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Kin 187 > CVD - Chronic heart failure > Flashcards

CVD - Chronic heart failure Flashcards

(112 cards)

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1
Q

What is Chronic Heart Failure (CHF)

A

Syndrome of the inability of the heart to deliver adequate blood/oxygen to the body

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2
Q

What are the different heart failure (HF) - for each side

A

Left sided HF = failure to properly pump blood out to the body - systolic and diastolic failure

Right sided HF = back ups in the area that collects used blood

Congestive heart failure

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3
Q

Systolic HF is

A

Less blood pumped out of ventricles

Weakened heart muscle cant squeeze as well

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4
Q

Diastolic HF is

A

Less blood fills the ventricles

Stiff heart muscle cant relax normally

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5
Q

When does CHF occur

A

When heart is unable to pump sufficiently to maintain blood flow to meet body demands

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6
Q

What is affected by CHF

A

Reduced cardiac output - due to left/right ventricular dysfunction

Systolic dysfunction - due to impairment of left ventricle

Diastolic dysfunction - due to resistance to filling of one or both ventricles

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7
Q

Systolic dysfunction is when

A

The ventricles fill with blood and then can only pump out less than 40-50% of the blood

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8
Q

Diastolic dysfunction is when

A

The stiff ventricles fill with less blood

The ventricles then only can pump out 60% of the blood

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9
Q

What are the most common causes of CHF (3)

A

Conornary artery disease

Hypertension

Myocardial infarction

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10
Q

What causes systolic dysfunction (reduced ejection fraction)

A

Afterload

Impaired contractility

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11
Q

What is Afterload

What causes it

A

Chronic pressure overload

Advanced aortic stenosis
Uncontrolled severe hyptertension

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12
Q

What causes impaired contractility

A

Cononary artery disease

Chronic volume overload

Dilated cardiomyopathies

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13
Q

What causes diastolic dysfunction (preserved ejection fraction)

A

Impaired diastolic filling

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14
Q

Myocardial injury results in

A

Reduced cardiac output

Decreased carotid baroreceptor stimulation

Decreased renal perfusion

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15
Q

Reduced carotid BR stimulation and Renal perfusion results in

A

Activation of SNS and renin angiotensin aldosterone system (RAAS)

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16
Q

Activation of the SNS (from reduced carotid BR stimulation and Renal perfusion) results in

A

Increase HR and inotropy (contraction/force of muscle)

