Unit 5 - Cardiovascular Disorders 2 Flashcards
Define Heart Failure
Inability to effectively PUMP the amount of blood delivered to the heart
(inability to eject what it is receiving)
What are 4 causes of heart failure?
- MI
- Chronic Ischemic Heart Disease
- Valvular Disease
- Cardiomyopathy
What is chronic ischemic heart disease? (in simple terms)
Heart is not receiving enough oxygen to pump away happily
What wrong with the heart during valvular disease?
Problems with the heart’s valves
What is cardiomyopathy?
Something is wrong with the heart muscle itself
- heart wall
What is wrong with the heart when there is systolic dysfunction?
The heart doesn’t have enough FORCE
What is more prevalent, systolic or diastolic dysfunction?
Systolic!
- 60% of patients with heart failure have systolic heart failure
What kind of heart dysfunction is characterized by an ejection fraction of < 40%?
Systolic dysfunction
- LOW ejection fraction
What kind of heart dysfunction is characterized by an ejection fraction of > 50%
Diastolic dysfunction
- NEAR normal ejection fraction!
How is ejection fraction calculated?
(SV/EDV) x 100
= should be 55 - 70%
Average is 65%
What is associated with systolic dysfunction (2)?
- Poor contractility
- MI
What is associated with diastolic dysfunction?
- Slow or poor relaxation
- Aging
What is diastolic dysfunction (in simple terms)?
Ventricular muscle doesn’t relax very well
- poor distensibility
- amount of filling will be decreased
- CO will be decreased
What is it that causes the heart muscle as we get older to become less distensible?
- Deposits of calcium in the heart muscle
- Change in connective tissues (less elasticity)
What happens “in front” of the pump in LEFT sided heart failure?
- reduced ejection because there is less filling
- CO will decrease
- decreased oxygenation to the tissues
What happens “behind” the pump in LEFT sided heart failure?
- blood backs up in the LEFT atrium
- pressure is high in the veins of the lungs
- results in FLUID IN THE LUNGS
If the left side of the heart fails, what else could fail?
RIGHT side of the heart
- because of the fluid backing up into the lungs
What happens “in front” of the pump in RIGHT sided heart failure?
- not enough blood is going to reach the lungs
- decrease in oxygenation
- low cardiac output
What happens “behind” the pump in RIGHT sided heart failure?
- blood back up in the RIGHT atrium
- peripheral edema (blood backs up into the body)
What is happening during systole in LEFT sided heart failure?
Left ventricle does not pump enough blood to the body
What is happening during diastole in LEFT sided heart failure?
Left ventricle does not accept enough blood from the lungs
What is happening during systole in RIGHT sided heart failure?
Right ventricle does not pump enough oxygen to the lungs
What is happening during diastole in RIGHT sided heart failure?
Right ventricle does not accept enough blood from body
True or False:
Left sided heart failure can cause right sided heart failure
True
True or False:
Right sided heart failure can cause left sided heart failure
False
What are some manifestations of left sided heart failure?
- Activity intolerance
- Decreased CO
- Cyanosis
- Signs of hypoxia
- Cough with frothy sputum
- Paroxysmal nocturnal dyspnea
In what kind of heart failure will a patient exhibit orthopnea? What is it?
Difficulty breathing
- hard to breathe when laying down
- easier when sitting up
LEFT sided heart failure
What is paroxysmal nocturnal dyspnea?
- attacks of severe SOB and coughing that occur at night
- It usually awakens the person from sleep
What is ascites?
When is it seen?
Fluid collecting in the abdominal cavity
- Right sided heart failure
What are some manifestations of right sided heart failure?
- Edema
- Ascites
- Lack of appetite
- Impaired liver function
Explain why during RIGHT sided heart failure, a patient does not feel hungry.
Blood vessels in the GI tract are not being cleared
- signals for hunger are depressed as a result of lack of drainage
What is the pericardium?
Membrane enclosing the heart
What are the two layers of the pericardium?
- Parietal layer - outer layer
2. Visceral layer - inner layer
What is the endocardium continuous with?
Endothelium
What is between the parietal and visceral layer of the pericardium?
Pericardial cavity
What are the 3 classifications of heart wall disorders?
- Infectious (Rheumatic) Heart disease
- Cardiomyopathies
- Valvular disorders
What are the 3 kinds of Rheumatic Heart Disease?
- Endocarditis
- Myocarditis
- Pericarditis
What are two common ways that pericarditis can be caused?
- Dental work
- Urinary catheterization
What is pericarditis?
Inflammation of the pericardium
- restricts heart’s expansion
What does pericarditis cause?
- pain
- restriction of the heart’s movement due to exudate accumulation in pericardium
What is cardiac tamponade?
Rapid accumulation of exudate in the pericardial sac that compresses the heart
What happens to cardiac output if there is pericarditis?
- excess fluid in the envelope of the heart
- decreased filling
- EDV will decrease
- SC will decrease
- CARDIAC OUTPUT will decrease
What happens during constrictive pericarditis?
Fibrous scar tissue has formed by persistent presence of bacteria
- chronic inflammation
- decreased stretch of surface of the heart
What happens when inflammation goes from the pericardium and into the myocardiyum?
It will affect the electrical transmission in the heart
- affect ECG
What two things are caused by fibrous scar tissue in constrictive pericarditis?
- Frictional rub
2. Adhesions
What are the consequences of the LEFT and RIGHT ventricles of the heart not accepting enough blood due to pericardial effusion?
