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Physiology I Block 4 > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

one of the major causes of cardiac failure is

A

ischemic heart disease

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2
Q

what does heart failure mean

A

any heart condition that reduces ability of heart to pump enough blood to meet body’s needs

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3
Q

congestive heart failure

A

regular heart failure that also has congestion

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4
Q

any valvular defect can lead to

A

heart failure

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5
Q

just because you have coronary artery disease, or mitral regurtigation, or aortic stenosis, etc. doesn’t mean you have

A

heart failure

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6
Q

presence of cardiac disease does not mean your heart is

A

in failure

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7
Q

when cardiac disease progress to where heart cannot meet needs of the body, it becomes

A

failure

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8
Q

disease can lead to failure but

A

the disease itself doesn’t meant you are in failure

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9
Q

primary cardiac disease are the

A

myopathies - like dilated cardiomyopathy

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10
Q

primary cardiac disease are disease of

A

the muscle themselves

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11
Q

valvular defect, there isn’t anything wrong with the muscle -

A

the valve problem is what causes the problem with the muscle

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12
Q

what are the acute effects of moderate cardiac failure

A

reduced CO

damming of blood in the veins

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13
Q

why does atrial pressure increase after cardiac failure

A

blood is returning but the heart can’t pump enough out - so you get damming of veins

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14
Q

why do you get damming of veins b/c of moderate cardiac failure

A

heart can’t pum pout enough

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15
Q

right after heart is damaged what isfrst compensatory mechanism you see

A

sympathetic nervous system

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16
Q

describe sympathetic compensation after cardiac failure

A

Baroreceptor reflex, chemoreceptor reflex, CNS ischemic response(if really bad).
Increase rate and force (functional muscle)
Increase in venous return

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17
Q

what happens to cardiac function curve after compensation

A

it is going to move back up b/c of the compensation (see pg 4)

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18
Q

how much the cardiac function curve moves up after cardiac failure depends on

A

how much damage was caused

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19
Q

what two things happen in chronic stage of failure

A

retention of fluid by kidney

cardiac remodeling

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20
Q

why is there retention of fluid by kidney

cardiac remodeling in chronic stage of failure

A

to reach the critical cardiac output level for normal fluid balance

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21
Q

what happens in kidney during hcronic stage failure to increase fluid retention

A

decreased glomerular filtration
actiation of renin-angiotensin system
increased aldosterone secretion

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22
Q

moderate fluid retention in cardiac failure is beneficial - why?

A

increase in venous return to help compensate for dimnished pumping ability of heart