Myocardial toxicity

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17
Q

Activation of the RAAS results in

A

B type natriuretic peptides (BNP) released

A type natriuretic peptides (ANP) released

Vasconstriction - increases Afterload

Hemodynamic alterations - increases Preload

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18
Q

What causes vasoconstriction

A

Increased angiotensin 2

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19
Q

What causes hemodynamic alterations

A

Increased aldosterone

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20
Q

What does BNP and ANP both do

A

Decrease TPR and Central venous pressure

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21
Q

Where is BNP secreted and in response to what

A

By the ventricles in response to excessive stretching of cardiomyocytes

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22
Q

Where is ANP secreted and in response to what

A

By atria in response to high blood volume

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23
Q

What is the SNS then inhibited by

Which results in

A

Beta blockers

Negative remodeling

Worsened LV function

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24
Q

What is the RAAS inhibited by

A

ACE inhibitors

Angiotensin receptor blockers

Aldosterone antagonists

ADH antagonists

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25
Negative remodeling and worsened LV function result in
Symptoms of HF
26
During exercise the neural pathway consists of
Arterial baroreceptors and skeletal muscle mechano receptors go brain Brain creates sympathetic or parasympathetic to change HR and SV, also vasculature in muscle Changes cardiac output Changes in total vascular conductance Resets BP
27
The rein angiotensin aldosterone system is made up of
Liver Kidneys
28
Liver produces
Angiotensinogen
29
Kidney produces
Renin when there is a decrease in renal perfusion
30
Angiotensinogen and Renin create
Angiotensin 1
31
ACE is produced
On the surface of pulmonary and renal endothelium
32
Angiotensin 1 and ACE create
Angiotensin 2
33
Angiotensin 2 causes
Increase Sympathetic activity Increase Tubular NA and CL reabsorption and K excretion = H2O retention Stimulation of Adrenal gland cortex Stimulation of arteriolar vasoconstriction - increases blood pressure Stimulation of pituitary gland posterior lobe
34
All the stimulations of angiotensin cause what
Water and Salt retension Effective circulating volume to increase Perfusion of the juxtaglomerular apparatus to increase - inhibitatory signal to stop renin from being produced in kidney
35
What does the stimulation of the adrenal gland cortex cause
Aldosterone secretion Which stimulates H2O retention
36
What does the stimulation of the pituitary gland posterior lobe cause
ADH secretion Which stimulates H2O absorption in collecting duct
37
Regulation of stroke volume includes
EDV Aortic blood pressure Contractility of ventricles
38
What is EDV
End diastolic volume Volume of blood in ventricles = preload
39
What is aortic blood pressure
Pressure that heart must pump against to eject blood = afterload
40
What enhances contractility
Circulating Epi and NeoEpi Direct sympathetic stimulation of heart
41
Coronary artery disease (CAD) is a result of
Ischemic heart disease (IHD) Build up of plaque in the coronary arteries Risk factors
42
What is the most common cause of death
Coronary artery disease
43
What does the build up of plaque in coronary arteries cause
Leads to limited blood flow to the heart (ischemia) Leads to heart attack (MI)
44
What are the risk factos of CAD
High LDL Low HDL Hypertension Family history Diabetes Smoking Obesity
45
Medical management of CAD includes
Pharmacological treatment Coronary intervention Revascularisation
46
Pharmacological treatment of CAD involves
Statin (cholesterol lowering) Beta blockers Calcium channel blockers Antiplatelet drugs (aspirin)
47
Coronary intervention of CAD involes
Angioplasty - unblocking blood vessel Coronary stent - widening of blood vessel
48
Revascularisation of CAD involves
Coronary artery bypass grafting ``` 4 different levels: Single Double Triple Quadruple ```
49
Myocardial infaraction occurs when
Blood flow stops to a part of the heart Causes damage to cardiac muscle Mostly due to coronary artery disease
50
Heart attack (MI) risk in monitored by
Atherosclerotic plaque Inflammation indicated by high sensitivity C - reactive protein (hs-CRP) Calcification from calcium deposit as part of plaque formation
51
rs-CRP risk levels are
<1 mg/L = low risk 1-3 mg/L = average risk > 3 mg/L = high risk
52
Elevated levels of CRP predict
Risk of MI and stroke
53
Calcification can be detected by
CT scans Detect calcium deposits from plaque formation
54
What produces CRP and in response to what
Liver In response to factors released by macrophages and adipocytes
55
What are the typical signs of myocardial infarction
Discomfort in center of chest Uncomfortable pressure, pain Pain/discomfort in one or both arms, back, neck, jaw or stomach Shortness of breath with or without chest discomfort Breaking out in cold sweat, nausea or lightheadness
56
Medications and precautions during exercise (list of drugs)
Diuretics Beta Blockers Vasodilators, ACE inhibitors and angiotensin receptor blockers Calcium channel blockers CNS active drugs Alpha receptor blockers
57
Diuretics result in
No impact on aerobic capacity False positive test
58
Beta blockers result in
Decreased submax and max HR Sometimes decreased exercise capacity
59
Vasodilators , ACE inhibitors and Angiotensin receptor blockers result in
Do not affect HR response May experience Hypotension
60
Calcium channel blockers may result in
Decrease HR response at rest and during exercise
61
CNS active drugs result in
Attenuating effects on HR and BP during exercise
62
Alpha receptor blockers result in
Significantly lower BP Minimal effects on HR and metabolic responses to exercise
63
True positive refers to
Positive exercise test CVD
64
True negative refers to
Negative exercise test No CVD
65
False positive refers to