Left ventricle: - decreased cardiac output - decreased blood pressure and shock Right ventricle: - increased venous pressure - jugular distention
What are the 3 ways that malfunctioning heart muscle can cause heart failure (myocardial disorders)?
- Ventricles are too thick (not enough room for blood inside)
- Ventricles are too stiff to stretch
- Ventricles are too weak to pump out blood that is in them
If the heart muscle wall was thickened, what kind of heart dysfunction would it result in (systolic or diastolic)?
Diastolic dysfunction
- poor relaxation
- hypertrophy of the cardiac muscle
If the ventricles are too stiff to stretch, what kind of heart dysfunction would it result in (systolic or diastolic)?
Diastolic dysfunction
If the ventricles are too weak to pump out the blood that is in them, what kind of heart dysfunction would it result in (systolic or diastolic)?
Systolic dysfunction
- result of MI
What happens during myocarditis?
Ventricular muscle becomes too weak
What are the 3 kinds of cardiomyopathies?
- Dilated
- Hypertrophic
- Restrictive
What are dilated cardiomyopathies?
Muscle mass is small, the inside space of the heart is large (aka large cavity)
What are hypertrophic cardiomyopathies?
Thicker heart muscle, the inside space of the heart is small
- small cavity = SV is small = CO is small
What are restrictive cardiomyopathies?
Heart becomes stiff, heart size is normal, muscle wall isn’t thick or thin
- just stiff
- results in less relaxation; subejct to diastolic failure
What is the cause behind hypertrophic cardimyopathy?
Defects in the contractile proteins of the heart
- makes cells too weak
- they hypertrophy to do the same amount of work as normal cells
- bigger cells need more oxygen and perform less efficiently
What is the name of the valve between the right atrium and right ventricle?
Tricuspid valve
- AV valve
What is the name of the valve between the left atrium and left ventricle?
Bicuspid valve (mitral) - AV valve
What is the name of the valve leaving the left ventricle?
Aortic valve
- semilunar valve
What is the name of the valve leaving the right ventricle?
Pulmonary valve
- semi lunar valve
What are the valves of the heart a part of (continuous with)?
Endocardium of the heart
What are two types of valve defects?
- Stenosis
2. Regurgitation
What happens during stenosis?
Valve will not open all the way
- it is harder to force blood through it
- valve is too STIFF
What happens during regurgitation?
Valve will not close all the way
- it leaks when it should be closed
- blood flowing in opposite direction
What is physiologically similar to regurgitation?
Valve prolapse
What does stenosis sound like?
Whistling
- high-pitched
What does regurgitation sound like?
Whooshing
- low-pitched
True or False:
Left sided heart problems happen more often than right sided heart problems
True
- because there is more pressure
What are examples of left sided valvular disorders?
- Mitral (stenosis or regurgitation)
2. Aortic (stenosis or regurgitation)
What will we see in aortic valve stenosis?
- perfusion is down
- cyanosis can develop
- weak pulse
- VENTRICULAR HYPERTROPHY!
- low CO
What will we see in mitral (bicuspid) valve stenosis?
- Blood pooling in left atria
- low CO
What will we see in aortic valve regurgitation?
- blood is being drawn from the aorta back into the left ventricle
- left ventricle is congested
- low CO
What will we see in mitral (bicuspid) valve regurgitation?
- blood backing up into the left atrium
- blood pooling in the left atria
- low CO
What is shock?
Inability to maintain adequate pressure in the peripheral circulation
- perfusion of tissues is compromised
What are 4 kinds of shock?
- Cardiogenic
- Hypovolemic
- Distributive
- Septic
What is cardiogenic shock?
Heart is not producing enough force to circulate the blood
- heart is the problem
- low CO
What is hypovolemic shock?
Patient doesn’t have enough fluid in the body, even if the heart is okay
- you don’t have enough pressure to circulate properly
- low volume = low CO
When does distributive shock occur?
When peripheral resistance is TOO LOW
- MAP = CO x TPR
- blood vessels are TOO WIDE, doesn’t matter if CO is sufficient
What kind of shock is septic shock categorized as?
Distributive
What is a long term complication of MI?
Shock
Explain the feedback system that responds to cardiogenic shock
- Heart fails to pump blood adequately
- Decreased CO lowers BP
- Sympathetic system responds
- Vasoconstriction increases resistance to blood flow
- Increased workload on heart worsens heart failure
Explain what is happening during distributive shock
- Blood vessels dilate
- Not enough blood to fill the circulatory system
- Blood flow decreases
- Less blood is returned to the heart
- Less blood is circulated to the body
What are some CAUSES of distributive shock?
- decreased sympathetic activity
- brain or spine injury
- anesthetics
- insulin shock
- vasodilators
- anaphylactic shock
- sepsis
- vessel damage from severe hypovolemia
What is another term for anaphylactic shock?
Type 1 hypersensitivity
- blood pressure drops
Why can sepsis cause distributive shock?
Blood vessels dilate, and blood pressure drops
What is another term for septic shock?
SIRS
- Systemic inflammatory response syndrome
- 40 % mortality
- inflammatory mediators increase the metabolic rate of tissues, so they need more oxygen
What are 2 complications of shock?
- Acute renal failure
2. Acute respiratory distress syndrome
Why does shock cause renal failure?
Pressure in the blood in the kidneys can be too low
= CANNOT filters
- cannot get rid of wastes in the blood
Why does shock cause respiratory failure?
Cannot pump enough blood to the lungs to get enough oxygen
- they will be gasping for air
