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BSMS 103 > T3 - Heart failure > Flashcards

T3 - Heart failure Flashcards

1
Q

what is heart failure the impaired ability of?

A

ventricular ejection (systolic) and filling (diastolic)

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2
Q

what is the CO equation?

A

CO = HR x SV

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3
Q

what is stroke volume?

A

amount of blood pumped out the LV per beat

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4
Q

what is something that would increase preload?

A

increased blood volume and vasoconstriction

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5
Q

what is something that would decrease preload?

A

vasodilation and decreased blood volume

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6
Q

what is pre load?

A

pressure the heart is under before it contracts (volume of blood stretching the cardiomyocytes at the end of diastole)

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7
Q

what is after load

A

resistance the heart must work against to eject blood

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8
Q

in what situation will there be a decreased CO even though HR is high and why?

A

arrhythmia

- not enough time for ventricular filling therefore decreased stroke volume and cardiac output

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9
Q

what describes the relationship between preload and CO?

A

frank starling law

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10
Q

describe how a large increase in preload can decrease cardiac output

A

cardiomyocytes can be too much which reduces in less contraction and therefore less cardiac output and less stroke volume

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11
Q

what is high output heart failure?

A

heart function is normal but cant meet high body demands (due to a medical condition)

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12
Q

what can cause high output heart failure?

A

thyrotoxicosis (lots of thyroid hormones), anaemia, pregnancy, pagers disease, acromegaly, sepsis

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13
Q

what are the two types of low output heart failure?

A

systolic and diastolic

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14
Q

what is systolic heart failure and what are the three main causes?

A

progressive deterioration of myocardial function

- caused by ischaemic injury, volume overload and pressure overload

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15
Q

what is diastolic heart failure?

A

inability of the chamber to relax or expand and fill during diastole to reach an adequate blood volume

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16
Q

what type of heart failure has a normal ejection fraction but cant fill properly?

A

low output diastolic heart failure

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17
Q

what are four causes of diastolic heart failure?

A

LV hypertrophy, infiltrative disorders, constrictive pericarditis, restrictive cardiomyopathies

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18
Q

give five broad causes of heart failure

A

coronary heart disease, hypertensive heart disease, valvular heart disease, myocardial disease/cardiomyopathy or congenital heart disease

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19
Q

what is a cardiomyopathy?

A

diffuse disease of heart muscle that leads to functional impairment

20
Q

how is cardiomyopathy characterised?

A
  • heart muscle of stretched, thick or stiff

- dilated hypertrophic or restrictive

21
Q

what proportion of dilated cardiomyopathies are familial and what does this cause?

A

50% are familial and this triggers T cell mediated inflammation in the heart

22
Q

what type of cardiomyopathy can myocarditis cause?

A

dilated CM

23
Q

what type of cardiomyopathy is caused by amyloid and what does this result in?

A

restrictive CM

- results in stiff walls and impaired filling

24
Q

what are the three compensation mechanisms in HF that maintain arterial pressure and perfusion to organs?

A

1) frank starling - vasoconstriction to increase venous return therefore increasing preload, stretch and FOC
2) myocardial structure change - hypertrophy
3) neurohumoral system - NA release increases HR and FOC, atrial and B type naturietic peptide increase HR as well as activating RAAS

25
Q

what stimulates activation of the RAAS?

A

low CO and therefore low BP

26
Q

what does activation of the RAAS cause?

A
  • increased sympathetic input

- increased aldosterone which therefore increases Na+ retention and vasoconstriction - not good in HF

27
Q

what three compensatory mechanisms from a normal healthy heart can worsen HF?

A
  • vasoconstriction - increases resistance heart pumps against therefore increasing after load and decreasing CO
  • Na/H20 retention (via aldosterone) - increase in fluid volume increases preload which increases stretch in the heart which decreases FOC and CO
  • tachycardia - decreases diastolic filling time therefore decreased ventricular filling therefore reducing SV and CO
28
Q

what does pressure overload cause?

A
  • concentric left ventricular hypertrophy
  • stretched muscle therefore decreased cavity diameter
  • thick walls and lower atrial/ventricular volume
29
Q

what does volume overload cause?

A
  • chamber dilation with increased ventricular pressure
  • deposition of new sarcomeres with increased length and width
  • very dilated ventricles with thin muscular walls but increased muscle mass in proportion to chamber diameter
30
Q

what causes pressure overload?

A

high blood pressure or aortic stenosis

31
Q

what causes volume overload?

A

mitral or aortic regurgitation

32
Q

what three ways can heart failure be categorised?

A
  • which side (L, R or biventricular)
  • acute or chronic
  • compensated (handle compensation mechanisms with treatment) or decompensated (previously compensated now unwell again)
33
Q

where does the back up of blood come from that causes LHS HF and where does this cause congestion?

A

back up of blood from LA which goes back into pulmonary circulation causing congestion in the lungs

34
Q

what are four causes of LS HF?

A

iscahemic heart disease, valvular heart disease, hypertension and myocardial disease

35
Q

what does pulmonary congestion due to LSHF result in (O2 diffusion distance)?

A

increased O2 diffusion distance, harder to breathe and wet lungs

36
Q

what are the symptoms of wet lungs due to LSHF?

A

dyspnoea on exertion, orthopnea (relieved by sitting or standing), paroxysmal nocturnal dyspnoea

37
Q

what effect does LSHF have on the kidneys?

A

lower CO means lower renal perfusion which causes activation of RAAS

  • increased aldosterone and Na+ retention
  • increased blood volume and interstitial fluid
38
Q

what are the brain symptoms from LSHF?

A
  • less specific
  • hypoxic encephalopathy (brain injury due to O2 deprivation)
  • irritability/attention loss
  • restlessness
  • coma
39
Q

what is the main cause of RSHF?

A

LSHF (congestive)

40
Q

what is cor pulmonale and what causes it?

A

enlargement of the RHS of the heart due to lung disease

- often caused by respiratory disease eg COPD or PE

41
Q

apart from cor pulmonale, what are two other causes of RSHF?

A

valvular heart disease and congenital heart disease

42
Q

what effect does RSHF have on the

i) liver
ii) spleen
iii) abdomen
iv) subcutaneous tissue
v) pleura and pericardium

A 
I) congestive hepatomegaly, lobar necrosis and cardiac cirrhosis
ii) congestive splenomegaly 
iii) ascites
iv) oedema
v) effusions
(anything with lots of fluid)
43
Q

what are the two causes of biventricular heart failure?

A

1) same pathological process on each side of the heart

2) as a consequence of LSHF - volume overload in the pulmonary circulation which causes RSHF

44
Q

what is the clinical presentation of biventricular HF?

A
  • excess fluid accumulation (dyspnoea, orthopnea, oedema, ascites)
  • reduced CO causing fatigue and weakness
45
Q

what are 10 clinical signs of HF

A
  • cool/pale/cyanotic extremities
  • tachycardia due to increased sympathetic activity
  • elevated JVP
  • 3rd heart sound (galloping)
  • displaced apex due to LV enlargement
  • crackles or decreased breath sounds
  • ascities
  • peripheral oedema
  • hepatomegaly
46
Q

what can be measured when testing for HF?

A

NT-pro BMP levels - if normal it probably isn’t HF

BSMS 103 (23 decks)

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