Heart Failure Flashcards Preview

Pathophysiology > Heart Failure > Flashcards

Flashcards in Heart Failure Deck (35):
1

What does chronotropy mean?

Heart rate

2

What is vascular resistance/peripheral resistance?

Squeeze of blood vessels outside the heart resisting blood flow

3

What is Cardiac Output (CO) a measure of?

How much blood is pumped out of the left ventricle in 1 minute

4

What is Stroke Volume (SV) a measure of?

The volume of the blood ejected with each beat of the heart

5

Define: Ionotropy

Contractility

6

Define: Preload

Filling of ventricles and stretch of walls (dealing with the tension applied to the ventricular walls)

Stretch (IN)

7

What happens if we increase preload?

The tension on the walls increase which causes oxygen demand to increase as well.

8

Define: Afterload

The amount of pressure that is acting on the heart.

Squeeze (OUT)

9

Describe how low and high after loads affect the blood's travels.

Low afterload: easy for blood to exit the heart

High afterload: hard for blood to exit the heart

10

What is stroke volume affected by?

Contractility (ionotropy)
Afterload (squeeze/resistance)
Preload (stretch/filling)

11

If stroke volume increases, cardiac output (CO) ______.

Increases

12

How would you increase stroke volume?

Increase contractility
Increase preload
Decrease afterload

13

How would you decrease stroke volume?

Decrease contractility
Decrease preload
Increase afterload

14

LVEDV (preload)

Left ventricular end diastolic volume (The volume at the end of rest-so when it is filling).

15

What two ways can heart failure occur?

1. MI (myocardial infarction) - heart dies! One lane of blood traffic is shut down.

2. High blood pressure acts as a traffic jam for blood

**Both of these things cause a decrease in stroke volume.

16

What 4 things can be done to compensate for heart failure?

1. Increase heart rate
2. Increase amount of blood (increases preload - RAAS)
3. Redirect blood to heart (vasoconstriction of blood vessels, endothelin, RAAS, SNS)
4. Construct more lanes (Ventricular hypertrophy & remodelling)

17

What are the pros and cons of:
1. increase heart rate

Pro:
Helps maintain cardiac output

Con:
short filling time, increase BP, increase oxygen demand, risk of arrhythmias, puts stress on the heart

18

What are the pros and cons of:
2. increase amount of blood

Pro:
Increase stroke volume (more stretch, more preload)

Con:
Pulmonary and or peripheral edema, increased oxygen demand, water retention

19

What are the pros and cons of:
3. redirect blood to the heart

Pro:
Helps maintain blood pressure, recruits blood to heart and brain.

Con:
Increased afterload (resistance) which decreases stroke volume

20

What are the pros and cons of:
4. ventricular hypertrophy & remodelling

Pro:
Helps to maintain CO, decreases oxygen demand

Con:
Increased risk of ischemia, dysfunction, fibrosis and arrhythmias, ventricle becomes smaller

21

Describe natuiretic hormones and how they cause vasoconstriction.

-causes an increase in intracellular sodium and calcium (bad)
-inhibits the cellular Na/K ATPase (sodium builds up in the cell and it becomes more excitable and causes our vessels to constrict)

22

Describe natuiretic peptides and how they cause vasodilation.

-secreted by the brain and atria to try and counteract negative compensatory mechanisms in heart failure (good)
-promote water loss (diuresis which causes vasodilation) to decrease total peripheral resistance (TPR)

23

What is the difference between left and right sided heart failure?

Right-sided HF:
-right side is failing
-blood backed up in abdominal organs and periphery

Left-sided HF:
-left side is failing
-blood backed up in lungs

24

List some symptoms of heart failure.

Fluid retention and edema:
-rales (crackling sound upon auscultation with stethoscope)
-rapid weight gain
-pitting edema (squishy feet and ankles)
-elevated jugular venous pressure (JVP)

Shortness of Breath:
-orthopnea - difficulty breathing when lying down
-cough
-dyspnea - difficult breathing

Fatigue (especially with activity)
Confusion
Cyanosis (oxgen depletion) - blue lips, fingers or toes

25

Describe the 2 types of diagnostic imaging used on the heart: CXR and ECHO

Chest X Ray (CXR):
-shows an enlarged cardiac silhouette
-if the cardiothoracic ratio is > 50% then the heart is enlarged (not normal)

Echocardiogram (ECHO):
-uses ultrasound waves to image the heart
-detects abnormalities in both structure and function

26

What is LVEF?

Left ventricular ejection fraction: It is how much blood is being expelled from the left ventricle

Normal: 55-70%
Heart failure: less than 40%

27

Describe what JVP is and what a normal value is.

JVP (jugular venous pressure)
Elevation indicates volume overload
Normal: less than 4 cm above sternal angle

28

Define: Ascites

Fluid accumulation in the peritoneal space

29

What are some non-pharmacological treatments available to patients to decrease their risk of heart failure?

-salt restriction
-fluid restriction
-stop smoking
-monitor weight daily
-exercise once symptoms are controlled

30

Describe using the Frank-Starling Law how stroke volume and preload are connected in both a normal patient and a patient with heart failure

In a patient with heart failure, the stroke volume is decreased from what it would be in a normal patient. Because the HF patient has lower stroke volume, that means you have less blood getting to the heart and it is not able to be pumped out.

31

Describe using the Frank-Starling Law how stroke volume and afterload are connected in both a normal patient and a patient with heart failure

In a patient with heart failure, the stroke volume is decreased from what it would be in a normal patient.

32

Why would a patient with HF be experiencing weight gain?

due to excess water retention

33

Why would a patient with HF be experiencing peripheral edema?

due to excess water retention in feet/ankles

34

Why would a patient with HF be experiencing SOB/coughing?

Fluid in lungs; not getting enough blood to lungs to trade off oxygen and CO2

35

Recall Matthew from the clinical case study: What types of medication could help Matthew with his symptoms?

-A diuretic
-Drugs to disrupt RAAS (angiotensin receptor blockers/inhibitors)
-Beta blockers - slow the heart rate by blocking the affect of adrenaline
-Aldosterone antagonists
-Digoxin (when patient is dying) - this is a positive ionotrope (contractile) which squeezes the heart to give the patient a little bit of extra time of life