Week 2- KEY SLIDES Flashcards
PART 1: HEART FAILURE (HF)
PART 1: HEART FAILURE (HF)
What are the (3) main portions of the O2 supply chain?
- Tissue
- Heart
- Airway/lungs
Cardinal S/Sx of cardiac dysfunction. (6)
- ) Inappropriate fatigue and/or weakness
- ) Dyspnea (SOB)
- ) Exercise intolerance
- ) Rapid/irregular heartbeat
- ) Bilateral LE swelling
- ) Persistent cough
Basic Facts:
- The heart generates almost all of its energy needed to drive its primary function (pumping blood) through ________ metabolism (O2 requiring process).
- Does the heart have an energy storage?
- Are O2 needs constant?
- Inability to match energy __________ and _________ compromises cardiac function.
- aerobic metabolism
- No, the heart matches its energy needs with energy synthesis.
- No, O2 needs are variable. (exercise!)
- energy synthesis and energy expenditure
CO = ___ x ___
CO = SV x HR
What are the (3) contributing factors to SV?
- ) Preload
- ) Contractility
- ) Afterload
HR is influenced by _________ and __________ tone.
parasympathetic and sympathetic
Wiggers Diagram
Wiggers Diagram
- Patients with Left Sided HF have compromised __________.
- What is the impact of L Sided HF? (3)
-CONTRACTILITY
- ) Reduced SV, EF, and CO. →
- ) Blood flow (O2 delivery) to the body is reduced. →
- ) Fatigue, exercise intolerance, SOB
L Sided HF S/Sx. (10)
- ) Exertional Dyspnea (SOB)
- ) Fatigue, tiredness
- ) Paroxysmal Nocturnal Dyspnea
- ) Orthopnea (SOB w/ recumbent position)
- ) Tachycardia
- ) Cyanosis
- ) Confusion
- ) Restlessness
- ) Elevated Pulmonary Capillary Wedge Pressure
- ) Pulmonary Congestion
- Patients with Right Sided HF have compromised __________.
- What is the impact of R Sided HF?
- CONTRACTILITY
- Accumulation (congestion) of blood in RV, RA, and the SYSTEMC CIRCULATION resulting in systemic S/Sx.
R Sided HF S/Sx. (9)
- ) Fatigue
- ) ↑ Peripheral Venous Pressure
- ) Ascites (Fluid in abdomen)
- ) Spleen/Liver Enlargement
- ) Possible secondary to chronic pulmonary problems
- ) JVD
- ) Anorexia & Complaints of GI Distress
- ) Weight Gain
- ) Dependent Edema (systemic accumulation)
What is CHF?
Congestive Heart Failure
- A clinical condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in the myocardium.
- Type of HF most commonly seen.
Describe the (5) stages of CHF.
Normal
-No symptoms, normal exercise, normal LV function.
Asymptomatic LV Dysfunction
-No symptoms, normal exercise, abnormal LV function.
Compensated CHF
-No symptoms, ↓ exercise, abnormal LV function.
Decompensated CHF
-Symptoms, ↓↓ exercise, abnormal LV function.
Refractory CHF
-Symptoms not controlled w/ treatment.
HFrEF vs HFpEF.
HFrEF (Systolic HF)
-LV contractility recuded, in turn reducing EF and O2 delivery. Net effect is reduced delivery of blood to systemic circulcation.
HFpEF (Diastolic HF)
-Ventricles lose ability to relax normally and become stiffer/less compliant. Heart chambers cannot fill normally during diastole.
- Is HFrEF more common in men or women?
- Is HFpEF more common in men or women?
- men
- women
NYHA HF Classifications. (4)
Stage 1
-Cardiac disease, but no symptoms or limitations in ordinary physical activity.
Stage 2
-Mild symptoms and slight limitations during ordinary activity.
Stage 3
-Significant limitations in activity due to symptoms. Comfortable only at rest.
Stage 4
-Severe limitations. Symptoms even while at rest.
Last Words:
- HF is now recognized as a __________ disease rather than simply heart disease.
- Is HF exclusively a “cardio-centric” disease?
- neuroendocrine disease
- No, can have endothelial dysfunction, skeletal muscle damage, kidney dysfunction, and decreased systemic blood flow and accompanying increased total peripheral resistance secondary to excessive sympathetic stimulation causing vasoconstriction.
