Heart Failure Flashcards
Heart failure, often referred to as _________
congestive heart failure (CHF)
Heart failure is the common end point for many forms of cardiac disease and
typically is a progressive condition with a poor prognosis
T/F
T
Roughly one half of patients of heart failure die within ______ of receiving a diagnosis of CHF
5 years
CHF occurs when the heart cannot generate ______ to meet the metabolic demands of the tissues, or
can only do so at ___________;
sufficient output
higher-than-normal filling pressures
in a (minority or majority ?) of cases, heart failure is a consequence of greatly increased tissue demands, as in ______, or decreased oxygen carrying capacity, as in ________ (high output failure).
Minority
hyperthyroidism
anemia
ONSET
The onset of CHF is sometimes abrupt, as in the setting of a (small or large?) myocardial infarct or (acute or chronic?) valve dysfunction. •
Large
Acute
ONSET
In most cases, however, CHF develops ______ and ______ owing to the cumulative effects of _________ or —————- of myocardium.
gradually and insidiously
chronic work overload
progressive loss
CAUSES of heart failure
Heart failure may result from ______ or ______ dysfunction. L
systolic or diastolic
CAUSES of heart failure
Systolic dysfunction results from inadequate myocardial _______ function, usually as a consequence of ischemic heart disease or hypertension.
contractile
CAUSES of heart failure
Diastolic dysfunction refers to an inability of the heart to adequately _____ and ____, which may be a consequence of massive ____________, Myocardial _____,
_____ deposition, or constrictive pericarditis.
relax and fill
left ventricular hypertrophy
fibrosis; amyloid
Approximately one half of CHF cases are attributable to (systolic of diastolic?) dysfunction, with a greater frequency seen in ____, _______ patients, and (men or women?) .
Diastolic
older adults, diabetic
Women
OTHER CAUSES of CHF
______ dysfunction (e.g., due to endocarditis)
may occur following rapid increases in _______ or_______, even if the heart is normal.
valve
blood volume
blood pressure
PATHOGENESIS of CHF: FORWARD-BACKWARD FAILURE
When, the failing heart can no longer efficiently pump blood, there is an increase in _______ ventricular volumes, increased _______ pressures, and elevated _______ pressures.
Thus, inadequate ________— called (forward or backward?) failure—is almost always accompanied by
increased ____________—that is, (forward or backward?) failure.
end-diastolic
end-diastolic
venous
cardiac output ; Forward
congestion of the venous circulation; backward
PATHOGENESIS
FORWARD-BACKWARD FAILURE
Although the root problem in CHF typically is deficient _______, virtually every other organ is _______ by some combination of ________ and _______
cardiac function
eventually affected
forward and backward failure.
PATHOGENESIS of CHF
The cardiovascular system attempts to compensate for reduced myocardial contractility or increased hemodynamic burden through several homeostatic mechanisms:
___________ mechanism
Activation of _______ systems
Activation of the _________ system Release of ____________
Myocardial ________ changes
Frank-Starling
neurohumoral
renin-angiotensin-aldosterone
atrial natriuretic peptide
structural
PATHOGENESIS
• The Frank-Starling mechanism.
Increased end-diastolic filling volumes ____ the heart and cause increased __________; these lengthened fibers ________________ , thereby increasing cardiac output.
dilate; cardiac myofiber stretching
contract more forcibly
PATHOGENESIS
• The Frank-Starling mechanism.
If the dilated ventricle is able to maintain cardiac output by this means, the patient is said to be in ______________
However, ventricular dilation comes at the expense of ________ and magnifies the ____________ of an already-compromised myocardium.
With time, the failing muscle is no longer able to propel sufficient blood to meet the needs of the body, and the patient develops _____________
compensated heart failure.
increased wall tension
oxygen requirements
decompensated heart failure.
PATHOGENESIS
• Activation of neurohumoral systems:
Release of the neurotransmitter _________ by the autonomic nervous system increases _____ and augments myocardial ______ and vascular ______.
norepinephrine
heart rate
contractility
resistance
PATHOGENESIS
• Activation of the renin-angiotensin-aldosterone system spurs ____________(augmenting circulatory volume) and increases ________
water and salt retention
vascular tone.
PATHOGENESIS
• Release of atrial natriuretic peptide acts to balance the _________ through _____ and ____________.
renin- angiotensin-aldosterone system
diuresis
vascular smooth muscle relaxation
PATHOGENESIS
• Myocardial structural changes, including augmented ______. Cardiac myocytes adapt to increased workload by _________, a change that is accompanied by myocyte ______ (_______)
muscle mass
assembling new sarcomeres
enlargement
hypertrophy
PATHOGENESIS
In pressure overload states (e.g., hypertension or valvular stenosis), new sarcomeres tend to be added in (parallel or series?) to the (short or long?) axis of the myocytes, adjacent to existing sarcomeres. The growing muscle fiber diameter thus results in ( concentric or eccentric ?) ________—the ventricular wall _______ increases (with or without ?) an increase in the _______
Parallel ; long
Concentric
hypertrophy
thickness
Without ; size of the chamber.
PATHOGENESIS
In volume overload states (e.g., valvular regurgitation or shunts), the new sarcomeres are added in (parallel or series?) with existing sarcomeres, so that the muscle fiber _____ increases.
Consequently, the ventricle tends to ____, and the resulting wall thickness can be _____,______, or ______; thus,
Series; length
dilate
increased, normal, or decreased
heart _____—rather than ________—is the best measure of hypertrophy in volume-overloaded hearts.
Weight
wall thickness
