Heart Failure & Cardiomyopathies (Exam 2) Flashcards
(150 cards)
1
Q
A clinical syndrome that occurs when the heart is unable to transport blood effectively to meet the metabolic demands of the body
A
heart failure
2
Q
What are the 2 possible problems with heart failure?
A
1) inotropic abnormality (pump problem, problem with contractile function of the heart which is systolic dysfunction)
2) compliance abnormality (filling problem, stiff, non-compliant heart prevents adequate filling which is a diastolic dysfunction)
3
Q
What are the 5 classes of heart failure symptons?
A
class 1= no limitation of physical activity, no symptoms with normal activity
class 2= slight limitation of physical activity, ordinary activity causes dyspnea and fatigue
class 3= marked limitation of physical activity, comfortable at rest but less than ordinary activity cause symptoms like tying shoes or walking to the next room
class 4= severe limitations with symptoms occurring at rest, unable to engage in any physical activity without discomfort (all activities cause symptoms)
class 5= bedridden and on life support
4
Q
A primary cardiac disorder that is associated with abnormalities of ventricular wall thickness, size of ventricular cavity, contractility, relaxation, conduction, and rhythm
A
idiopathic cardiomyopathies
5
Q
Muscle weakness from chronic ischemia, as well as wall motion abnormalities and scarring from infarction can affect the efficacy of both systolic and diastolic function
A
coronary artery disease
6
Q
-hypertension, aortic stenosis, pulmonary stenosis, pulmonary hypertension
-high afterload results in ventricular hypertrophy and enlargement
-a hypertrophic ventricle becomes stiff and noncompliant which is a diastolic dysfunction
A
pressure overload
7
Q
-mitral valve regurg, aortic regurg, tricuspid regurg, pulmonary regurg, pregnancy, hypernatremia
-these conditions result in increased preload which is increased workload on the heart
A
volume overload
8
Q
Toxins can stress the heart, weaken the muscle and cause decreased contractility or arrhythmias. What are some examples of toxins?
A
-alcohol
-cocaine
-some meds
-smoking
9
Q
Various endocrine/metabolic disorders can adversely affect the structure, function, and electrical condition system of the heart. Some conditions that increase the metabolic demands of the body can create a supply and demand problem. What are some examples that do this?
A
-thiamine def
-diabetes
-thyrotoxicosis
-severe anemia
10
Q
What conditions are characterized by deposition of abnormal substances within the heart tissue which leads to change in both structure and function of the myocardium?
A
infiltrative diseases like amyloidosis, hemochromatosis, sarcoidosis, and radiation
11
Q
Myocarditis or inflammation of the heart muscle results in diminished contractility/pumping ability of the heart which is a _____________ dysfunction
A
systolic
12
Q
A hypertrophic ventricle becomes stiff and noncompliant. This is a _____________ dysfunction
A
diastolic
13
Q
Signs and symptoms of heart failure is a direct result of?
A
blood backing up AND the failure of forward blood flow
14
Q
Decreased forward blood flow to the body in heart failure would give what symptoms?
A
-fatigue
-weakness
-SOB
-drowsiness
-altered mental status
15
Q
Backward blood flow on the left side of heart would cause pulmonary congestion during heart failure. What would be the signs and symptoms?
A
-SOB
-cough
-orthopnea (SOB while lying down)
-paroxysmal nocturnal dyspnea (patient wakes up coughing and gasping for breath)
16
Q
Backward blood flow on the right side of heart would cause systemic venous congestion during heart failure. What would be the signs and symptoms?
A
-increased jugular venous pressure (JVP)
-adema
-ascites
17
Q
What may a chest xray show for someone with heart failure?
test q
A
-pulmonary effusion
-pulmonary edema (Kerley B lines, horizontal lines in the interstitium that indicate fluid in the lungs)
-cardiomegaly
18
Q
-a protein made by the heart that is released secondary to elevated filling pressures (increased workload)
-functions to decrease circulating volume by diuresis
-elevated levels occur in heart failure
A
brain natriuretic peptide (BNP)
19
Q
Assesses structure and function, valve abnormalities, pericardial effusion, wall motion abnormalities, ejection fraction
A
echocardiogram
20
Q
This is done if ischemic heart disease is the suspected cause of heart failure?
A
cardiac catheterization
21
Q
What test would show nonspecific changes, low voltage, arrhythmias, evidence of MI?
A
EKG
22
Q
What are the 4 categories of heart failure?
