressure in pulmonary circulation
- can lead to right ventricular failure
- increased transudation and oedema in lung
What are the causes of left and right ventricular failure?
- coronary heart disease
- hypertension
- cardiomyopathies
- drugs
- toxins
- endocrine
- nutrition
- infiltrative
Describe the clinical effects of left ventricular failure
- pulmonary oedema
- dilated pulmonary vessels
- alveoli filled with fluid where gas exchange cannot take place
Describe the clinical effects of right ventricular failure
- nutmeg liver from backpressure in hepatic vein
- pitting oedema in feet and ankles
What is congestive cardiac failure?
left and right ventricular failure
Describe the clinical features of examination of a patient with heart failure
- decreased alertness, nutritional status and weight
- decreased rhythm and character of pulse
- high blood pressure
- fluid overload (jugular venous pressure)
- peripheral oedema
- crackles in lungs, tachycardia
- apex displacement, gallop rhythm, murmurs
What are the clinical features of forward failure?
- reduced perfusion of tissues
- more associated with advanced failure
What are the clinical features of backward failure?
- due to increased venous pressure
- dominated by fluid retention and tissue congestion
Describe the B-natiruretic protein
- stress response protein
- reduces volume in the body by peeing
- an increase in work in the heart increases BNP
- biomarker for level of heart failure
What effect does BNP have on the body?
- vessel dilatation
- natiruresis
- modulation angiotension and aldosterone
- reduction in BP
Describe the end-organ effects of systemic hypertension
- essential: slow changes in vessels and heart with chronic end-organ dysfunction
- malignant/accelerated: rapid changes in vessels with acute end-organ dysfunction