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23
Q

body is trying to reabsorb fluids to stretch heart to

A

make it better pump and bring CO to normal level

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24
Q

if fluid retention gets to point where CO is normal, then

A

the body won’t retain more fluid

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25
too much fluid retention in response to cardiac fauilre is
bad - fine line b/w how much is god and how much is bad
26
if there is too mjuch fluid in severe cardiac failure what could happen
overstretch the heart - this is BAD
27
b/c of the too much fluid in severe cardiac failure what could happen in lungs
filtration of fluid into the lungs, causing pulmonary edema and because of that deoxygenation of blood
28
if you have too much fluid in severe cardiac filuare what coul dhappen inrest of body
edema
29
collateral circulation will being to penetrate the peripheral portions of the infarcted area of the
heart
30
what happens to the muscle part of undamged portion of heart after MI
hypertrophy
31
what happens to infarcted area of heart after MI
collateral blood supply penetrates the peripheral portions of infarcted heart
32
what do you see in compensated heart failure
normal cardiac output at rest | higher than normal right atrial pressure
33
in compensated heart failure there is normal CO but
it takes a lot more stretching of the heart to do it and a lot of fluid retention
34
in compensated heart failure you see reduced
cardiac reserve
35
a person in compensated heart failur eis fine at rest, but
exercise is a problem b/c there are reduced cardiac reserves. you have gotten the CO to where it needs to be, but any more need and the heart an't keep up
36
cardiac disease moving into failure you will always see what immediate effect
increase sympathetic nervous stimulation
37
wwhat is the intermediate phase of compensated heart failure
reabsorption of fluid by kidneys
38
reabsorption of fluid by kidneys - what three things do we see happen in kidney
1. Decreased glomerular filtration 2. Increased renin angiotensin system 3. Increased aldosterone secretion
39
what is the final thing you will always see in heart failure
remodeling of the heart
40
what two things can you see in remodeling of th eheart
Collateral blood supply | Hypertrophy
41
in pt with decreased sympathetic activity compared to when the heart fialed b/c they are at normal CO and arterial pressure, sympathetic stimulation may lessen depending on
what it needs to be at to hav normal CO
42
left side heart failure will often lead to
right side failure
43
right side failure leads to
congestion of peripheral tissues
44
what will you see in right side heart failure
liver congestion fluid in abdomen (ascites) GI congestion
45
what congenital problems can lead to right side heart failure
pulmonary hypertension & tetrology of fallot
46
acute left side heart failure can occur how quickly
minutes
47
acute left side heart failure causes rapid
congestion of lungs and pulmonary edema
48
ruptured mitral valve chordae tenindae could elad to
acute left side heart failure
49
death of acute left side heart failure in
minutes to hours
50
left or right side failure is very slow to cause what kind of edema
peripheral
51
most peripheral edema is caused by fluid retntion of
kidneys
52
atrial natriuretic peptide are produed where
heart - in atria
53
brain type natruiretic peptide - where is it produced
ventricle of heart
54
natruiretic means
trying to increase salt excretion
55
natruiretic peptide trying to relieve
congestion during heart failure - they are trying to increase fluid and salt excretion
56
whenever heart is stretched, like in failure, the stretchign causes the release of
ANP & BNP
57
what does ANP stand for
atrial natruiretic peptide
58
what does BNP stand for
brain type natruiretic peptide
59
what do ANP and BNP do in kidney
decrease renin which decreases angiotesin II and aldosterone which decrease blood volume
60
what natural thing prevent extreme congestive symptoms during cardiac failure
ANP & BNP
61
ANP & BNP levels are used to determine
level of heart failure
62
ANP & BNP in extreme heart failure are
overwhelmed, can't decrease blood volume/edema enough
63
what happens if no matter what body does it can't reach the critical cardiac output level for normal fluid balance
decompensated heart failure happens
64
decompensated heart failure leads to what kid of heart
severely damaged
65
in decompensated heart failure, cannot maintain normal cardiac output despite
sympathetic stimulation fluid retention cardiac remodeling
66
in decompensated heart failure what are kidneys doing
continuously saying heart presure is low, so keep keeping fluids more and more fluid
67
what happens to right atrial pressure in decompensated heart failure
kidney keeps reabsorbing more fluid, to put more back to heart, but heart can't keep up so right atrial pressure keeps increasing
68
progressive edema formation in
decompensated heart failure
69
ultimately decompenstaed heart failure will result in
