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Bio 252- atherosclerosis > Congestive Heart Failure > Flashcards

Congestive Heart Failure Flashcards

1
Q

Congestive heart failure is not a _______

A

disease it is a complication of other diseases A SYNDROME

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2
Q

Congestive Heart failure is due to

A

serious heart disease (endpoint of serious heart disease)

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3
Q

Congestive heart failure results in

A

cardiac, pulmonary & systemic congestion

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4
Q

Etiology of congestive heart failure (major ones)

A
  • CAD
  • uncontrolled hypertension
  • cardiomyopathy
  • valvular disease
  • MI
  • excessive cardiac workload
  • volume overload
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5
Q

Most important risk factors to target for prevention of congestive heart failure

A
  • Ischemic heart disease
  • Hyperlipidemia
  • smoking
  • low ejection fraction
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6
Q

normal healthy heart can increase CO apporx

A

5x @ resting level (this is called cardiac reserve)

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7
Q

When in heart failure

A

cardiac reserve used at rest

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8
Q

Patho of left sided heart failure

A
  • Left ventricle fails to eject sufficient volume
  • Residual volume develops in left ventricle
  • Left atrium pumps harder to empty blood into left ventricle
  • fails to empty full
  • residual volume in Left atrium
  • Left atrium unable to receive full pulmonary return
  • pulmonary congestion & edema
  • Right ventricle workload increases
  • Right ventricle hypertrophy (to meet demand)
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9
Q

left sided heart failure

A
  • failure to eject into systemic circuit
  • results in inadequate cardiac output
  • pooling into pulmonary circuit
  • leads to pulmonary congestion & pulmonary edema
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10
Q

with left sided heart failure the heart fails to eject into

A

systemic circuit

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11
Q

left sided heart failure leads to

A

pulmonary congestion & pulmonary edema

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12
Q

Right sided heart failure

A
  • Failure to eject into pulmonary circuit
  • pooling in systemic circuit
  • causes peripheral edema & abdominal distention
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13
Q

with right sided heart failure heart fails to eject into

A

pulmonary circuit

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14
Q

right sided heart failure causes

A

-peripheral edema & abdominal distention

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15
Q

right sided heart failure normally follows

A

left sided failure

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16
Q

Manifestations of Right sided heart failure

A

Congestion of peripheral tissues:

  • Dependent edema & ascites
  • GI tract congestion (anorexia, wt loss, GI distress)
  • Liver congestion (signs related to impaired liver function)
17
Q

Manifestations of Left sided heart failure

A

Decreased cardiac output:
-leads to activity intolerance & signs of decreased tissue perfusion
Pulmonary congestion:
-leads to impaired gas change (cyanosis & signs of hypoxia) and pulmonary edema (cough w frothy sputum, orthopnea, paroxysmal nocturnal dyspnea)

18
Q

What is ascites

A

accumulation of fluid in peritoneal cavity, causing abdominal swelling

19
Q

Compensated heart failure

A
  • body trying to repair, minimize compensate, if can’t fails
  • compensation before heart failure
  • compensatory mechanisms conceal extent of damage
  • clinically asymptomatic
20
Q

Compensatory mechanisms for heart failure

A
  • Ventricle Dilation (Frank-Starling Law)
  • Sympathetic nervous system
  • Renin angiotensin adlosterone system
  • Naturiuetic peptides (ANP & BNP)
  • Endothelins
  • Cardiac hypertrophy & remodeling
21
Q

Ventricle dilation (compensatory mechanism)

A

(also known as Frank-Starling Law)

  • increase EDV (end diastolic volume), leads to muscle stretch, increases preload, increases cardiac ouput
  • cannot do this on a long term basis
22
Q

what 3 compensatory mechanisms start working in minutes to hours

A
  • Ventricle Dilation (Frank-Starling Law)
  • Sympathetic nervous system
  • Renin angiotensin adlosterone system
23
Q

What is the end diastolic volume

A

volume of blood in the right and/or left ventricle at end load or filling in (diastole) or amount of blood in ventricles just before systole

24
Q

what is the preload

A

preload is the end diastolic volume that stretches the right or left ventricle of the heart to its greatest dimensions

25
Q

Sympathetic nervous system (compensatory mechanism)

A

Activated by a decrease in C02, aims to Increase Cardiac output, causes:
-Vasoconstriction (increase pressure in vessels, Increase venous return)
-Tachycardia
-Increases contractility
(all of these increase cardiac output)

26
Q

RAAS (compensatory mechanism)

A

approx 25% of cardiac output goes to kidneys

  • decrease in cardiac output leads to decrease in renal perfusion
  • RAAS triggered
  • Angiotensin II
  • Aldosterone & ADH (aldosterone also causes vasoconstriction)
  • Hypervolemia
  • Increases preload
  • increases cardiac output
27
Q

natriuretic peptides (ANP & BNP) (compensatory mechanism)

A
  • both produced by heart (ANP in atrium & BNP in ventricles)
  • Both potent causes diuresis & naturesis (sodium loss through kidney, decreasing blood volume)
  • affects vascular smooth muscle (vasoconstriction & dilation)
  • Oppose action of SNS & RAAS
28
Q

Endothelins (compensatory mechanism)

A
  • secreted chemicals by endothelium & cardiac muscle
  • Vasoconstrictors
  • cause vascular & cardiac & smooth muscle hypertrophy
29
Q

Endothelins (compensatory mechanism)

A
  • secreted chemicals by endothelium & cardiac muscle
  • Vasoconstrictors
  • cause vascular & cardiac & smooth muscle hypertrophy – occurs in cardiac muscle so more forceful contractions can occur
  • needs more resources so demand can’t be met long term
30
Q

Cardiac hypertrophy & remodeling (compensatory mechanism)

A
  • hypertrophy d/t increased workload
  • eventually decreases contractility
  • requires more oxygen– cardiac dysfunction
31
Q

Manifestations of congestive heart failure

A
  • various
  • decrease CO (effects of impaired pumping)
  • decreased renal perfusion
  • SNS responses: increase BP, tachycardia, vasoconstriction
32
Q

Diagnosing congestive heart failure

A
  • History & physical exam (risk factors present)
  • Lab tests (renal fx, fluid electrolutes, liver fx, CBC, Hct, ABGs)
  • ECG & echocardiogram
33
Q

Treatment for acute congestive heart failure

A

Stabilize & correct cause (see MI)

34
Q

Treatment for chronic congestive heart failure

A

Symptomatic (relive mnfts), decrease risks and increase function

Bio 252- atherosclerosis (37 decks)

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