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Cardiopulm > Week 5 Heart Failure and Cardiomyopathy > Flashcards

Week 5 Heart Failure and Cardiomyopathy Flashcards

1
Q

In a heart with HF

A

:impaired ventricular contractility, increased afterload, or impaired filling of ventricles can lead to systolic or diastolic dysfunction

Systemic compensation occurs, including increases sympathetic activity, increase in specific hormone circulation, vasoconstriction, ventricular remodeling

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2
Q

Cardiac output

A

volume of blood ejected from left ventricle each minute

typically 4-6 L/min

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3
Q

CO =

A

HR x stroke volume

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4
Q

Preload is also called

A

left ventricle end-diastolic pressure (LVEDP)

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5
Q

Preload measures

A

stretch on L ventricle at the end of diastole

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6
Q

Increased preload may occur in HF which can

A

increase cardiac muscle O2 requirement

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7
Q

Many HF medications work to decrease preload

A

nitrates, diuretics, ACE inhibitors, ARB’s, calcium channels blockers

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8
Q

Afterload

A

the force against which the L ventricle is contracting to eject blood

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9
Q

Higher afterload =

A

lower cardiac output

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10
Q

Lower afterload =

A

higher cardiac output

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11
Q

Aortic pressures and peripheral pressures/resistance can

A

increase afterload

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12
Q

Increase afterload =

A

decreased stroke volume = increase blood left in chambers of heart after systole

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13
Q

In HFL elevated afterload leads to

A

long-term ventricular hypertrophy. While the body initial compensates with other systems, over time this leads to diastolic dysfunction (due to decreased compliance of ventricles – EF preserved) and eventually systolic dysfunction (EF reduced)

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14
Q

Contractility is affect by

A

HR, afterload, preload, sympathetic/parasympathetic activation

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15
Q

Contractility is decsribed as

A

the heart’s inherent ability to contract

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16
Q

Contractility is related to the Frank-Starling mechanism

A

force of cardiac muscle contraction is proportional to resting length of the muscle fibers

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17
Q

Increase preload =

A

increase contractility = increased stroke volume

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18
Q

Ejection fraction

A

“A ratio or percentage of the volume of blood ejected out of the ventricles relative to the volume of blood received by the ventricles prior to contraction.”
Normal=60-70%

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19
Q

Reduced ejection fraction – systolic dysfunction
(HFrEF)

A

impaired contractility, increase afterload

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20
Q

Preserved ejection fraction – diastolic dysfunction
(HFpEF)

A

impaired ventricular filling

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21
Q

Systemic compensations in HF

A

Increased blood volume (to increase preload)
Increased sympathetic nervous system activation
Increased HR
Decreased vagal/parasympathetic activation
Increased antidiuretic hormone
Increased renin-angiotensin-aldosterone mechanism activation (RAAS) – regulates blood volume and peripheral resistance
Increased peripheral resistance

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22
Q

HFrEF

A

CAD**
MI
Valvular regurgitation
Dilated cardiomyopathy
Aortic stenosis HTN

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23
Q

HFpEF

A

Left ventricular hypertrophy
Fibrosis of heart musculature
MI
Cardiac tamponade
Cardiomyopathies

24
Q

Class A

A

at high risk for HF but w/o structural heart disease or symptoms

25
Q

Class B

A

structural heart disease but w/o signs and symptoms of HF

26
Q

Class c

A

structural heart disease with current or prior symptoms of HF

27
Q

Class D

A

Refractory HF requiring specialized interventions

28
Q

Class I

A

no limitations of physical activity. Ordinary physical activity does not cause symptoms of HF

29
Q

Class II

A

Slight limitation of physical activity. Comfortable at rest but ordinary physical activity results in symptoms of HF

30
Q

Class III

A

Marked limitation of activity. Comfortable at rest but less than ordinary activity causes symptoms of HF

31
Q

Class IV

A

Unable to carry on any physical activity w/o symptoms of HF or symptoms of HF at rest

32
Q

HF common presentation

A

Dyspnea
Orthopnea
Fatigue
JVD
Peripheral edema
Tachycardia
Cachexia

33
Q

HF prognosis

A

HF prognosis is generally poor
5-year mortality ranges from 45-60%
Patients with severe HF have a 1-year mortality rate of 60%

34
Q

Dilated

A

Dilation of heart chambers, particularly L ventricle

35
Q

Dilated causes

A

genetics (40%), toxins (chemo, drugs, alcohol), pregnancy, metabolic conditions involving the thyroid, myocarditis

36
Q

Dilated patho

A

L ventricle enlargement leading to decreased contractility and stroke volume

37
Q

Dilated symptoms similar to HF

A

dyspnea, orthopnea, edema, fatigue

38
Q

Restrictive

A

Stiffness of myocardium resulting in decreased/impaired filling and diastolic dysfunction

39
Q

Restrictive causes

A

amyloidosis (protein build-up) and sarcoidosis (inflammatory disease resulting in granulomas)

Caused by increased fibrotic tissues in the heart

40
Q

Hypertrophic

A

Thickening of walls of heart chamber

41
Q

Hypertrophic interesting fact

A

accounts for 1/3 of sudden cardiac deaths in young athletic population, especially in football and basketball
IOK(-p=[0

42
Q

Hypertrophic symptoms often present at

A

a younger age, but some people are asymptomatic

43
Q

Hypertrophic common symptoms

A

dyspnea and angina

44
Q

Valve disease is more common on

A

L side due to elevated pressures

45
Q

Risk factors for valve disease

A

RA, IVDA, smoking, obesity, congenital heart defects, family hx, autoimmune disorders, age

46
Q

Mitral valve stenosis

A

most cases caused by rheumatic fever

47
Q

Mitral valve regurgitation

A

caused by calcification, rupture of chordae tendinae or papillary muscles

48
Q

Mitral prolapse

A

leaflets prolapse into L atrium

49
Q

Mitral valve presentations

A

dyspnea, pulm HTN, pulmonary edema, fatigue, weakness

50
Q

Aortic regurgitation

A

aortic insufficiency

51
Q

Aortic regurgitation causes

A

congenital (2 instead of 3 leaflets to valve), ankylosing spondylitis, Marfan syndrome, HTN, endocarditis, rheumatic disease

52
Q

Aortic regurgitation common s&s

A

syncope, angina, SOB, weakness/fatigue

53
Q

Aortic stenosis

A

very common in older adults >65 y/o

54
Q

Aortic stenosis causes

A

calcification/atherosclerosis or rheumatic disease

55
Q

Aortic stenosis common s&s

A

syncope, angina, fatigue, dyspnea, decreased activity tolerance

Cardiopulm (11 decks)

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