Cardiac Patho pt.2 (Exam 3)

Question 1

Heart Failure

Answer 1

Left versus right sided

Systolic Versus Diastolic

Preserved Versus Reduced

Question 2

Cardiomyopathy

Answer 2

Disease that affect the myocardium (heart muscle)

LEAD TO HEART FAILURE AND HEART FAILURE SYMPTOMS

Question 3

What causes Cardiomyopathy

Answer 3

Idiopathic

Can be related to ischemia - HTN - Inherited disorders - infections - toxins - myocarditis - auto-immune condition

Question 4

3 Types of Cardiomyopathy

Answer 4

Dilated cardiomyopathy

Hypertrophic cardiomyopathy

Restrictive cardiomyopathy

Question 5

Dilated Cardiomyopathy

Answer 5

Ventricles become dialted

Ischemic Problems - Alc - Drugs -Valve Disease - Post Partum - Infection

Question 6

Hypertrophic Cardiomyopathy

Answer 6

Related to HTN. Ventricles become enlarged

Question 7

Restrictive Cardiomyopathy

Answer 7

Usually RS

Hardening. Muscle become rigid

Question 8

Heart Failure: Definition

Answer 8

Chronic progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen

Heart can not keep up with its workload

Question 9

What factors determine CO

Answer 9

Heart rate

Stroke volume

Question 10

Three factors involving stroke volume

Answer 10

Preload

Afterload

Myocardial contractility

Question 11

Preload

Answer 11

Fluid volume

Amount of volume in LV before it systole (it pumps)

Question 12

Afterload

Answer 12

The pressure the hearts have to squeeze against as it contracts

Directly Related to BP

High blood pressure = Higher afterload

Question 13

Myocardial contractility

Answer 13

Is the pump working like it should

Is the heart pumping effectively

Question 14

Heart failure results in

Answer 14

Decreased Cardiac output, decreased myocardial contractility, increased preload, increased afterload

Question 15

Pathological changes that occur in Heart Failure (4)

Answer 15

Volume overload (to much volume on board)

Impaired ventricular filling - occurs during diastole

Weakened Ventricular Muscle

Decreased ventricular Contractile function - systole

Question 16

Etiology: Major causes of HF

Answer 16

Repeated ischemic episodes (CAD)

Myocardial infarction + papillary muscle rupture

Chronic HTN

COPD (Pulmonary pressure alters and RVF)

Dysrhythmias (decrease CO and perfusion to coronary arteries)

Valve disorders; mitral insufficiency, aortic stenosis

Pulmonary Embolism (RVF)

Question 17

RF’s for HF

Answer 17

Hypertension and DM are the greatest risk factors

MI’s within 6 months

Black and African Americans

Age

Family hx and genetics

Obesity

Ischemic Heart disease

Lifestyle factors

STABLE ANGINA IS NOT

COPD

Severe Anemia

Congenital heart defects

Viruses: Myocarditis (Inlfammation)

Alcohol abuse/Drug Abuse

Kidney Conditions

Question 18

Heart Failure Classifications

Answer 18

Right Sided

Left Sided

Question 19

Left Sided Heart failure blood

Answer 19

Backs up into the pulmonary circulations

Question 20

Right sided heart failure blood

Answer 20

Backs up into systemic circulation

Question 21

Left Sided HF: Etiology

Answer 21

Congestion in LEFT chambers

LV increases in size (LVH)

Backflow into pulmonary veins

Congestion into the LUNGS

Question 22

Left Sided HF: S/S

Answer 22

Cough-crackles-wheezes

Frothy sputum may be blood tinged

Paroxysmal nocturnal dyspnea (PND) (Wake up and can not breath)

Orthopnea (Can’t breath laying flat)

Question 23

What is the condition in which you wake up and can not breath

Answer 23

paroxysmal. nocturnal dyspnea

associated with LS heart failure

Question 24

What is the condition in which you can not breath while laying flat

Answer 24

Orthopnea

Question 25

Right Sided HF: Eitiology

Answer 25

Due to COPD (cor pulmonale) Congestion in RIGHT chambers RV increases in size (RVH) Backflow into vena cava, decreased to the lungs Congestion in jugular viens, liver, lower extremities

Question 26

Right sided HF: S/S

Answer 26

JVD Dependent Edema Weight Gain ascites fatigue Hepatosplenomegaly (enlarged spleen and liver) Loss of appietite

Question 27

Most common cause of left HF

Answer 27

HTN

Question 28

Most common causes of right HF

Answer 28

COPD

Question 29

Ejection Fraction

Answer 29

Percentage of blood pumped out of the LV with each squeeze. Normal = 55-65%

Question 30

Heart Failure: Reduced Ejection Fractions

Answer 30

(HFrEF) (Systolic HF) Determined by patients ejection fraction --- < 40%

Question 31

HFrEF caused by

Answer 31

Impaired contractile function, increased afterload, cardiomyopathy, and mechanical problems Left ventricle loses ability generate pressure to eject blood enough percentage of blood Weakened muscle cannot generate stroke volume and the lowers cardiac output LV fails, blood backs up, causes fluid backup and accumulation

Question 32

Heart Failure with Preserved Ejection Fraction

Answer 32

(HpEF) (Diastolic HF) Inability of the ventricles to relax and fill during diastole

Question 33

HFpEF caused by

Answer 33

Inability of the ventricles to relax and fill Most commonly HTN. Females are at greater risk LV is stiff and non compliant leading to high filling pressure and decreased stroke volume Ejection is normal or only moderately decreased (40-49%)

Question 34

Ejection Fractions HFpEF

Answer 34

Ejection fraction is preserved at 40-49%

Question 35

Ejection Fractions HFrEF

Answer 35

Ejection fraction is reduced to <40%

Question 36

Ventricular Remodeling

Answer 36

A weakened heart muscles starts to secretes molecular substances like Angiotensin II, aldosterone, endothelin, TNF-alpha, catecholamines, insulin-like growth factor, and growth hormone These substances provoke genetic changes, apoptosis and hypertrophy of cardiac myocytes, as well as collagen deposits and myocardial fibrosis Molecules causes changes and lead to ENLARGEMENT AND DILATION of LV and causes worsening HF

Question 37

S3 Gallop

Answer 37

Low pitched sound heard after S2 (Aortic and Pulmonic Closing) During rapid filling of the ventricles In adults older tahn 40 years an S3 is abnormal and indicative of heart failure

Question 38

HFpEF: Common in

Answer 38

Older age females

Question 39

HFrEF: Common in

Answer 39

Younger age males