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Semester 2 > CVS Session 11 > Flashcards

CVS Session 11 Flashcards

1
Q

What is high output heart failure?

A

When the output remains the same but demand increases

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2
Q

Give examples of some causes of heart failure.

A 
IHD
Hypertrophic cardiomyopathy
Hypertension
Valvular disease
Dilated cardiomyopathy
Arrhythmias 
Amyloidosis
Pericardial disease
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3
Q

What is the primary cause of systolic heart failure?

A

IHD

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4
Q

What can cause high output heart failure?

A

A-V fistula

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5
Q

What can cause dilated cardiomyopathy?

A

Alcohol/drugs/poisoning
Idiopathic
Pregnancy
Viral/bacterial/mycobacteria

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6
Q

What kind of care is often needed with class IV heart failure?

A

Palliative

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7
Q

Describe Class I heart failure.

A

Asymptomatic

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8
Q

What class of heart failure is a patient who describes having symptoms of breathlessness on ordinary physical activity but is asymptomatic at rest?

A

II

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9
Q

How do patients with Class III heart failure present?

A

Marked limitation of physical activity

Asymptomatic at rest

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10
Q

Which class of heart failure do patients who are unable to carry out physical activity w/out symptoms belong?

A

IV

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11
Q

Which class of heart failure patients may be symptomatic at rest?

A

IV

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12
Q

What does cardiac output depend on?

A

HR
Venous capacity
Aortic and peripheral impedance
Myocardial contractility

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13
Q

What is left ventricular preload?

A

Venous capacity

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14
Q

What is after load?

A

Pressure needed to overcome aortic and peripheral impedance

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15
Q

What is plotted on each axis to give a graph of Starling’s law of the heart?

A 
X = cardiac filling/end diastolic volume
Y = cardiac output
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16
Q

What does Starling’s law of the heart state?

A

Force developed in a muscle fibre depends on the degree to which the fibre is stretched

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17
Q

What is the average cardiac output for an adult?

A

5 litres per minute

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18
Q

What is the average stroke volume for an adult?

A

75 ml per beat

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19
Q

What is the average LV end systolic volume?

A

75 ml

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20
Q

What is the average LV end diastolic volume?

A

150 ml

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21
Q

In what range does a healthy ejection fraction lie?

A

> 50%

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22
Q

Who much does the average adult heart weigh?

A

330 g

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23
Q

Describe the fine line in treatment for gross heart failure.

A

Over treat with too many diuretics

Undertreat so fluid levels are too high –> congestive symptoms

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24
Q

What can decrease cardiac output it becomes ineffective in a normal heart?

A

Dehydration

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25
Q

What is systolic heart failure?

A

Inability to effectively pump blood out of the heart

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26
Q

How does the remodelling of the heart in acute infarction and diastolic/systolic heart failure differ?

A

Acute - one sided due to injury

Diastolic/systolic - same both sides

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27
Q

What happens to the left ventricular capacity in systolic dysfunction?

A

Increases due to thinning of myocardial wall

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28
Q

What causes mitral regurgitation in systolic dysfunction?

A

Valve leaflets are pulled apart due to cardiac dilation

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29
Q

What changes to the heart are seen in diastolic dysfunction?

A

Hypertrophy

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30
Q

What are the structural changes to the heart in heart failure?

A

Loss of muscle
Uncoordinated contraction
Myocardial fibre orientation slips

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31
Q

What happens to the collagen levels in the ECM of cardiac myocytes in heart failure?

A

Increase

III > I

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32
Q

What is heart failure?

A

Clinical syndrome caused by an abnormality of the heart which means cardiac output does not meet the demand of metabolising tissues

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33
Q

What happens to myocytes in systolic dysfunction?

A 
Lysis
Vacuolation
Hypertrophy
SR dysfunction
Changes the calcium availability
Changes to receptor regulation
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34
Q

What mediates the sympathetic nervous system?

A

Baroreceptors

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35
Q

What effects does activation of the sympathetic nervous system have?

A

Increase cardiac contractility
Arterial and venous vasoconstriction
Tachycardia

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36
Q

What long-term damaging effects does activation of the sympathetic nervous system have?

A 
Down regulation of beta-adrenoceptors
Cardiac hypertrophy
Myocyte apoptosis and necrosis via alpha-receptor stimulation
Increase RAAS
Reduce HR variability
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37
Q

Name an anti-diuretic hormone.

A

Vasopressin

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38
Q

What does ADH act on?

A

V2 receptors in the collecting duct

39
Q

What electrolyte state does ADH release cause?

A

Hyponatraemia

40
Q

How does ADH increase cardiac output?

A

Causes water retention
Decreases systemic resistance
Increase HR

41
Q

Give the products of angiotensinogen.

A

Angiotensinogen –> angiotensin I –> angiotensin II

42
Q

Which receptors does angiotensin II act on?

A

AT1R

AT2R

43
Q

How does bradykinin work?

A

Acts on Bk2R

Increases NO

44
Q

What can activation of the AT1R cause?

A

Stroke
Hypertension
LVH
Renal failure

45
Q

What are the effects of natriuretic hormones?

A

Vasodilatation

Increased sodium excretion

46
Q

What does natriuretic hormone stimulate upon detection of atrial and ventricular stretch?

A

Constriction of afferent and dilatation of efferent arterioles in kidney

47
Q

What effect does constriction of afferent arterioles and dilatation of efferent arterioles have on kidney function?

A

Decreases sodium retention
Decreases renin
Decreases aldosterone

48
Q

Where does brain natriuretic detect stretch?

A

Ventricles

49
Q

Do atrial and brain natriuretic peptides have the same effects?

A

Yes

50
Q

What can be measured in the blood in addition to carrying out an ECG to investigate heart failure?

