Heart Failure

Question 1

Heart failure caused by any condition that does what?

Answer 1

↓ efficiency of myocardium thru damage or overloading

Question 2

Physiological definition of HF

Answer 2

heart unable to pump at required rate for metabolizing tissues OR has to use elevated filling pressure to do so

Question 3

Clinical definition of HF

Answer 3

abnormalities of L vent fxn and neuorhormal regulation accompanied by:
effort intolerance
fluid retention
reduced longevity

Question 4

Goal of cardiovascular system is?

Answer 4

maintain CO

Question 5

Consequences of ↓ CO? (2)

Answer 5

hypoperfusion of organs

exercise intolerance

Question 6

Consequences of left failure?

Answer 6

↑ L atrial pressure ->

pulmonary congestion and dyspnea

Question 7

Consequences of right failure?

Answer 7

↑ R atrial pressure ->
systemic congestion
LE edema

Question 8

Life expectancy w/ L vent failure?

Answer 8

5 yrs

Question 9

HTN causes what kind of overload?

Answer 9

pressure overload

Question 10

Valvular disease causes what kind of overload?

Answer 10

pressure and volume overload

Question 11

MI causes what kind of dysfxn?

Answer 11

regional

Question 12

Cardiac dyfxn characterized by? (4)

Answer 12

↑heart size and mass
adnorm proteins
fibrosis
inadequate vasculature

Question 13

Depression of contractility leads to?

Answer 13

↓ length-tension curve:

ejection of ↓ SV at same EDV

Question 14

Symp NS compensation for ↓ contractility?

Answer 14

can stim ↑ contractility but not back to normal levels,

eventually SNS is exhausted

Question 15

Symp NS becomes depressed when what happens (3)?

Answer 15

1) ↓ cardiac NE stores
2) ↓ β-adrenoceptor denisty
3) ↓ catecholamine sensitivity

Question 16

Physio basis for ↓ contractility? (3)

Answer 16

1) impaired Ca2+-induced Ca2+ release
2) fiber-type changes
3) ↓ Ca2+ sensitivity

Question 17

Kidney tries to compensate for ↓ CO how?

Answer 17

retains H2O to cause ↑ in blood volume ->

↑ EDV

Question 18

Final signs of HF: contractility?

Answer 18

contractility significantly decreased, SNS no longer able to compensate

Question 19

Final signs of HF: SV?

Answer 19

no longer able to maintain SV

Question 20

Final signs of HF: stretch?

Answer 20

mm fibers stretched beyond optimal length

Question 21

Final signs of HF: EDV?

Answer 21

increased EDV no longer effective

Question 22

Forward failure caused by?

Answer 22

inadequate SV

Question 23

Backward failure caused by?

Answer 23

blood back-up in venous system ->

congestive HF

Question 24

Eccentric hypertrophy is?

Answer 24

↑ mm mass where vent gets longer/bigger, not thicker (adds sarcomeres)

Question 25

Eccentric hypertrophy caused by?

Answer 25

volume overload: vents dilate -> regurg and ↑ diastolic P -> ↑ mm mass

Question 26

Concentric hypertrophy is?

Answer 26

↑ mm mass where walls get thicker (∆ in ratio of contractile proteins to mitochondria) results in smaller chambers

Question 27

Concentric hypertrophy caused by?

Answer 27

pressure overload: chronic SNS stim -> ↑ contractility -> SNS exhaustion

Question 28

1st step in L vent failure?

Answer 28

L vent weakens -> ↓ emptying

Question 29

2nd step in L vent failure?

Answer 29

↓ CO to system

Question 30

3rd step in L vent failure?

Answer 30

↓ renal blood flow -> stim renin-angiotension/aldosterone secretion (fluid retention) this is postive-feedback loop

Question 31

4th step in L vent failure?

Answer 31

blood back-up in pulmonary vein -> | ↑ P in pulmonary capillaries

Question 32

5th step L vent failure?

Answer 32

↑ P in pulmonary capillaries -> | pulmonary congestion/edema

Question 33

High pulmonary arterial pressure from L vent failure can lead to what effect on R heart?

Answer 33

↑ afterload in R vent | Ѧ R vent failure

Question 34

L vent failure causes edema where?

Answer 34

pulmonary | Most common = CHF

Question 35

R vent failure causes edema where?

Answer 35

peripheral

Question 36

1st step R vent failure?

Answer 36

R vent weakens -> ↓ emptying

Question 37

2nd step R vent failure?

Answer 37

↓ CO to system

Question 38

3rd step R vent failure?

Answer 38

↓ renal blood flow -> | stim renin-angiotension/aldosterone secretion (fluid retention)

Question 39

4th step R vent failure?

Answer 39

blood back-up in systemic circ (vena cava) -> ↑ venous P -> ↑ capillary P

Question 40

5th step R vent failure?

Answer 40

↑ capillary P -> | edema in LE, liver, abdominal organs

Question 41

6th step R vent failure?

Answer 41

venous P now extremely ↑ -> | distended neck vein and cerebral edema

Question 42

Shock is result of what?

Answer 42

failure of CVS to adequately perfuse tissues -> | impaired oxygenation and cell metabolism

Question 43

Shock progresses to?

Answer 43

hypotension, organ failure and death

Question 44

Cardiogenic shock is result of?

Answer 44

↓ myocardial fxn

Question 45

Hypovolemic/hemorrhagic shock is result of?

Answer 45

↓ blood volume | bleeding, diarrhea, vomiting, burns

Question 46

Vasogenic (vessel produced) shock is result of?

Answer 46

vasodilation from: 1) anaphylactic rxn (peripheral vasodi) 2) septic (massive vasodi)

Question 47

Neurogenic shock is result of?

Answer 47

inhibited symp vasoconstrictor nerves -> | loss of vascular tone

Question 48

Common final event of all types of shock is?

Answer 48

hypoxia

Question 49

Hemorrhagic Shock specifically due to?

Answer 49

fall in arterial pressure (MAP) from massive blood loss

Question 50

Compensatory response to Hemorrhagic Shock?

Answer 50

Baroreceptor reflex -> ↑ SNS: ↑ HR, contractility, TPR, venoconstriction, shunting blood from skin to organs RAS: ↑ angiotensin II and aldosterone ADH release

Question 51

Result of Irreversible Shock?

Answer 51

body can't compensate -> severe vasoconstriction of essential beds (brain, heart, renal)