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Flashcards in heart failure 2 Deck (22):
1

diastolic failure

1. ↑ stiffness requires ↑ pressure to achieve the same LV filling volume
2. difficulty/impaired filling
3. ↓lusitropy / decrease in relaxation
4. Produces ↓ SV

2

hallmark of diastolic dysfunction is

1. normal ejection fraction
2. ventricular wall thickening

3

Primary causes of diastolic HF

1. high afterload/pressure overload
2. myocardial thickening/fibrosis
3. external compression

4

High afterload / pressure overload caused by?

1. Hypertension (long-standing)
2. Aortic stenosis
3. Dialysis (inadequate volume removal)

5

Myocardial thickening / fibrosis can be caused by

1. Hypertrophic cardiomyopathy
2. Primary restrictive cardiomopathy

6

External compression

1. Pericardial fibrosis / constrictive pericarditis
2. Pericardial effusion

7

Primary causes of right-sided HF

1. Left heart failure
2. Lung disease / pulmonary HTN / RV pressure overload
3. RV Volume overload
4. Damage to the RV myocardium

8

Left heart failure can be caused by?

Backward HF from LV dysfunction stresses the right side by increasing pulmonary venous pressures

9

Lung disease / pulmonary HTN / RV pressure overload can be caused by?

1. Called “cor pulmonale” when primary lung dz causes HF
2. COPD, primary pulmonary hypertension, sleep apnea

10

RV Volume overload can be cause by?

1. Shunt (interatrial septal defect)
2. Tricuspid regurgitation

11

Damage to the RV myocardium
can be caused by?

1. Isolated RV infarct
2. Myocarditis

12

Clinically HF forms coexist

1. Systolic dysfunction is typically accompanied by diastolic dysfunction and vice versa
a. Fibrosis (scar tissue can’t contract or relax)
b. Ischemia (relaxation is energy dependent)
2. LV failure often causes RV failure

13

The cycle of HF: the problem

decreased CO

14

The cycle of HF: the solution?

1. Compensatory responses
2. Neurohormal activation
3. Frank-Starling (increasing preload)
4. Ventricular hypertrophy and dilation

15

heart failure can be compensated for by?

frank starling by the SV being preserved by increased end diastolic filling/pressure

16

chronic neurohormonal activation promotes HF by?

1. adrenergic activation
2. renin-angiotensin activation

17

adrenergic activation leads to

1. vasoconstriction
2. tachycardia
3. inotropic augentation

18

renin-angiotensin activation leads to

1. vasoconstriction
2. salt/water retention

19

neurohumoral activation leads to

1. NE
2. angiotension
3. aldosterone

20

remodeling growth of cardiac muscle call can be

1. hypertrophy
2. hyperplasia
3. necrosis
4. fibrosis

21

consequences of cardiac remodeling

1. decreased contractile force
2. decreased dynamic function
3. increased diastolic stiffness

22

compensation for low CO

1. sodium/fluid retention
2. hypertrophy
3. dilation
4. tachycardia