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Flashcards in Heart Failure Deck (46)
1

Heart Failure Basic components

1) Poor forward blood flow = low flow (decr cardiac ouput)

2) Backward buildup of pressure = congestion (incr filling pressures) as a response to low flow

2

3 factors that affect stroke volume

1) preload (incr sv)
2) afterload (decr sv)
3) inotropy (incr SV)

3

2 factors affecting CO

1) HR (incr CO)
2) SV (incr CO)

4

Effect of Preload on Stroke volume vs. Ventricular EDP

increased filling of ventricle, incr ventricular output (SV)

5

the more LV is filled, the ____

more it will contract

6

the ____ the more it will contract

more LV is filled

7

incr ___ produces increased SV and CO for given inotropic state

Preload

8

incr preload increases ___ and ____ for given inotropic state

SV and CO

9

Effect of inotropy on SV vs. ventricular EDP curve

shifts curve upwards

10

Same filling (preload) of LV produces a ___

greater squeeze of contraction

11

Determinants of inotropy

catecholaminergic/adrenergic stim

calcium

12

incr inotropy produces increased ___ and ____ for the same preload

SV and CO

13

incr ____ produces increased SV and CO for the same preload

inotropy

14

Effect of increased preload on PV loop

increased end diastolic pressure (more filling on the LV)

15

Effect of increased inotropy on PV loop

increased pressure (height) and decr end systolic volume

pump with greater force and empty more of the LV

16

effect of increased afterload on PV loop

increased end systolic volume and increased pressure

have to pump with more force against higher resistance and empty LESS of LV

17

Systolic HF basics

weak/damaged myocardium (thinner walls)

18

Systolic HF problem

problem with squeeze
decr contraction and decr inotropy

19

hallmarks of systolic dysfunction

decreased ejection fraction

ventricular enlargement

20

PV loop with systolic HF

decr top pressure line and shift curve to the right

decr inotropy, decr SV (pump out less) and lower systolic blood pressure b/c less force

incr end diastolic volume b/c walls are thinner

21

Primary causes of systolic HF

1) direct destruction of heart muscle cells
2) overstressed heart muscle
3) volume overloaded heart muscle

22

causes of Direct destruction of heart muscle cells

MI
viral myocarditis
peripartum
dilated cardiomyopathy
alcohol

23

causes of Overstressed heart muscle

tachycardia mediated HF
meth use
stress provoked

24

causes of volume overloaded heart muscle

mitral regurg
high cardiac output
- shunting of blood
- wet beriberi

25

Diastolic HF basics

stiff/noncompliant heart

26

Diastolic HF problem

impaired filling

decr lusitropy

27

hallmark of diastolic HF

normal ejection fraction
ventricular wall thickening

28

PV loop in diastolic HF

incr bottom pressure line, decr top pressure line, decr end diastolic volume

incr stiffness so need higher baseline pressure to keep stiff wall open
can't fill as much blood due to thick walls
decr top pressure line due to stiffer walls

29

causes of diastolic HF

1) High afterload / pressure overload
2) Myocardial thickening / fibrosis
3) External compression

30

causes of High afterload / pressure overload

longstanding HTN
aortic stenosis
dialysis

31

causes of mycoardial thickening/fibrosis

HCM
primary restrictive cardiomyopathy

32

causes of external compression

pericardial fibrosis/constrictive pericarditis
pericardial effusion

33

Right sided HF

can't pump blood through lungs adequately

34

Right sided HF
what causes forward RV HF

decr circulating blood flow

35

Right sided HF
what causes backward RV HF

incr venous pressure

36

Primary causes of right sided HF

1) Left sided HF
2) lung disease/pulmonary HTN/RV pressure overload
3) RV volume overload
4) damage to RV myocardium

37

why does left heart failure cause right heart failure

backward HF stresses right side by incr pulm venous pressures

38

Do HF forms coexist?

Yes
with fibrosis and ischemia

39

Body's compensatory responses to decr cardiac output in heart failure

1) neurohormonal activation
2) frank-starling (incr preload)
3) ventricular hypertrophy and dilation

40

Normal response to decr cardiac output (JGA route)

1) dehydration or bleeding

2) decr LV filling, decr CO

3) juxtaglomerular apparatus sense low flow and activ renin system

4) incr sodium retention
5) activate vasoconstriction

6) incr volume and incr LV filling

41

Normal response to decr cardiac output

1) dehydration or bleeding

2) decr LV filling, decr CO

3) baroreceptors sense lower pressure

4) adrenergic activation
5) incr HR and vasoconstriction
6) incr blood volume and incr LV filling

42

Neurohormonal compensatory mechanism- additional effect

supranormal filling pressures

43

HF effect on SV vs. ventricular end diastolic pressure curve

shift down

given pressure, less stroke volume

44

Frank Starling compensation

incr LV filling

incr SV

stroke volume preserved by increasing end diastolic filling and pressure

45

Vascular remodeling via hypertrophy and dilation

Long term incr in cardiac workload and metab demand
(4 things)

1) ventricular hypertrophy
2) ventricular dilation
3) myocardial damage/apoptosis
4) myocardial fibrosis

46

Vascular remodeling via hypertrophy and dilation

Overtime remodeling causes (3)

1) decr contractile force
2) decr dynamic function
2) incr diastolic stiffness