Positive exercise test No CVD
66
False negative refers to
Negative exercise test CVD
67
Adrenalin and Noradrenalin affect on Alpha 1 leads to
Smooth muscle contraction
68
Adrenalin and Noradrenalin affect on Alpha 2 leads to
Inhibition of transmitter release Smooth muscle contraction
69
Adrenalin and Noradrenalin affect on Beta leads to
Heart muslce contraction Smooth muscle relaxation Glycogenolysis
70
In patient aerobic frequency (FITT) with CAD and MI
2-4 times/day for 1st 3 days in hospital 2 times/day for day 4 in hospital
71
In patient aerobic Intensity (FITT) with CAD and MI
To tolerance if asymptomatic RPE <= 13 Post MI/CHF = HR <=120 bpm or HRrest +20 bpm Post surgery = HRrest +30 bpm
72
In patient aerobic Time (FITT) with CAD and MI
Begin intermittent bouts of 3-5 mins as tolerated Rest period - slower walk 2:1 exercise/rest ratio Progress to 10-15mins
73
In patient aerobic Type (FITT) with CAD and MI
Tolerate
74
Aerobic prescription with CAD and MI (FITT)
4-7 days/wk (short bouts of 1-10mins) RPE 11 to 16 40-80% HR below ischemic threshold Warm up 5 -10min 20-60 min exercise Tolerate
75
Muscular strength and endurance prescription with CAD and MI (FITT)
3-4 days/week 2-4 sets 12-15 reps 8-10 exercises As long as it takes Functional movements Circuit training Avoid straining and holding breath
76
What are the increasing effects of exercise training with CAD and MI
Maximal oxygen consumption Ventilatory response Anaerobic and ventilatory threshold HDL Self efficacy Numbers of endothelial progenitors cells and cells that promote angiogensis and vascular regeneration Vegal tone
77
What are the decreasing effects of exercise training with CAD and MI
Modest decrease in body weight, fat stores, BP, total blood cholesterol etc Relief of angina Protection against triggering MI by vigerous physical exertion Coronary inflammatory markers (hs-CRP) Adrenergic activity
78
What is the exercise response in CHF
Alterations in Central, Peripheral and Ventilatory abnormalities
79
Exercise testing considerations for CHF (table)*****
*******
80
Exercise programming in CHF consists of
Referral to cardiac rehabilitation Basic CCD4 recommendations Re evaluate frequently Prolong warm up and cool down Perceived exertion and dyspnea scales > target heart rates No isometric exercise Electrocardiogram monitoring required when history Resistance training safe in people with systolic dysfunction who are stable
81
What is the neural effect of exercise training in CHF
Central Reflex Neurohumoral
82
What is the muscular effect of exercise training in CHF
Biochemical Metabolic Structural
83
What is the cardiac effect of exercise training in CHF
Contractility Hemodynamic
84
What is the vascular effect of exercise training in CHF
Vasodilatory
85
Overall exercise training in HF causes
RAAS to decrease Chemoreceptors reducing stimulation of SNA Arterial baroreceptors increasing inhibition of SNA Exercise pressor reflex reducing stimulation of SNA Overall reduction in ANG 2 - reduces SNA and ventilation
86
Reduction in RAAS causes
Less circulating and tissue ANG 2 Increase blood flow
87
Exercise pressor reflex causes
Reduced SNA stimulation Increase TRPV 1 receptors Increase CB1 recpetors Decrease inflammation
88
Missing ____ reflects absence of atrial depolarization in atrial fibrillation
P Wave
89
Restoring the heart to a normal rhythm by pharmacologic agents is one way for the medical management of atrial fibrillation
False
90
Heart rate responses to exercise in individuals with atrial fibrillation can be affected by medication use
True
91
During exercise, stroke volume in individuals with atrial fibrillation is reduced due to limited atrial assistance during ventricular systole
False
92
Hs-CRP level 2mg/L classifies average risk for cardiovascular disease
True
93
______ happens when the blood flow to a part of the heart is blocked and cause cardiac muscle cell death
Heart attack
94
Which of following describes general pathophysiology of chronic heart failure
Increase in preload
95
If your patient (with heart failure) takes __________, it will lower BP significantly during exercise (or testing) and will have minimal effects of HR and metabolic response to exercise
Alpha receptor blockers
96
BNP is secreted by atria in response to high blood volume
False
97
Aldosterone is secreted from pituitary gland, and it increases water retention in collecting duct
False
98
Weakened heart muscle which cannot squeeze the ventricle well describes the typical characteristic of diastolic heart failure
False
99
Which of the following describes the effect of exercise training in patients with Coronary Artery Disease and Myocardial Infarction
Decreased Hs-CRP level
100
Coronary artery disease leads limited blood flow to the heart which causes ischemia, then it may lead ____
Heart attack
101
Ventilation perfusion mismatching is a typical characteristic of heart failure indicated by VE/VCO2 slope ≤34 as a poor prognosis
False
102
End diastolic volume in systolic heart failure will decrease with exercise training
True
103
True positive in testing indicates
Tested positive for CVD Have CVD
104
False positive in testing indicates
Tested positive for CVD But dont actually have CVD
105
True Negative in testing indicates
Tested negative for CVD No CVD
106
False Negative in testing indicates
Tested negative for CVD But you actually have CVD
107
Diuretics do what
Increase urine production Have no impact on aerobic capacity Can result in a false positive test
108
Beta blockers do what
Decrease submax and max heart rate Sometimes decrease exercise capacity
109
Vasodilators, ACE inhibitors and angiotensin receptor blockers do what
Have no affect on HR response May experience hypotension
110
Calcium channel blockers do what
Some may decrease HR response at rest and during exercise
111
CNS active drugs do what
Have attenuating effects on HR and BP during exercise
112
Alpha receptor blockers do what
Significantly lower BP Have minimal effects on HR and metabolic responses to exercise

Kin 187 (21 decks)

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