PART 2: ISCHEMIC HEART DISEASE
PART 2: ISCHEMIC HEART DISEASE
- What is ischemia?
- What is hypoxemia?
- What is hypoxia?
- Ischemia = A condition in which the blood flow (and thus O2) is restricted or reduced in a part of the body.
- Hypoxemia = Low O2 in blood. (O2 sats!!)
- Hypoxia = Low O2 at tissue.
What is ACS?
Acute Coronary Syndrome
-UMBRELLA term for a range of symptoms associated with sudden, reduced blood flow to the heart.
ACS diagnosis is dependent on Hx and examination. What will be found during each of these?
Hx
- chest/left arm pain
- Hx of CAD
Examination
- Hypotension/diaphoresis
- Pulmonary edema/rales
- ECG changes
- Elevated cardiac biomarkers
What is the most common diagnosis under the umbrella term ACS that is the most common cause of death in the US and western EU?
IHD
Describe the (3) steps of progression of IHD?
- ) CAD (plaque build up)
- ) Angina (due to blood flow difficulty)
- ) Heart Attack (plaque breaks off and blocks artery)
IHD Risk Factors. (10)
- ) Age/Gender
- ) Smoking Hx
- ) Family Hx
- ) Hyperlipidemia
- ) HTN
- ) Diabetes
- ) Obesity
- ) Poor diet
- ) Physical inactivity
- ) High levels of stress
What is angina pectoris?
Intermittent chest pain caused by transient but reversible myocardial ischemia.
Describe the difference between unstable and stable angina.
- Stable angina occurs at a predictable HR.
- Unstable angina onset is unpredictable.
-Both stable and unstable angina are brought on by exertion or other forms of stress and presents as crushing/squeezing substernal sensation w/ possible radiation to the arm.
Describe the (4) functional classifications of angina.
Class I = occurs after prolonged exertion
Class II = walking >2 blocks or >1 flight of stairs
Class III = walking <2 blocks or <1 flight of stairs
Class IV = occurs at minimal exertion or rest
MI- “_____ is _________”
“Time is Tissue”
-If ischemic insult is sufficiently long, tissue damage and death results.
- What is a natural unexpected death secondary to cardiac causes with rapid loss of consciousness?
- What percentage of CAD deaths do they make up?
- Sudden Cardiac Death
- Make up 50% of CAD deaths.
Sudden Cardiac Death Anatomical Findings. (3)
- Acute Coronary Plaque Rupture of Thrombosis
- Clinically quiet MI
- No acute lesions but >60% stenosis of a coronary artery. (often LAD)
PART 3: HTN
PART 3: HTN
What is Poiseuille’s Law?
-Q=ΔP X r4
Flow=pressure gradient* radius^4
- If the radius decreases, the resistance to blood flow __________ and blood flow _________.
- How can we preserve blood flow if r decreases? What effect does this have on the heart?
- increases
- decreases
-Increase ΔP which means the heart has to work harder.
Systolic BP is the ________ pressure exerted against the wall of a blood vessel, while diastolic BP is the _________ pressure exerted against the wall of a blood vessel.
- maximum
- minimum
- What is double product?
- What is the equation for it?
- Double product is an index of myocardial O2 consumption.
- DP = HR*SBP
Describe each of the following BP categories:
- Normal
- Elevated
- HTN Stage 1
- HTN Stage 2
- Hypertensive Crisis
Normal
-SBP <120, DBP <80
Elevated
-SBP 120-129, DBP <80
HTN Stage 1
-SBP 130-139, DBP 80-89
HTN Stage 2
-SBP >140, DBP >90
Hypertensive Crisis
-SBP >180, DBP >120
Only 20% of patients take ALL HTN medications. What are some reasons for this? (7)
- Unpleasant side effects
- Interference with sexual function
- Cost
- Doesn’t change the way a patient feels
- Increased age
- Gender (female), Race (African American)
- Essential (90%) HTN (no known cause)
- Secondary (10%) HTN (caused by conditions that affect kidneys, arteries, heart or endocrine system)
Explain how HTN can lead to kidney disease. (3 steps)
- ) Uncontrolled high BP can cause arteries in the glomeruli to narrow, weaken, or harden.
- ) These damaged arteries deliver less and less filtrate to the nephron.
- ) The kidneys perceive reduced filtration as a reason to increase water and Na+ reabsoprtion resulting in increased blood volume (preload) and therefore BP.