A
1) right vs. left
2) systolic vs diastolic
3) high output vs low output
4) acute vs chronic
23
Q
ventricular contraction =
A
systole
24
Q
ventricular filling/relaxation =
A
diastole
25
the amount of blood pumped out of the heart per minute
cardiac output
26
The volume of blood pumped out of the left ventricle with each contraction
stroke volume
27
stroke volume is dependent on what 3 things?
1) contractility (increase force of contraction will increase stroke volume)
2) preload (increase preload will increase filling and stroke volume)
3) afterload (decreased afterload will increase cardiac output and vice versa)
28
The percentage of end diastolic (EDV) that is ejected during systole
ejection fraction
29
What is a normal ejection fraction?
50-75%
30
The force of circulating blood in the walls of the arteries
blood pressure
31
decreased cardiac output= decreased
blood pressure
32
Systolic heart failure is what type of problem?
pump problem
33
The ventricular contraction cannot generate a stroke volume to meet the metabolic demands of the body which decreases cardiac output
systolic heart failure which is a pump problem
34
What are the 3 causes of systolic heart failure?
1) decreased contractility and CO
2) increased preload + decreased contractility (more volume but less strength) + decreased CO
3) increased afterload (increased resistance to outflow) + decreased CO
35
What are 3 examples that would cause decreased contractility/CO and ultimately result in systolic heart failure?
1) MI/ ischemic cardiomyopathy
2) myocarditis
3) dilated cardiomyopathy
36
What are 2 examples that would cause increased preload, decreased contractility (more volume but less strength) and decreased CO and ultimately result in systolic heart failure?
aortic or mitral regurg
37
What are 3 examples that would cause increased afterload (increased resistance to outflow) and decreased CO ultimately resulting in systolic heart failure?
1) hypertension
2) coarctation of aorta
3) aortic stenosis
38
Diastolic heart failure is a _________ problem
filling
39
The ventricular myocardium is noncompliant (stiff, fibrotic) and unable to accept blood normally from the atrium. Ejection fraction may be normal
diastolic heart failure which is a filling problem
40
What are the 2 causes of diastolic heart failure?
1) decreased preload (filing capacity), decreased venous return to the heart, decreased SV, decreased CO
2) increased afterload, myocardial hypertrophy, decreased filling, decreased CO
41
What are the 5 examples for decreased preload (filing capacity), decreased venous return to the heart, decreased stoke volume, and decreased CO ultimately causing diastolic heart failure?
1) ischemic heart disease
2) restrictive cardiomyopathy
3) pericarditis
4) cardiac tamponade
5) tachyarrhythmia
42
What are the 6 examples for increased afterload, myocardial hypertrophy, decreased filling, and decreased CO ultimately causing diastolic heart failure?
1) chronic hypertension
2) severe chronic aortic stenosis
3) coarctation of the aorta
4) hypertrophic obstructive cardiomyopathy (HOCM)
5) pulmonary embolism
6) pulmonary stenosis
43
Genetic condition of hypertrophy of the heart muscle especially interventricular septum
hypertrophic obstructive cardiomyopathy (HOCM)
44
T/F: if one parent has hypertrophic obstructive cardiomyopathy (HOCM), each offspring has a 50% chance of expressing the trait
true
45
Thickened interventricular septum and left ventricular hypertrophy leads to decreased compliance and outflow obstruction. This can lead to sudden death in young athletes
hypertrophic obstructive cardiomyopathy (HOCM)
46
Sports physicals screen for this condition
hypertrophic obstructive cardiomyopathy (HOCM)
47
holosystolic murmur heard along the left sternal border
-increases intensity while standing and with valsalva maneuver
-decreases intensity with squatting
hypertrophic obstructive cardiomyopathy (HOCM)
48
Inability of the left heart to pump into systemic circulation
left heart failure
49
What happens with left sided heart failure?
-heart tries to compensate by pumping harder
-left heart become weaker
-increased LV ESV
-increased LV EDV
-increased left atrial pressure
-increased pulmonary venous pressure
-symptoms of SOB, orthopnea, pulmonary edema, fatigue
50
What are the symptoms of left sided heart failure?
-SOB/ breathlessness
-orthopnea
-pulmonary edema
-fatigue
-dyspnea on exertion
-weakness
-confusion
-palpitations
-diaphoresis
-cough
-insomnia
-anorexia
-tachycardia
-extra heart sounds
-moist rales
-pleural effusion
51
Inability of the right heart to pump into pulmonary circulation
right heart failure
52
What happens with right heart failure?
