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TAS Cardiology > Heart Failure ✅ > Flashcards

Heart Failure ✅ Flashcards

(60 cards)

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1
Q

What is heart failure?

A

When the heart is unable to maintain adequate perfusion of the tissues for normal metabolism

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2
Q

What can the causes of heart failure be divided into?

A
  • Volume overload
  • Pressure overload
  • Cardiac arrhythmias
  • Ventricular dysfunction
  • Other
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3
Q

What are the causes of volume overload leading to heart faiure?

A
  • Left-to-right shunts
  • Valvular regurgitation
  • Complex regional cardiac lesions
  • Arteriovenous malformations
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4
Q

Give 2 arteriovenous malformations that can lead to heart failure?

A
  • Vein of Galen

- Haemangioma

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5
Q

What can cause pressure overload leading to heart failure?

A
  • Left heart obstruction
  • Acute hypertension
  • Right heart obstruction
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6
Q

Give 3 causes of left heart obstruction leading to heart failure

A
  • Aortic stenosis
  • Coarctation of the aorta
  • Hypoplastic left heart
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7
Q

Give 2 causes of acute hypertension that can lead to heart failure?

A
  • Haemolytic uraemic syndrome

- Glomerulonephritis

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8
Q

Give a cause of right heart obstruction that can lead to heart failure

A

Pulmonary stenosis

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9
Q

What cardiac arrhythmias can lead to heart failure?

A
  • Congenital complete heart block
  • Supraventricular tachycardia
  • Ventricular tachycardia
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10
Q

What causes of ventricular dysfunction can lead to heart failure?

A
  • Myocarditis
  • Cardiomyopathy
  • Sepsis
  • Anaemia
  • Pericardial effusion/cardiac tamponade
  • Ischaemia
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11
Q

What kinds of cardiomyopathy can lead to heart failure?

A
  • Dilated
  • Hypertrophic
  • Restrictive
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12
Q

What can cause ventricular ischaemia leading to heart failure?

A
  • Birth asphyxia

- Anomalous left coronary artery

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13
Q

What is the most likely underlying cause of heart failure dependent on?

A

The age of the child

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14
Q

What is the most likely underlying cause of heart failure in neonates and infants younger than 2 months?

A

Structural heart diesaes

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15
Q

What are the other causes of heart failure?

A
  • Chronic hypertension
  • Renal failure
  • Metabolic disorders
  • Endocrine disorders
  • Anaemia
  • Illicit or accidental drug ingestion
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16
Q

What happens to the heart muscle in chronic heart failure?

A

There is a decrease in contractility of the affected heart muscle

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17
Q

What effect does the decrease in contactility of the heart muscle in chronic heart failure have on the Starlin curve?

A

It shifts it to the right

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18
Q

What is the implication of the reduced contractility of the heart in chronic heart failure?

A

Increasing preload has a smaller effect on stroke volume than seen in a healthy heart, leading to a low cardiac output state

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19
Q

What does the low cardiac output state trigger in chronic heart failure?

A

Cardiac, autonomic, and hormonal compensatory changes

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20
Q

What do cardiac compensatory changes aim to do in the low cardiac output state of chronic heart failure?

A

Increase stroke volume

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21
Q

What do attempts to increase stroke volume through cardiac compensatory mechanisms in chronic heart failure lead to?

A

Increased wall tension

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22
Q

What effect does the increased wall tension due to cardiac compensatory mechanisms in chronic heart failure have?

A

Increases oxygen consumption of the myocardium

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23
Q

What structural changes can develop to compensate in chronic heart failure?

A

Cardiac hypertrophy or dilatation

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24
Q

Why might cardiac hypertrophy or dilatation develop in chronic heart failure?

