Yr 2 CVS- Heart Failure

Question 1

What is BNP and its significance?

Answer 1

BNP stands for brain or B-type natriuretic peptide

BNP levels go up when the heart cannot pump the way it should. A result greater than 100 pg/mL is abnormal. The higher the number, the more likely heart failure is present and the more severe it is. Sometimes other conditions can cause high BNP levels.

Question 2

Where is BNP produced? What are its physiological effects?

Answer 2

BNP is produced in the left ventricle not only by cardiomyocytes but also by endothelial cells, T cells, and macrophages

Response to ventricles stretching- measure ventricular blood volume and amount of stretch.

The major physiological effects of ANP and BNP are vasodilation, natriuresis, and inhibition of the renin-angiotensin-aldosterone (RAAS) and the sympathetic nervous systems; all of which are supposed to suppress the progression of heart failure.

Question 3

Why does LABA and LABA make the it worse for heart failure?

Answer 3

LABAs and LAMAs are believed to cause sympathetic overactivation by activating sympathetic beta-2 adrenergic receptors and suppressing parasympathetic muscarinic-3 receptors, which could contribute to the CVD risk.

LABA will increase HR push damagae heart muscle to contract and increases o2 demand

Question 4

What suggests a left ventricular systolic dysfunction?

Answer 4

Swelling of ankles would suggest it

Systolic murmur

JVP suggest it.

Ejection fraction low (40%)

Question 5

What suggest a right ventricular dsyfunction?

Answer 5

Peripheral edema.

Anorexia, nausea, and abdominal pain related to congestion hepatomegaly.

Fatigue, dypnea (related to inadequate Cardiac Output)

Question 6

What valve abnormalities might expect in left ventricular dsyfuntion?

Answer 6

Aortic stenosis

Mitral regurgitation

Question 7

Describe the chain of events that leads to the development of peripheral oedema in a patient with left ventricular dysfunction?

Answer 7

Question 8

If the patient cannot tolerate an ACE inhibitor or an ARB (angiotensin 2 receptor blocker) he/she will be offered hydralazine and nitrates. How do these drugs affect the patients’ vasculature?

Answer 8

With proper dose selection, the hydralazine-nitrate combination provides balanced afterload-preload reduction with a lowering of ventricular filling pressure, and systemic and pulmonic vascular resistance

Nitrates Vasodialiation- reduce vasoconstriction- more blood can go to the coronary a and veins also dilate so less preload/less strain