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Flashcards in Heart Failure Deck (53):
1

Heart failure produces a complex of symptoms related to:

inadequate perfusion of tissues and retention of fluid

2

Most common diagnosis of hospitalized pts aged 65 year and older

heart failure

3

What 'state' is the heart in in heart failure in regards to its ability to pump blood and cardiac filling pressures

heart is unable to pump blood at a rate sufficient to meet the requirements of metabolizing tissues, or is only able to do so only if the cardiac filling pressures are abnormally high (or both)

4

Three major determinants of stroke volume

– Contractility, preload, afterload

5

measured as LV end diastolic volume or pressure

preload

6

cardiac function increases as a function of ______

preload

7

In hear fail.. pt will increased _____ trying to achieve an increase in SV. This doesn't happen and instead we end up with______

LVED pressure or volume pulmonary congestion

8

Resistance the ventricle must overcome to empty its contents – Largely a consequence of aortic pressure

Afterload

9

Preload is related to: Afterload is related to:

Frank Starling Curve Laplaces law

10

Afterload rises in response to higher pressure load (hypertension) or increased chamber size (dilated LV)... as a result we see:

– Increases in wall thickness serves a compensatory role to reduce wall stress

11

Accounts for the changes in myocardial force for a given set of preload and afterload conditions – Influenced by the availability of intracellular Ca

contractility

12

On a Frank--Starling curve, a change in contractility shifts the curve in an

upward or downward direction

13

What point on pressure volume loop does the mitral vavle open?

mitral valve close?

Q image thumb

Opens at point a = beginning of diastole

Closes at point b

 

A image thumb
14

What point represents isovolumetric contraction

isovolumetric relaxation

Q image thumb

b-c

d-a

15

What point represents the aortic valve opening?

closing?

Q image thumb

opens at c

closes at d

16

What curve represents compliance?

Q image thumb

a-b

17

 When arterial pressure (afterload) and contractility are held constant, sequential increases (lines 1, 2, 3) in preload (measured in this case as end­-diastolic volume [EDV]) are associated with loops that have progressively _______ but a con­stant ________

(refer to image on left)

Q image thumb

higher stroke volumes

end-systolic volume (ESV)

18

When the preload (EDV) and contractility are held constant, sequential increases (points 1, 2, 3) in arterial pressure (after­load) are associated with loops that have progres­sively lower _____and higher _______. 

(refer to image on right)

Q image thumb

stroke volumes 

end-systolic volumes

19

There is a nearly linear relationship between the afterload and ESV, termed the

 end-systolic pres­sure-volume relation (ESPVR)

20

• If afterload is increased, then pressure generated during ejection increases
Thus more_____ is expended to overcome resistance to eject, and les fiber shortening occurs

work

21

Relationship between End systolic volume and afterload is approximately

linear

--greater the afterload the higher the end systolic volume

22

Slope of ESPVR line is fnx of contractility:

with increased contractility the line becomes _______

steeper

A image thumb
23

When we increase contractility of the heart the ventricle will:

Q image thumb

empty more completely... thus we get smaller ESV thus increased SV

24

 Stroke volume is a function of 

preload, afterload, and contractility.
– Augmented with increased preload, decreased afterload, or increased contractility
 

25

• End-diastolic volume (or EDP) is used as an index _____ and is influenced by:
 

preload
– End-diastolic volume is influenced by chamber compliance
 

26

 End-systolic volume depends on the______ and 
__________, but not on________

afterload and contractilty

not on preload

27

Heart Failure is a result of a wide variety of CV diseases, those that:
 

 

– Impair ventricular contractility
– Increase afterload
– Impair relaxation and filling

28

What abnormalities could lead to Heart failure

 

– Emptying, i.e., systolic dysfunction
– Filling, i.e., diastolic dysfunction

29

How are pts with heart fail categorized?