A

To try and balance the increased presure and keep the wall stress unchanged

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25
What might be required to treat cardiac dilation in chronic heart failure?
Diuretics
26
Why are diuretics used to treat dilation of the heart in chronic heart failure?
To reduce the preload
27
What autonomic compensatory changes might develop in early heart failure?
Increase in sympathetic stimulation
28
What triggers the increase in sympathetic stimulation in early heart failure?
Baroreceptors
29
How is increased sympathetic stimulation achieved in autonomic compensation for early heart failure?
Increased adrenal secretion of adrenaline and neural release of noradrenaline
30
What is the result of increased adrenaline and noradrenaline in early heart failure?
- Increases heart rate - Increases cardiac contracility - Increases blood pressure
31
How does adrenaline and noradrenaline increase the blood pressure in early heart failure?
By causing peripheral vasoconstriction
32
What negative effect can autonomic compensaotry changes in heart failure?
In the failing heart, the increase in afterload increases cardiac demands and will eventually further depress cardiac output
33
What effect does chronic adrenergic stimulation secondary to autonomic compensatory changes in chronic heart failure have?
- Hypermetabolism - Arrhythmogenesis - Direct myocardial toxicity
34
What effect does chronic adrenergic stimualtion have on the myocardium?
- Apoptosis - Hypertrophy - Focal myocardium
35
What does chronic exposure to high catecholeamine levels secondary to autonomic compensatory changes in chronic heart failure result in?
Decreased density of ß-adrenergic receptors on the myocardial surface
36
What does a decreased density of ß-adrenergic receptors on the myocardial cell surface result in?
Functional loss of the catecholamine-mediated inotropic response
37
What happens to the heart rate variability in chronic heart failure?
It is reduced
38
Why is the heart rate variability reduced in chronic heart failure?
Due to reduced sympathetic and vagal modulation at the sinus node
39
What is the clinical relevance of reduced heart rate variability in chronic heart failure?
It can be used as a prognostic marker
40
What hormones are involved in compensatory mechanisms in heart failure?
- Renin - Angiotensin II - Aldosterone - ADH - Endothelin
41
Why is renin released in heart failure?
Reduced blood flow to the kidneys results in a marked increase in renin production
42
What is the result of increased renin in heart failure?
It leads to stimulation of the renin-angiotensin-aldosterone system
43
What are the effects of angiotensin II?
- Acts as a potent vasoconstrictor - Stimulates release of noradrenaline from sympathetic nerve terminals - Inhibits vagal tone - Promotes release of aldosterone
44
Where does angiotensin II act as a potent vasoconstrictor?
- Renal effect arterioles | - Systemic circulation
45
What is the action of aldosterone?
- Increases sodium and water reabsorption | - Increases excretion of potassium
46
Where does aldosterone act to increase the excretion of potassium?
In the renal tubules
47
What is the effect of aldosterone increasing sodium and water reabsorption?
- Increases blood volume and central venous pressure (preload) - Increases peripheral oedema
48
What is the effect of volume expansion caused by aldosterone in chronic heart failure?
Leads to pressure overload resulting in the release of natriuretic peptides
49
What is the action of natriuretic peptides?
They antagonise the effect of angiotensin II on vascular tone and sodium reabsorption, causing vasodilation and natriuresis
50
Where does anti-diuretic hormone act?
On the renal collecting ducts
51
What is the action of ADH on the renal collecting ducts?
Increases water permeability and reduces urine formation
52
What is the result of the increased water permeability of the collecting ducts due to ADH action?
It increases total blood volume and so preload and afterload
53
What is endothelin secreted from?
Vascular endothelial cells
54
What is the function of endothelin?
It is a potent vasoconstrictor
55
Where does endothelin have pronounced vasoconstrictive effects?
On the renal vasculture
56
What does the vasoconstrive effect of endothelin on the renal vasculture promote?
The retention of sodium
57
What is the clinical relevance of plasma measurements of endothelin-1?
It is used as a prognostic indicator in heart failure
58
How effective are compensatory mechanisms in heart failure?
Only offer limited improvement
59
What is the limitation of compensatory mechanisms in chronic heart failure?
Increased cardiac filling initially increases cardiac output as per Starling’s law, but prolonged excessive filling results in progressive dilation of the heart, triggering hypertrophy and eventually failure
60
What is the result of increased renin in heart failur?

TAS Cardiology (7 decks)

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