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MD3001 > Systemic Effects of CVS Disease > Flashcards

Systemic Effects of CVS Disease Flashcards

1
Q

Define cardiac failure.

A

Failure of the heart to pump sufficient blood to satisfy metabolic demands, resulting in under-perfusion which causes fluid retention and increased blood volume.

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2
Q

Who is more likely to show symptoms of heart failure, an active person or a sedentary person who doesn’t exercise (assuming both do have cardiac failure) ? Explain why.

A

The active person is more likely to be symptomatic (because higher metabolic demands, more difficult for heart to pump sufficient blood to satisfy those).

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3
Q

Distinguish between acute, chronic and acute-on-chronic heart failures.

A

• Acute heart failure
– rapid onset of symptoms, often with definable cause e.g. myocardial infarction, ventricular septal defect

• Chronic heart failure
– slow onset of symptoms, associated with, for example, ischaemic or valvular heart disease. May be multiple causes.

• Acute-on-chronic heart failure
– chronic failure becomes decompensated by an acute event (e.g. chronic cardiac failure patients gets a further MI)

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4
Q

What is systolic cardiac failure ?

A

• Failure of the pump to move blood in systole (due to reduced ejection fraction and reduced ventricular contraction)

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5
Q

What are the causes of systolic cardiac failures ?

A
  • Myocardial ischaemia
  • Myocardial infarction
  • Myocardial scarring
  • Myocarditis
  • Drugs eg alcohol, anti-cancer cytotoxics, cocaine
  • Muscular disorders eg DMD
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6
Q

What are the effects of systolic cardiac failure ?

A
  • Reduced cardiac output
  • Feedback to atria and right side of heart (may start with L ventricular hypertrophy, but over time R ventricular hypertrophy due to probably backflow problem)
  • Pulmonary oedema (due to increased pulmonary pressure) then
  • Peripheal oedema (due to congestion of systemic capillaries)
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7
Q

Can systolic and diastolic cardiac failure coexist ?

A

Yes.

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8
Q

Is the fluid making up pulmonary and peripheral oedema in systolic cardiac failure exudate or transudate ? Why ?

A

The fluid making up pulmonary and peripheral oedema in systolic cardiac failure is transudate (if it were exudate, it would synonymous with inflammation, with protein leakage)

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9
Q

How do we treat systolic heart failure (what do we have to address) ?

A

Support

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10
Q

What is diastolic heart failure ?

A

Failure of ventricular wall to relax due to restrictive, stiff ventricle leading to reduced ventricular filling, reduced blood for systole and finally elevated end diastolic pressure.

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11
Q

What are the causes of diastolic heart failure ?

A
  • Scarring (fibrotic heart) plus most causes of systolic

* Infiltrative disease eg amyloid

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12
Q

What are the effects of diastolic heart failure ?

A
  • None
  • Pulmonary and peripheral oedema •Response to exercise (intolerance)
  • Tachycardia and pulmonary acute oedema
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13
Q

How do we treat diastolic heart failure (what do we have to address) ?

A

•Reduce AV conduction

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14
Q

What is another name for diastolic heart failure ?

A

Heart failure with preserved ejection fraction

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15
Q

Are the right ventricular failure’s effects primarily systemic or pulmonary ? the left ventricular failure’s effects ?

A
  • Right: Primary effects systemic

* Left: Primary effects pulmonary

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16
Q

Identify the the causes of left and right ventricular failure.

A

• CHD
• HYPERTENSION
• CARDIOMYOPATHIES: Familial/genetic or non-familial/non-genetic (including acquired, e.g. Myocarditis) Hypertrophic (HCM), dilated (DCM), restrictive (RCM), arrhythmogenic right ventricular (ARVC), unclassified
• DRUGS: beta-Blockers (if reduce hypertension to slow HR, heart function decreases, i.e. can be promoting cardiac failure), calcium antagonists, antiarrhythmics, cytotoxic agents
• TOXINS: Alcohol, medication, cocaine, trace elements (mercury, cobalt, arsenic)
• ENDOCRINE: Diabetes mellitus, hypo/hyperthyroidism, Cushing syndrome, adrenal insufficiency, excessive growth hormone, phaeochromocytoma
• NUTRITION: Deficiency of thiamine, selenium, carnitine. Obesity, cachexia
• INFILTRATIVE Sarcoidosis, amyloidosis, haemochromatosis, connective tissue
disease
• OTHERS Chagas’ disease, HIV infection, peripartum cardiomyopathy, end- stage renal failure

Left ventricular failure is particularly resulting from hypertensive and ischaemic heart failure

Right ventricular failure is particularly
caused by:
- Left ventricular failure
-Intrinsic lung disease
-‘Cor pulmonale’ due to pulmonary hypertension
-Primary pulmonary hypertension

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17
Q

Describe the clinical effects of left and right ventricular failure.

A

Left ventricular failure:

1) pulmonary edema, with associated symptoms (orthopnea, PND, cough with frothy sputum) + pulmonary hypertension and, eventually, right ventricular failure
2) activity intolerance and reduced tissue perfusion (also possibly high BP and cardiogenic shock) all due to reduced CO

Right ventricular failure:

1) peripheral edema/congestion
2) liver congestion
3) GI tract congestion

18
Q

Define congestive heart failure.

