Heart Failure Flashcards
1
Q
HEART FAILURE: PART 1
A
HEART FAILURE: PART 1
2
Q
The heart generates almost all of its energy needed to drive its primary function (pumping blood) through ________ metabolism (O2 requiring processes).
A
aerobic
3
Q
Where is O2 consumed?
A
mitochondria
4
Q
Is there energy storage within the heart?
A
No, the heart matches its energy needs for contractile activity with energy synthesis in real time.
5
Q
An ________ to match energy synthesis (O2) with energy expenditure (contractility) compromises cardiac function.
A
inability
6
Q
We can link the ___ supply chain to the cardinal signs and symptoms of cardiac dysfunction, what are these S/S?
A
O2
- Inappropriate fatigue/weakness
- dyspnea (SOB)
- Exercise intolerance (6MWT)
- Rapid or irregular heart beat
- Bilateral LE swelling
- Persistent cough
7
Q
- Cardiac output is a measure of ______ __________.
- CO = __ * __
- Resting CO = _______
- Resting SV = ________
- Resting HR = ________
A
- cardiac function
- SV*HR
- 4.5-5.0 L/min
- 60-70 mls
- 70 bpm
8
Q
What 3 important factors is SV dependant on?
A
- preload
- afterload
- contractility
9
Q
What is ejection fraction?
A
EF = (EDV-ESV)/EDV*100
-Ejection fraction is the amount of blood from the left ventricle that is ejected % wise.
10
Q
- What is a normal EF range?
- EF can remain ________ despite a change in EDV or ESV.
A
- 60-75%
- unchanged
11
Q
- Does the heart have its own circulatory system?
- Blood flows through these vessels only during cardiac __________.
A
- Yes, coronary arteries
- systole
12
Q
Coronary blood flow is regulated by what 4 things?
A
- coronary artery pressure
- local metabolic signals
- signals from the endothelium
- neural and hormonal molecules
13
Q
What is the most important determinant of CO?
A
radius of vessel
14
Q
Look at Wiggers Diagram
A
Look at Wiggers Diagram
15
Q
What is heart failure?
A
“The situation where the heart is incapable of maintaining a cardiac output adequate to accommodate metabolic needs and venous return”
16
Q
Heart failure (HF) is a complex clinical syndrome that results from any __________ or __________ impairment of ventricular ______ or _______ of blood.
A
- structural or functional
- filling or ejection
17
Q
Is heart failure a reason to not treat a patient?
A
No
18
Q
Causes of Heart Failure (HF):
- _______ ________ Disease (CAD; 2/3’s of all cases)/ischemic heart disease (IHD)
- Uncontrolled ____(pulmonary or systemic)
- Valvular disease
- Uncontrolled ________
- Long standing _______ abuse
- Hx of __’s
- Age
- Age associated increased ventricular stiffness (loss of compliance)
A
- Coronary Artery Disease
- HTN
- diabetes
- ETOH
- MI
19
Q
CAD is responsible for about / of all heart failure cases.
A
2/3
20
Q
HEART FAILURE: PART 2
A
HEART FAILURE: PART 2
21
Q
Heart Failure (HF) Common Clinical Signs:
- Fluid ________
- Ascites: Fluid retention in the _______
- Pleural effusions (fluid between the ______ pleura)
- _________ ________ distension(JVD)
- _____________ (enlargement of liver)
- Pitting edema
- _______cardia
- S3gallop
A
- retention
- abdomen
- lung
- Jugular Venous Distension (JVD)
- hepatomegaly
- tachycardia
22
Q
Can heart failure be L or R sided?
A
Yes, it can be both
23
Q
HFpEF vs HFrEF
A
HFpEF = Heart Failure w/ preserved ejection fraction
HFrEF = Heart Failure w/ reduced ejection fraction
24
Q
Patients with left sided HF have compromised __________. What is the impact of this?
A
Contractility
- reduced SV, EF, and CO
- blood flow to the body is reduced
- fatigue, exercise intolerance, SOB
25
What are some causes of left sided HF?
- HTN
- CAD (Coronary Artery Disease)
- Arrhythmias
- Decreased CO caused by impaired ventricular filling and decreased ventricular relaxation
26
How does HTN cause HF?
Causes cardiac hypertrophy which increases myocardial damage leading to remodeling and reduced contractility
27
How does CAD cause HF?
chronic ischemic damage to myocardium causing remodeling and scaring which decreases contractility
28
Reduced LV contractility results in a decrease in LV ___ and LV ____.
-SV (stroke volume) and EF (ejection fraction)
29
What is vascular congestion?
An engorgement of a vascular structure with blood that changes the pressure within that structure.
30
What is pulmonary congestion?
Accumulation of fluid in the lungs.
31
What is PVD?
Peripheral Vascular Disease
| -Accumulation of fluid in the peripheral vasculature causing engorgement.
32
Reduced contractility leads to increased left ventricular ______ and _________ causing congestion.
LVEDV and LVEDP
33
An increase in LVEDV and LVEDP leads to blood accumulation where?
Left Atrium, causing a increase in LA diastolic pressure
34
An increase in LA diastolic pressure reduces blood movement from the _____ to the atrium.
lungs
35
Reduced blood movement from the lungs to the atrium causes what?