- ) Reduced filtration activates renin-angiotensin cascade which favors water and Na+ reabsorption.
- ) Net effect is ↑ preload, ↑ total peripheral resistance, and ↓ ability to control BP.
- Creates downward spiral in kidney function.
- KNOW BP OF ALL PATIENTS WITH KIDNEY DISEASE!
Explain how kidney disease can lead to HTN.
- ) As kidneys become increasingly dyfunctional they lose ability to regulate BP.
- ) Pt becomes hypertensive by same process as stated before.
Can diabetes lead to HTN? If so, how?
Yes
- Chronically elevated glucose levels damage glomerular filtration, thereby reducing it.
- Kidney responds by reabsorbing more water and Na+, increasing fluid volume and BP.
What is Cor Pulmonale?
- Enlargement/dysfunction of RV caused by a primary pulmonary disorder.
- PULMONARY HTN
Why can the R side of the heart move the same blood volume as the L side? (4)
- ) Shorter length of tubing
- ) More compliant vessels
- ) Much lower impact of gravity on blood flow
- ) Q=𐤃P * r⁴
Assessment Criteria for Taking BP. (11)
- ) Resting for 5m prior
- ) legs uncrossed
- ) feet on floor
- ) arm supported
- ) correct cuff size
- ) cuff placed over bare arm
- ) no talking
- ) no phone or reading
- ) BP taken in both arms
- ) correctly identifying BP from arm with higher reading
- ) correctly identifying which arm to use for future readings (one with higher BP)
PART 4: CARDIOMYOPATHIES
PART 4: CARDIOMYOPATHIES
Cardiomyopathy:
- What is cardiomyopathy?
- Is decline in cardiac function reversible?
- Are these patients appropriate for heart transplants?
- Disorder within the cardiac myocytes themselves which resulting in decreased cardiac performance.
- No, typically leads to irreversible decline in cardiac function.
- Yes, often long-term cardiomyopathy patients are appropriate for transplantation.
What is the most powerful risk stratifier for cardimyopathy?
LVEF
What are the (3) types of cardiomyopathies?
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
- Restrictive Cardiomyopathy
Dilated Cardiomyopathy:
- What is it? What does this lead to?
- _______ heart weight.
- _______ walls.
- Impaired _______ function with cardiac enlargement.
- _________
- Abnormal cardiac morphology (chamber dilation) and contractile impairment resulting in decreased EF and/or SV.
- increased heart weight
- thinned walls
- impaired systolic function
- fibrosis
What are some causes of Dilated Cardiomyopathy? (6)
- ETOH/toxic substances
- Poor nutrition (B1 deficiency)
- Idiopathic, family Hx
- AIDS
- CT
- Cancer therapies
Hypertrophic Cardiomyopathy:
- What is it? What does this lead to?
- ___ gene defects which cause defects in sarcomeric proteins.
- What is most often the first clinical manifestation?
- Majority of cases are ___________.
- What are the 2 types?
- Thickened LV wall with non-dilated LV chamber leading to hypertrophy out of proportion to hemodynamic load and decreased functional capacity.
- 9
- sudden death
- asymptomatic
- Obstructive and Nonobstructive HCM
Restrictive Cardiomyopathy:
- What is it? What does this lead to?
- _____ and ____ are normal.
- _________
- Characterized by restricted diastolic filling due to wall loss of compliance. Leads to diminished EDV and compromised SV.
- EDV and EF normal
- fibrosis
Cardiomyopathy:
- Which type of cardiomyopathies have diastolic dysfunction? Which ones have systolic dysfunction?
- Which is the single most common cause of death in healthy young people?
- Which is the most rare form?
- Which is the most common?
- Diastolic (Hypertrophic, Restrictive), Systolic (Dilated)
- Hypertrophic Cardiomyopathy
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
Myocarditis:
- What is it?
- What is it usually caused by?
- What can it lead to?
- Inflammation of the myocardium.
- Usually caused by viral infection.
- Can lead to HF, arrhythmia, and sudden death.
What are the (4) types of aneurysms? Describe each.
True
- Saccular = unilateral outpouching
- Fusiform = bilateral outpouching
- Dissecting = bilateral outpouching w/ vessel wall separation creating a cavity.
False
-False = Wall ruptures and blood clot is retained in outpouching of tissue.
