Unit 2_Heart Failure Flashcards
What can the following result in:
- Coronary artery disease (CAD) – “progressive atherosclerosis”
- Post myocardial infarction
- Intrinsic muscle disease
- Increased pressure/volume load
1. Hypertension
2. Valvular disease
Heart failure
What heart failure etiology is caused by:
1. Post myocardial infarction
- Heart muscle is damaged, which in turn has a negative impact on pumping function.
- Necrotic muscle tissue is replaced by scar tissue and no longer contributes to ejection of blood.
2. Intrinsic muscle disease - myocarditis, cardiomyopathy
- Coxsackievirus, bacteria, genetic, alcohol or drug induced, Idiopathic
Decrease in myocardial capacity (loss of ability to maintain cardiac output)
What heart failure etiology is caused by:
1. Hypertensive cardiovascular disease
- Increased resistance to blood flow.
- Results from :
+ Diffuse or localized vessel narrowing
+ Fluid retention
Requires an increased Driving Pressure – “the heart has to work harder to pump blood into the systemic and/or pulmonary circulation”.
- Valvular disease
- Changes in valve integrity effects the hearts efficiency in maintaining pressure gradients.
Increased (peripheral) pressure/volume (increased “load” on the heart to maintain cardiac output)
What disease can be:
1. Acquired (example Rheumatic fever)
2. Chronic (in response to CVD mechanisms of chronic inflation)
3. Genetic/Congenital
Often classified as:
A. Stenosis
B. Insufficiency
Valvular Disease
What valvular disease starts out as:
Group A Beta Hemolytic Streptococcal bacteria –> Bacteremia Antigen-Antibody Complexes –> Vegetations on Heart Valves –> Infective Endocarditis –> Calcification and Valve Scarring
Rheumatic Fever
What disease appears via the following signs/symptoms:
- Murmur
- Palpitations
- Tachycardia
- Shortness of Breath
A clinical exam is conducted via a Echocardiogram.
This disease is fairly common and does not typically result in serious complications.
Mitral Valve Prolapse
What demonstrates that increased contractility
(and resulting end diastolic volume in the left ventricle)
will result in higher performance (cardiac output)?
Contractility is lost with heart failure.
Results in a loss of stroke volume and subsequent cardiac output (“decompensated Starling curve”).
Frank-Starling Curve
Loss of contractility is due to _______ ventricular size
increased
Why can ventricular size increase?
- Hypertrophy
- Dilation –> dilated cardiomyopathy
What is the Adaptation to decrease in myocardial capacity?
Causes include:
1. Myocarditis - “Inflammation of the myocardium”. Potential Causes:
- Viral or bacterial infection
- Radiation treatment for a malignancy
- Sarcoidosis – inflammatory disorder
- Systemic Lupus erythmatosus (SLE) -autoimmune disorder
- Drugs (examples – lithium, cocaine)
2. Myocardial infarction
Both cases result in a loss of contractility due to changes in the cardiac muscle tissue.
ventricular hypertrophy or dilation
What are the two rating scales of classifying heart failure?
New York Heart Association
American Heart Association
What class of heart failure includes patient symptoms of:
- Class I (Mild): ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea
- Class II (Mild): slight limitation of physical activity
- Class III (Moderate): marked limitation of physical activity
- Class IV (Severe): Symptoms of cardiac insufficiency at rest
New York Heart Association
What class of heart failure includes patient symptoms of:
- A: High risk of developing HF (underlying causes)
- B: Structural heart deficits without marked limitations in activity
- C: Advanced structural changes
- D: Advanced structural changes
AHA comparison
What side of heart failure includes increased congestion?
Left Side Heart Failure
What side of heart failure includes decreased perfusion?
Right Side Heart Failure
What side heart failure includes the following:
Acute MI – left ventricle
Systemic hypertension
Mitral or Aortic Valvular Disease
Coarctation of the aorta
Left side heart failure
What is known as when a section of the aorta is narrower than the rest?
Congenital coarctation of the aorta
What results in increased pressure and can trigger cardiomyopathy?
coarctation of the aorta
What are the following clinical pulmonary signs and symptoms of?
Passive congestion
Pulmonary edema
Orthopnea
Paroxysmal Nocturnal Dyspnea
Left side heart failure
What are the following clinical renal signs and symptoms of?
Decreased renal perfusion
Sodium and Water Retention
Physiology: Renin-Angiotension-Aldosterone system
Decreased blood pressure results in the kidneys release of renin which triggers:
Angiotension – vasoconstriction
Aldosterone – water retention
Results in:
Hypertension hypotension
Anasarca
Pedal edema (Pitting)
Facial edema
Left side heart failure
What are the following clinical signs and symptoms of?
Pulsus Alterans (alternating strong and weak pulse beats)
Fever and Pallor
Cardiac Cachexia
Third Heart Sound
“lub-dub-dub”
S3 is the sound of an early mitral valve opening and blood entering the ventricle
Left side heart failure
What side heart failure includes:
Acute MI - Right Ventricle
Pulmonary hypertension
Tricuspid/Pulmonic Valvular Disease
Pulmonary Artery Stenosis
- Congenital
Pulmonary hypertension can lead to cor pulmonale
Right Side Heart Failure
What are the following clinical pulmonary signs and symptoms of?
Increased pulmonary vascular resistance – High incidence of COPD
No Pulmonary Edema
No Passive Congestion
Right side heart failure
What are the following clinical Hepatic, Spleen, Renal signs and symptoms of?
Passive Congestion
- Splenomegaly
- Hepatomegaly
- Ascites – “fluid accumulation in the abdominal cavity”
- Low blood pressure –> Renal loss of perfusion triggers Renin
Physiology: Renin-Angiotension-Aldosterone system
- Decreased blood pressure results in the kidneys release of renin which triggers:
1. Angiotension – vasoconstriction
2. Aldosterone – water retention
Results in:
Hypertension –> hypotension
Anasarca
Pedal edema (Pitting)
Facial edema
Right side heart failure