progressive edema everywhere - b/c kidneys are trying to keep up fluid retention but it is not enought o have normal CO
70
what is main problem in decompensated heart fialure
heart not a good pump
71
how do you try to help person in decompensated heart failure
try to make it a better pump | try to get rid of edema
72
how do we get rid of edema with drugs
diahretics
73
if yiu don't decrease edema in decompensated heart failure what will happen to pt
drown in own fluids, edema will just continue
74
what are the clinical consequences of decompensated heart failure
progressive edema, esp. the lungs rales dyspnea
75
what is rales
clicking, rattling, crackling noises in lungs
76
what is dyspnea
difficulty breathing
77
why is there dyspnea in decompensated heart failure
so much fluid in lungs its harder foroxygen to diffuse from alveoli into blood
78
lack of appropriate therapy in decompensated heart failure leads to
death
79
what drugs do you give to pt in decompensated heart failrue to strengthen heart
cardiotonic drugs
80
digitalis is a form of
cardiotonic drug
81
biventricular heart failure
both ventricles failing
82
unilateral heart failure
one side of heart is failing
83
left side failure an lead to
right side failure
84
left side heart failure means
something is going on just the left side of the heart
85
left side heart failure causes what edema
pulmonary edema
86
If right side of heart is pumping out 5 L/min and left is pumping out 4 L/min what happens
blood will back up in left atria and if left atria pressures increase then it also increases in lungs and get pulmonary edema
87
anything that increases left atrial pressure will increase back into
lungs - pulmonary congestion, pulmonary edema, problems w/ breathing and posture changes
88
if you're in decompensated heart failure when do you need therapy to help
immediately or you'll die
89
if heart is overworked in heart failure pt can
die
90
frequent cause of death in pts who have heart failure is often
acute pulmonary edema
91
what often causes the acute pulmonary edema in pt w/ heart failure that kills them
temporary overload of heart - like old person cutting grass when they shouldn't be
92
increased workload on already wekaned heart, what happens
damning of blood in lungs, elevates pulmonary capillary pressure, fluid begins to transude into the lung tissues and alveoli, decreases oxygenation of blood further weakens heart - periphersal vasodilation, increases venous return which further increases work load on the heart
93
review pg 21
21
94
one of first lines of treatment for heart failure is
diuretics
95
thiazide is a
diuretic
96
natriuretic peptides is a
diuretic & vasodilator
97
natriuretic peptides isn't used often b/c
have to be infused, not activated orally
98
why do you want to vasodilate in situation where there is heart failure
decrease afterload | they make it easier for heart to pump out blood
99
ACE inhibitors are
vasodilators
100
Angiotensin receptor blockers are
vasodilators
101
digitalis is a
positivie ionotropoic agents - stimulate contractility in heart thatsfailing
102
positive inotropic drugs do what
stimulate contractility
103
beta agonist are examples of
cardiostimulatory
104
cariostimulatory, what is another way to say this
inotropic drug
105
what is problemw ith giving someone in heart failur ea beta agonist?
they are arthymogenic in high concentrations, so you are making heart more likely to have arrhythmia
106
beta blockers can be used in heart failure as a
cardioinhibitory
107
why can beta blockers be used in heart failure
blocking effects of sympathetic nerves so making it less arrhytmagenic can protect the beta receptors
108
in heart failure what happens to number of beta receptors
they fall
109
calcium channel blocker are for dysfunction of
diastolic dysfunction
110
calcium channel blockers ia what kind of drug
cardioinhibitory
111
when you hear myoptahy it means
valves are ok, blood vessels are ok, something inherently wrong in the muscle itself that causes heart disaese
112
myopathy means
pathology of the muscle
113
three main cardiomyopathy
dilated hypertrophic restrictive (won't talk about this)
114
we won't be directly tested on dilated and hypertrophic myopathy
:)
115
do we know what causes dilated cardiomyopathy
no - but we konw somethings that can contribute to it like alcoholic and diabetes
116
see my ntoes on cardiomyopathy to review and understand
in xodo
117
person with dilated cardiomyopathy what is main problem?
systolic dysfunction - heart doesn't pump strong enough
118
pt with dilated cardiomyopathy what kind of drug?
to make the heart pump harder - positive inotropic agent like digitalis
119
person with hypertropic cardiomyopathy how would you treat them
cardioinhibiotry drugs like beta blockers and calcium channel blockers
120
what is wrong with heart in hypertropic cardiomyopathy
it doesnt relax right - problem is in diastolic
121
what drugs for hypertropic cardiomyopathy
beta blockers | calcium channel blocker
122
what are the cardiostimulatory drugs (there are 3)
digitalis beta agonist phosphodiesterase inhibitors

Physiology I Block 4 (13 decks)

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