 Heart failure with reduced EF
Heart failure with preserved EF

30

In heart fail with reduced EF:

Ventricle has diminished capacity to eject blood because of 

impaired contractility or pressure overload

A image thumb
31

Possible causes of reduced EF:

May result from:
– destruction of myocytes
– abnormal myocyte function
– fibrosis

If it's pressure overload: ejection is impaired by increased resistance to flow

32

Causes of heart fail with preserved EF

Usually demonstrate abnormalities in diastolic function
– Impaired early relaxation and/or increased stiffness

For instance:
• Acute ischemia
• Hypertrophy
• Fibrosis
• Restrictive 
cardiomyopathy
• Pericardial diseases

 

33

In right sided heart fail: RV has_____ compliance
These patients are susceptible to failure with a sudden increase in______
 

high

afterload

34

Right-sided heart failure that results from a primary pulmonary process is called:
 

– Cor pulmonale

35

What tries to maintain forward stroke volume and to maintain perfusion of vital organs in heart fail?

 

Frank-Starling mechanism and hypertrophy 

-issue is chornic increase in EDV (from frank) and left ventricle stiffness (from hypertrophy) will increase atrial pressure

36

What neurohormal activation occurs in heart fail

increase SNS

activate renin-angiotensin-aldosterone axis

release anti-diuretics

37

What is the goal of neurohormonal activation in heart fail pts and what are the consequences?

activating SNS/angtiotensin/ADH becuase we try to miaintain perfusion of vital organs via increase CO and maintaning BP

Bad news is w/ chronic activation we get increase in afterload and fluid retention

38

Long term compensatory mechanisms and neurohormal activaiton in heart fail result in this viscious cycle:

 

low CO--> increase NE/AII/ET--> will increase Afterload--> which decreases EF which further decreases CO

39

Clinical manifestations in heart fail pts are precipitated by circumstances that 

increase cardiac workload and tip the balance to one of decompensation

40

What are some precipitating factors in heart fail pts?

increased metabolic demand (fever/anemia/tachy/pregnancy)

increased circulating volume, ie increased preload (renal fail, excess sodium or fluid)

conditions increasing afterload (uncontrolled HTN, pulmonary embolism)

Fail to take prescribed heart fail meds or very slow HR

41

Symptoms and findings of Left sided heart fail

Dyspnea ,Orthopnea, Paroxysmal nocturnal dyspnea, Fatigue

Diaphoresis (sweating)
Tachycardia, tachypnea
 Pulmonary rales
•Loud P2
•S3 gallop (in systolic dysfunction)
• S4 gallop (in diastolic dysfunction)

42

Symptoms and findings of right sided heart fail

peripheral edema, RUQ discomfort (d/t hepatic enlargement)

jugular venous distention, hepatomegaly, peripheral edema

43

Loud P2, and S3 gallop or S4 gallop can all be  heard in

left sided heart fail

44

Pt has Cardiac disease, but no limitation in physical activity, what NYHA class is he

 

Class I mild

45

Pt has symptoms below, what NYHA class is he?

– Marked limitation of physical activity
– Dyspnea with minimal exertion (i.e., slowly walking up stairs)
– Comfortable only at res

Class III - moderate

46

Pt has  Slight limitation of physical activity and Dyspnea and fatigue with moderate exertion (i.e., walking up stairs quickly, what NYHA class?

Class II: mild

47

Pt has severe limitation of activity and symptoms are present at rest. what class is she?

Class IV: severe

48

Prognosis for heart fail

5 year mortality rate of:

If severe symptoms, class III or IV we have

5 year mortality at 45-60%

40% survival of one year if severe

49

Mortality in heart fail is due to:

refractory heart failure and sudden cardiac death

50

There is no difference in prognosis in pts with preserved EF or reduced EF

T/F

True

51

Goals of therapy for Heart fail d/t reduced EF

 Correct underlying condition causing heart 
failure
• Eliminate acute precipitating cause of symptoms
• Management of heart failure symptoms
– Pulmonary and systemic vascular congestion
– Provide measures to increase forward cardiac output
• Modulation of neurohormonal response
• Prolong survival

52

• Glycoside derived from plant species 
from the genus digitalis (foxglove)
• Only cardiac glycoside available in 
the U.S.
• Chemically consists of a steroid 
nucleus linked to a lactone ring and a 
series of sugars

Digoxin---not used as much anymore in heart fail d/t reduced EF

53