A

Brain natriuretic hormone

51
Q

What balances effects of RAAS on vascular tone and sodium/water balance?

A

Atrial and brain natriuretic hormones

52
Q

Where is angiotensinogen released from?

A

Liver
Blood vessels
Brain

53
Q

Where is the sympathetic nervous system stimulated?

A

Macula Rensa

54
Q

What are the mechanisms of neuro-hormonal activation in heart failure?

A 
ADH
Sympathetic nervous system
RAAS
Natriuretic hormones
Endothelin
Prostaglandin E2 and I2
Nitric oxide
Bradykinin
Alpha-TNF
55
Q

What method of hormonal secretion does endothelin use?

A

Autocrine

56
Q

What can be measured in the blood that correlates with the severity of heart failure?

A

Endothelin

Brain natriuretic peptide

57
Q

Where is endothelin released from?

A

Vascular endothelial cells

58
Q

How does endothelin act as a renal vasoconstrictor?

A

Activates RAAS

59
Q

What is stimulated by NA and RAAS to cause vasodilation on afferent renal arterioles?

A

Prostaglandin E1 and I2

60
Q

Which enzyme may be blunted in heart failure which would result in a loss of vasodilation balance?

A

Nitric oxide synthase

61
Q

What molecule promotes natriuresis and vasodilation and stimulates prostaglandin production?

A

Bradykinin

62
Q

What are the roles of alpha-TNF in heart failure?

A

Depress myocardial function
May stimulate NO synthase
May have role in cachexia

63
Q

What might cause patients with chronic heart failure to lose weight?

A

Too breathless to eat
Muscle wastage
Alpha-TNF causing cachexia

64
Q

What causes skeletal muscle changes in the later stages of heart failure?

A

Neuro-hormonal increase in peripheral arterial resistance

65
Q

What causes the fatigue and exercise intolerance in the later stages of heart failure?

A

Decreased bloodflow to all skeletal muscles incl. limbs and respiratory

66
Q

Are there abnormalities in structure, function or both of skeletal muscle in the later stages of heart failure?

A

Both

67
Q

Why does decreased cardiac output have renal effects?

A

Kidneys have a large requirement for blood

68
Q

How is glomerular filtration rate maintained in early heart failure?

A

Haemodynamic changes at the glomerulus

69
Q

How does a fall in GFR appear in the blood?

A

High serum urea and creatinine

70
Q

What can exacerbate high serum levels of urea and creatinine?

A

Angiotensin II inhibitor

71
Q

What is often confused with heart failure on diagnosis?

A

Anaemia - contributes to symptoms

72
Q

What can cause anaemia in heart failure?

A 
Chronic inflammatory disease (not in mild)
Expanded plasma volume
Drug therapy
Iron malabsorption
Chronic renal failure
73
Q

What is a rare action of ACEI in some individuals on their bone marrow?

A

It is suppressed

74
Q

What is diastolic dysfunction?

A

Failure of cardiac relaxation

75
Q

Who is typically affected by diastolic dysfunction?

A

Elderly female w/ +ve Hx of hypertension/diabetes/obesity

76
Q

How can left ventricle function be described in diastolic dysfunction?

A

Normal

77
Q

What kind of left ventricular hypertrophy is seen in diastolic dysfunction?

A

Concentric

78
Q

How does diastolic dysfunction compare to systolic dysfunction clinically?

A

Diagnosis less clear cut

Hospitalisation and mortality similar

79
Q

Describe the pathogenesis of diastolic dysfunction.

A

Impaired myocardial relaxation
Decreased LV compliance
Impaired diastolic LV filling
Unable to compensate by increasing LV end diastolic pressure
Decreased cardiac output –> neuro-hormonal activation

80
Q

What is congestive heart failure?

A

When both sides of the heart are affected

81
Q

What is the most common cause of right-sided heart failure?

A

Left heart failure

82
Q

If right sided heart failure occurs in isolation, what is the likely cause?

A

Lung condition e.g. COPD, valvular disease, ASD, VSD

83
Q

What are the S/S for right sided heart failure?

A 
Fatigue
Dyspnoea
Anorexia
Nausea
Increased JVP
Tender, smooth hepatic enlargement
Pitting oedema
Ascites
Pleural effusion
84
Q

What type of heart rhythm is heard in a patient with left sided heart failure?

A

Gallop

85
Q

What are the S/S of mild left sided heart failure?

A

Fatigue
Exertional dyspnoea
Orthopnea
Paroxysmal nocturnal dyspnoea

86
Q

What S/S are seen when LHF progresses from a mild state?

A 
Tachycardia
Cardiomegaly
3rd +/- more rare 4th heart sound
Mitral regurgitation murmur
Basal pulmonary crackles
Peripheral oedema
87
Q

What is the first stage in heart failure management?

A

Correct underlying cause

88
Q

What lifestyle modifications can be made to manage heart failure?

A

Decrease salt, alcohol and BP

More aerobic exercise

89
Q

What classes of drugs can be used to improve the symptoms of heart failure?

A

Diuretics
Beta-blockers
Anti-arrhythmics

90
Q

What treatment can be used to inhibit rennin systems in order to delay the progression of heart failure if ACEI are not tolerated?

A

Nitrates

91
Q

How does a biventricular pacemaker work?

A

Increase biventricular heart contraction coordination to increase cardiac output (heart still failing but CO sufficient)

92
Q

How do implantable defibrillators work?

A

Pace quickly or deliver shock to heart to restore normal rhythm

93
Q

Why can ACEI cause a dry cough?

A

Increase bradykinin levels in the lungs

94
Q

What is a common cause for using angiotensin II receptor antagonists instead of ACEI to treat heart failure?

A

Dry cough

Semester 2 (45 decks)

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