Systemic Effects of CVS

Question 1

What is the definition of cardiac failure?

Answer 1

• 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

Question 2

Describe acute heart failure

Answer 2

rapid onset of symptoms, often with definable cause

eg. MI

Question 3

Describe chronic heart failure

Answer 3

slow onset of symptoms, associated with a disease such as ischaemic/valvular disease

Question 4

Describe acute-on-chronic heart failure

Answer 4

chronic failure which becomes decompensated by an acute event

Question 5

Describe systolic failure

Answer 5

• failure of pump to move blood in systole
• reduced ejection fraction
• reduced ventricular contraction

Question 6

What are the causes of systolic failure?

Answer 6

• myocardial ischaemia/infarction/scarring
• myocarditis
• drugs
• muscular disorders

Question 7

What are the effects of systolic failure?

Answer 7

• decreased CO
• feedback to atria and right side of heart
• pulmonary oedema then peripheral oedema

Question 8

How would you treat systolic failure?

Answer 8

• supportive treatment unless there is an underlying cause you can treat/remove
• positive ionotrope/diuretics

Question 9

Describe diastolic failure

Answer 9

• failure of ventricular wall to relax
• restrictive/stiff ventricle
• decreased ventricular filling, reduced blood
• elevated EDV

Question 10

What causes diastolic failure?

Answer 10

• scarring
• same problems as systolic
• infiltrative disease

Question 11

What are the effects of diastolic failure?

Answer 11

• none (can asymptomatic)
• pulmonary and peripheral oedema
• response to exercise (tachycardia, pulmonary acute oedema)

Question 12

What is the treatment for diastolic failure?

Answer 12

reduce AV conduction

Question 13

What are the primary effects of right heart failure?

Answer 13

• 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

Question 14

What are the primary effects of left heart failure?

Answer 14

• pulmonary effects
• backup of blood and increased pressure in pulmonary circulation
• can lead to right ventricular failure
• increased transudation and oedema in lung

Question 15

What are the causes of left and right ventricular failure?

Answer 15

• coronary heart disease
• hypertension
• cardiomyopathies
• drugs
• toxins
• endocrine
• nutrition
• infiltrative

Question 16

Describe the clinical effects of left ventricular failure

Answer 16

• pulmonary oedema
• dilated pulmonary vessels
• alveoli filled with fluid where gas exchange cannot take place

Question 17

Describe the clinical effects of right ventricular failure

Answer 17

• nutmeg liver from backpressure in hepatic vein

- pitting oedema in feet and ankles

Question 18

What is congestive cardiac failure?

Answer 18

left and right ventricular failure

Question 19

Describe the clinical features of examination of a patient with heart failure

Answer 19

• 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

Question 20

What are the clinical features of forward failure?

Answer 20

• reduced perfusion of tissues

- more associated with advanced failure

Question 21

What are the clinical features of backward failure?

Answer 21

• due to increased venous pressure

- dominated by fluid retention and tissue congestion

Question 22

Describe the B-natiruretic protein

Answer 22

• 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

Question 23

What effect does BNP have on the body?

Answer 23

• vessel dilatation
• natiruresis
• modulation angiotension and aldosterone
• reduction in BP

Question 24

Describe the end-organ effects of systemic hypertension

Answer 24

• essential: slow changes in vessels and heart with chronic end-organ dysfunction
• malignant/accelerated: rapid changes in vessels with acute end-organ dysfunction

Question 25

What are the end organs?

Answer 25

• brain
• heart
• kidneys
• arteries
• eyes

Question 26

Describe the end organ changes of the heart

Answer 26

• left ventricular hypertrophy (fibrosis/arrhythmias)
• coronary artery atheroma (ischaemic heart disease)
• cardiac failure

Question 27

Describe the end organ changes of the kidney

Answer 27

• nephrosclerosis ( drop out of nephrons due to vascular narrowing/proteinuria/haematuria)
• chronic renal failure
• acute renal failure associated with malignant hypertension

Question 28

Describe the end organ changes of the brain

Answer 28

• atherosclerosis
• ischaemia
• TIA
• infarct
• haemorrhage

Question 29

Describe the end organ changes of the eyes

Answer 29

• haemorrhage
• papilloedema
• more dramatic/acute in malignant hypertension

Question 30

What are the causes of pulmonary hypertension?

Answer 30

• increased vascular pulmonary resistance
• diffuse lung disease eg. COPD
• elevated left atrial pressure
• recurrent pulmonary emboli
• primary pulmonary hypertension
• left right shunts

Question 31

Describe the end-organ effects of pulmonary hypertension

Answer 31

• pulmonary arteries
• heart
• treat underlying cause
• symptomatic relief