A

Both L and R ventricular failures.

19
Q

Describe the key features of the clinical examination in patients with heart failure (what do we have to look at ?).

A

• Appearance -alertness, nutritional status, weight, fatigue
• 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

20
Q

Define forward heart failure. What are its main consequences ?

A

a concept of heart failure emphasizing the inadequacy of cardiac output as the primary cause.
– Consequences: reduced perfusion of tissues

21
Q

Define backward heart failure. What are its main consequences ?

A

a concept of heart failure emphasizing the contribution of passive engorgement of the systemic venous system as a cause.
– Consequences: Fluid retention and tissue congestion

22
Q

Which of forward or backward heart failure is most associated with advanced failure ?

A

Forward failure tends to be more associated with advanced failure

23
Q

Define pulmonary and systemic hypertension.

A

Pulmonary: increased pressure in the pulmonary artery
Systemic: Persistent raised blood pressure above 140/90 mmHg (in systemic arteries)

24
Q

What may we classify systemic hypertension ?

A

– Primary vs secondary (based on cause)

– Benign vs malignant (based on clinical presentation)

25
Q

What is another name for primary, systemic hypertension ?

A

Essential hypertension

26
Q

What is hypertension a risk factor for ?

A

– Cardiovascular disease
– Ischaemic heart disease
– Accelerated atherosclerosis
– Alzheimer type dementia?

27
Q

What is the proportion of people aged 45-54 years have blood pressure (BP) that is at least 140/90 mm Hg ?

A

30%

28
Q

What is the proportion of people aged 75 years or older have BP that is at least 140/90 mm Hg ?

A

70%

29
Q

Define Isolated systolic hypertension. What are the classes of isolated systolic hypertension ?

A

Dystolic BP >140 mm Hg and diastolic BP <90 mm Hg

– Grade 1 140-159/<90 mm Hg
– Grade 2 160/<90 mm Hg

30
Q

What are the different classes of “normal” hypertension ?

A

– Optimal 120/80 mm Hg
– Normal <130/<85 mm Hg
– High normal 130-139/85-89 mm Hg (=pre-hypertension)

31
Q

What proportion of all systemic hypertension is idiopathic ? secondary ?

A
  • 90% primary/essential/idiopathic

* 10% secondary

32
Q

Distinguish between the end-organ effects of essential vs malignant/accelerated systemic hypertension.

A

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

Malignant/accelerated
• Rapid changes (destruction) in vessels with acute end- organ dysfunction

33
Q

Identify the end-organ effects of systemic hypertension on the heart.

A 
1) HEART
• Left ventricular hypertrophy
– Fibrosis
– Arrhythmias
• Coronary artery atheroma
– Ischaemic heart disease
• Cardiac failure
34
Q

Identify the end-organ effects of systemic hypertension on the kidney.

A

• Nephrosclerosis
– Drop-out’ of nephrons due to vascular narrowing
– Proteinuria
– Haematuria
• Chronic renal failure
• Acute renal failure (associated with malignant hypertension specifically)

35
Q

Identify the end-organ effects of systemic hypertension on the arteries.

A

• Acceleration of atherosclerosis
• Intimal proliferation and hyalinisation of
arteries and arterioles
• Malignant hypertension –fibrinoid necrosis

36
Q

Identify the end-organ effects of systemic hypertension on the brain.

A
  • Atherosclerosis
  • Ischaemia and Transient Ischemic Attack (TIA)
  • Infarct
  • Haemorrhage
37
Q

Identify the end-organ effects of systemic hypertension on the eyes.

A
  • Papilloedema
  • Flame hemorrhage
  • Cotton wool spots (“damage to nerve fibers”)
38
Q

What are the causes of pulmonary hypertension ?

A

• Primary pulmonary hypertension (unknown
cause) - genetics

  • Increased pulmonary vascular resistance
  • Diffuse lung disease (e.g. COPD)
  • Elevated left atrial pressure (e.g. left ventricular failure, mitral valve stenosis)
  • Recurrent pulmonary emboli
  • Left-right shunts (e.g. ASD, VSD)
39
Q

What are the causes of systemic hypertension ?

A

• Primary hypertension (idiopathic)

• Renal disease
– altered blood pressure control (altering renal function curve, so not generating as much urine as needed to get BP down. In the long term, desensitize what’s going on in medullary CV control center, allowing system to operate at a higher BP than normal)

• Diabetes
– damaged endothelium (leading to decrease in prod of NO and change in vascular reactivity)

• Endocrine disorders
– Cushing’s, Conn’s, phaeochromocytoma etc.

• Coarctation (narrowing) of the aorta

• Some drugs (Related to hormonal regulation which can feed in regulation of BP. That’s why must check patient’s current drugs before starting hypertension treatment)
– e.g. contraceptive pill, cocaine, amphetamine, NSAIDs, some herbal remedies

• Pregnancy
– eclampsia (convulsions); pre-eclampsia (elevated BP in pregnancy with proteinuria)

40
Q

Describe the end-organ effects of pulmonary hypertension.

A
  • Pulmonary arteries (possible atherosclerosis)

* Long term compromise of oxygenation and tissue perfusion (due to higher resistance)

MD3001 (75 decks)

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