Increased blood volume in pulmonary circulation (PULMONARY EDEMA)
36
What is hemoptysis?
bloody sputum
37
What are the S/S of left sided HF?
- SOB, Dyspnea
- Fatigue, tiredness, exertional dyspnea
- Waking up feeling like you are suffocating (orthopnia, paraoxysmal nocturnal dyspnea)
- Decreased urine production (blood flow to kidneys)
- Coughs that develop with reclining
- Mitral valve regurgitation
38
Right sided HF is a reduced ______________ of the right ventricle. What is the impact of this?
Contractility
| -Accumulation of blood in RV, RA, and ultimately in the systemic circulation
39
Right sided HF results in __________ S/Sx.
systemic
40
What are the S/Sx of right sided failure?
- Reflects congestion in the systemic circulation
- Abdominal swelling (ascites)
- Kidney failure
- Jugular Vein Distension (JVD)
- Weight gain
- Dependent edema
- Increased frequency of DVT and PE's
41
HEART FAILURE: PART 3
HEART FAILURE: PART 3
42
Right sided HF ultimately meets up with ______ _______ ________.
left sided failure
43
Is the side of HF usually specified in the clinic?
No
44
What is CHF?
Congestive Heart Failure
-A clinical condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in myocardium.
45
- Left HF = low ___
| - Right HF = ________ venous congestion
- CO
| - systemic
46
List the stages of chronic CHF.
1. ) Normal
2. ) Asymptomatic LV Dysfunction
3. ) Compensated CHF
4. ) Decompensated CHF
5. ) Refractory CHF
47
At what stage in chronic CHF do we see abnormal LV function?
First seen in Asymptomatc LV Dysfunction, gets worse further down the stages.
48
At what stage in chronic CHF do we see a decrease in exercise tolerance?
First seen in Compensated CHF, gets worse further down the stages.
49
At what stage in chronic CHF do we see symptoms present?
First seen in Decompensated CHF, gets worse in Refractory CHF.
50
Describe the ABCD scheme of HF from the American Heart Association.
A- High-risk for CHF without structural heart disease or symptoms.
B- Diagnosed with structural heart disease, but not experiencing any CHF symptoms.
C- Structural heart disease with prior or current CHF symptoms
D- Advanced heart failure
51
Describe the NYHA HF classifications.
```
NYHA-1 = Cardiac disease, but no symptoms and no limitation in ordinary physical activity
NYHA-2 = Mild symptoms and slight limitation during ordinary activity
NYHA-3 = Significant limitation in activity due to symptoms. Comfortable only at rest.
NYHA-4 = Severe limitations. Symptoms even while at rest.
```
52
Can HF be acute?
Yes
53
In acute HF, HF symptoms appear suddenly or a rapid worsening of existing symptoms of heart failure occurs via ___________.
exacerbation
54
How would Acute HF present in a patient?
Sudden onset of dyspnea and limb and LE swelling
55
What is the 5lb rule?
- A 5lb increase in body weight in 24hrs.
| - A way to tell whether an exacerbation of HF is occuring.
56
Systolic HF (HFrEF) is when the left ventricular _____________ is reduced in turn reducing EF (L or R) and O2 delivery to periphery. The net effect is reduced delivery of blood into __________ and subsequent O2 delivery.
- contractility
| - systemic circulation
57
Diastolic HF (HFpEF) is a reduced ability for the ventricles to _____. Nearly half of all patients with HF have a normal ejection fraction.
fill
58
Diastolic HF is seen more frequently in?
- Older age
- Obese
- Females
- HTN
- Metabolic syndrome, renal dysfunction
59
Diastolic HF Pathophysiology:
- The ventricles lose their ability to ______ normally
- The ventricle becomes stiffer and less _________
- Heart chambers can not ___ normally during diastole
- Global loss of cardiac, vascular and peripheral reserve
- Often have pulmonary ____ and exercise ___________
- Says that HF can exist even in the presence of normal ___
- These patients should be achieving or exceeding the guideline-recommended doses of physical activity
- relax
- compliant
- fill
- HTN and exercise intolerance
- EF
60
Diastolic HF = HF_EF (more women or men?)
| Systolic HF = HF_EF (more women or men?)
Diastolic HF = HFpEF (women)
| Systolic HF = HFrEF (men)
61
Can cardiac remodeling be positive?
Yes
- Aerobic Exercise- mild to moderate dilation and mild to moderate increase in LV wall thickness
- Resistance Exercise- mild to moderate increase in LV wall thickness
62
- HF is now recognized as a ___________ disease rather than simply a heart disease.
- HF is a response to a long term hyper_______ and/or chronic hyper_________ state.
- neuroendocrine
| - hyperautonomic, hyperinflammatory
63
Is HF exclusively a "cardoi-centric" disease?
No
- endothelial dysfunction
- skeletal muscle damage
- kidney dysfunction
- decreased systemic blood flow and accompanying increased total peripheral resistance secondary to excessive sympathetic stimulation causing vasoconstriction
64
What type of HF is most commonly seen in clinical practice?
CHF
