CHF- Melissa (3)* Flashcards Preview

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Flashcards in CHF- Melissa (3)* Deck (34):
1

5 causes of cardiac dysfunction:

1. pump failure (weak myocytes, inability to relax)
2. Obstruction of flow ( ^ after load)
3. Regurgitant flow ( ^ preload)
4. Conduction anomalies
5. Ventricular/ Vascular rupture (discontinuity of system)

2

3 mechanisms by which the heart accommodates for ^ hemodynamic burden or myocardial contractility change:

1. Frank Starling
(^ preload = ^ dilation = ^contraction)

2. Hypertrophy
(physiologic / pathologic)

3. Neurohumoral Activation
(NE, Renin/ANG/Aldo, ANP)

3

Generally, what structural change in the heart precedes failure?
What are 2 causes of this change?

Hypertrophy --> Heart failure
1. ^ Mechanical workload
2. ^ Trophic signals--> ^ protein synthesis--> ^ # sarcomeres

4

Describe the CONCENTRIC pattern of cardiac hypertrophy:
- 2 most common causes
- Gross morphology
- Sarcomere arrangment

"Pressure Overlaod Hypertrophy"
- Causes: HTN, Aortic stenosis
- ^ wall diameter, normal/ smaller cavity
- Sarcomeres parallel to long axes of myocytes

5

Describe VOLUME-OVERLOAD cardiac hypertrophy:
- 2 most common causes
- Gross morphology
- Sarcomere arrangment

*Is it always dangerous?

- Causes: Mitral/ Aortic valve regurgitation
- +/- increase in wall diameter, ventricular dilation
- Sarcomeres assemble in seres (side-by-side) w/ existing


*may be caused physiologically by aerobic exercise

6

Which type of hypertrophy is a major risk for sudden cardiac death? What does it look like on EKG?

Left ventricular hypertrophy

Leads V2/3: see S waves > 30 mm.

7

Why is pathological cardiac hypertrophy dangerous to the heart (3)?

1. No capillary growth to meet new O2/ nutrient demands
2. Hypertrophied myocytes need more O2, nutrients, mitochondria than normal
3. ^ Fibrous tissue (less elastic)

8

4 possible outcomes of sudden cardiac hypertrophy:

1. inadequate organ perfusion (decompensation)
2. cardiac failure/sudden death
3. arrhythmia
4. neurohumoral stimulation

9

What causes physiological cardiac hypertrophy?
What type of hypertrophy is it + 2 reasons why it isn't dangerous?

Aerobic* exercise (vs static) & pregnancy--
volume load hypertrophy
1. ^ capillary density to accommodate
2. DECREASED resting HR and blood pressure

10

Does static exercise cause physiological hypertrophy?

Yes, but with more detrimental effects!
(Causes concentric/ pressure overload hypertrophy, aerobic causes volume overload hypertrophy.)

11

What are the two types of heart failure?

1. Forward failure--> poor perfusion
2. Backward failure--> pulm + peripheral edema

12

Most common cause of rt. heart failure?

Lt. heart failure

13

Which side of the heart fails more often? What is the ultimate result (2)?

LEFT HEART FAILURE-->
1. Congestion of pulmonary circulation
2. Poor peripheral blood flow

14

Left sided heart failure effects on the HEART:
(2 anatomical changes + 1 heart sound)

1. Hypertrophy of Lt ventricle (except mitral valve stenosis)
2. S3 heart sound (^ blood volume/ stiff ventricle)
3. Enlarged Lt atrium (A fib, stasis, embolus to brain)

15

What can enlargement of the Lt atrium cause as a result of L heart failure? (2)

A fib--> stasis--> thrombosis --> stroke
Also- compression of esophagus + left recurrent laryngeal nerve = hoarseness and dysphagia (FA)

*Hoarse voice was a practice questions one of the few I got right: thanks, First Aid Guy!*

16

What causes the S3 sound heard during left heart failure?
What does it sounds like?

^ blood in LV or stiff LV
Sound: "Ken-Tuck-y", early diastolic murmur due to ^ ventricle filling pressure

*NOTE: this sound can be normal in kiddos or athletes.

17

Left sided heart failure effects on the LUNG:
- What do you see on X-ray ?
- What do you see on tissue biopsy?

*MOST EFFECTED ORGAN*
^ pressure in pulm vv. --> pulm congestion + edema
- Kerley B lines on X-ray (interstitial transudate)
- Heart failure cells (Hemosiderin laden MQs)

18

3 clinical manifestations of L heart failure in the lungs:

1. cough
2. orthopnea
3. paroxysmal nocturnal dyspnea

19

Left sided heart failure effects on kidneys:

1. DECREASED renal perfusion-->
2. ^ RENIN prodxn by JGA-->
3. ^ ALDO-->
4. ^ Na + H2O retention--> ^ Interstitial fluid volume-->
5. ^ Pulm edema, ^ BUN, ^ Cr

20

Release of what molecule can be checked to dx. heart failure?

BNP

21

Left sided heart failure effects on brain:

Occur with advanced disease
Decreased perfusion--> Hypoxic encephalopathy

22

What is the most common cause of L Heart failure: systolic or diastolic dysfunction?

systolic (LV) dysfunction + insufficient stroke volume

23

What is the #1 cause of L heart failure + 2 other causative systolic dysfunctions:

What do these problems do the the ejection fraction?

#1: ISCHEMIC HEART DISEASE
2. HTN
3. Dilated cardiomyopathy

* DECREASED EF w/ DECREASED SV

24

3 diastolic dysfunctions that lead to L heart failure:
What do these problems do to the ejection fraction?

1. Massive LV hypertrophy
2. Myocardial fibrosis
3. Constrictive pericarditis
(All things that prevent the heart from stretching)

*DECREASED SV w/ possibly normal EF

25

What is "Cor Pulmonate"?
How common is this?
What are 3 common causes?

Isolated right heart failure (rare)
- parenchymal diseases of lung
- pulm vascular disorders (HTN, embolus)
- diseases that cause hypoxia

26

Rt heart failure effects on the heart (2):

Hypertrophy + dilation of RA, RV (whole right heart)

27

Rt heart failure effects on the liver (3):

^ Portal venous pressure-->
- Congestive hepatomegaly
- Chronic edema of bowel wall
- Ascitis

28

What is nutmeg liver and what causes it?

Rt heart failure--> congestion around central vv. in liver--> red-brown discoloration + pale periphery

29

What are three results of centrilobular necrosis of the liver caused by Rt heart failure? (Labs? Clinical findings?)

^^transaminases; jaundice; hepatomegaly

30

Rt heart failure effects on the Kidneys (3):

VENOUS congestion--> decreased excretion-->
1. WORSE fluid retention than lt. heart failure
2. peripheral edema
3. Azotemia (^ BUN)

31

Describe effects of Rt heart failure on the brain; what specifically causes these effects?

- similar to Lt heart failure
- caused by venous congestion + hypoxia

32

How does Rt heart failure effect the plural and pericardial spaces?

EFFUSION!
Compression of lungs by fluid in thoracic cavity--> atelectasis

33

What is the #2 sign of heart failure in a patient?

PERIPHERAL EDEMA of subcutaneous tissue:
- Commonly "dependent" (more in lower extremities)
- May be generalized ( anasarca)

34

2 most common signs of heart failure in clinic?

SOB + GENERALIZED EDEMA
* patients generally present with simultaneous rt and lt syndromes