-blood backs up into peripheral circulation
-increased venous pressure
-peripheral edema, ascites, renal failure (due to lack of perfusion secondary to decreased CO)
53
T/F: right sided heart failure most commonly occurs in conjunction with left sided heart failure
true
left HF -> pulmonary HTN-> increased afterload on RV-> RV hypertrophy-> right HF
54
What is the most common cause of right heart failure?
left heart failure
55
Enlargement of the RV secondary to a chronic lung disease that causes pulmonary hypertension
cor pulmonale
56
What is cor pulmonale usually due to?
COPD
other causes: cystic fibrosis, pulmonary fibrosis, infiltrative lung disease, pulmonary embolus
57
Cor pulmonale results in what side heart failure?
right side heart failure
58
A patient with a diseased heart has a condition that increases the metabolic demand of the body. This is a supply and demand mismatch
high output heart failure
59
What are the causes of high output heart failure?
-severe anemia
-thiamine def
-thyrotoxicosis
-pregnancy
60
A patient with a diseased heart that is unable to meet the demands of the body. CO cannot support homeostasis. Very grave condition
low output heart failure
61
Diminished CO results in hypoperfusion of the body
forward heart failure
62
What are the symptoms of forward heart failure?
-cool extremities
-peripheral pallor
-diaphoresis
-multisystem organ failure
63
Diminished CO and/or diminishing filling result in increased atrial pressure which is reflected backward to increased venous pressure
backward heart failure
64
What are the symptoms of backward heart failure?
-pulmonary edema
-dyspnea
-cough
-PND
-pitting edema
-JVD
-hepatojugular reflux
-ascites
-hepatomegaly
65
Forward heart failure -> low _______-> diminished venous return to the heart -> decreased filling + low CO -> backward heart failure (both problems typically coexist because it's a circular system
CO
66
What detects low blood pressure?
baroreceptors in the carotid sinus and aortic sinus
67
Baroreceptors send low bp detection message to the medulla via what cranial nerves?
9 and 10
68
What 2 centers are stimulated when blood pressure is low?
cardio-acceleratory center and vasomotor center
69
The cardio-acceleratory center is stimulated when blood pressure is low. Sympathetic stimulation of SA node will do what?
increase heart rate, CO, and BP
70
The cardio-acceleratory center is stimulated when blood pressure is low. Sympathetic stimulation of beta 1 receptors of the myocardium do what?
increase contractility, stroke volume, CO, and BP
71
The vasomotor center is stimulated when blood pressure is low. Sympathetic stimulation of alpha 1 receptors on smooth muscle in blood vessels does what?
vasoconstriction which will increase TPR, BP, and CO
vasoconstriction will also increase venous return, preload, SV, CO, and BP
72
The vasomotor center is stimulated when blood pressure is low. Sympathetic stimulation of alpha 1 receptors on smooth muscle of the renal vasculature does what?
decrease blood flow to the kidneys, decrease GFR and urine output which increases fluid retention, venous return, preload, SV, CO and BP
73
The vasomotor center is stimulated when blood pressure is low. Sympathetic stimulation of the nephron via beta 1 receptors on the JG cells does what?
renin is released through RAAS
renin converts angiotensinogen (made in liver) to ang 1, travels to lungs and is converted by ACE to ang 2
74
What are the 3 effects of ang 2?
1) stimulates posterior pituitary to secrete ADH (slows urine output, increases water resorption, circulating volume, and venous return)
2) stimulates vasoconstriction of arterioles (increase TPR and BP)
3) stimulates the adrenal gland to secrete aldosterone
75
Increased heart rate in a dysfunctional heart would cause what?
decreased diastolic filling, SV, and CO
76
Increased TPR in a dysfunctional heart would cause what?
increase afterload and workload on heart, decrease CO which causes ventricular remodeling and decreased diastolic filling which drops CO a lot
77
Increased preload in a dysfunctional heart would cause what?
volume overload, weak heart cannot contract effectively, decrease CO and congestion
78
What are the 4 clinical indicators of congestive heart failure?
1) systemic congestion
2) diminished systemic perfusion
3) pulmonary congestion
4) diminished pulmonary perfusion
79
What are the signs and symptoms of systemic congestion in congestive heart failure?
1) JVD
2) hepatosplenomegaly
3) peripheral edema
80
What are the signs and symptoms of diminished systemic perfusion in congestive heart failure?
1) weakness
2) fatigue
3) decreased exercise tolerance
4) exertional dyspnea
5) mental confusion
6) tissue hypoxia
81
What are the signs and symptoms of pulmonary congestion in congestive heart failure?
1) dyspnea
2) orthopnea
3) pulmonary edema
82
What are signs and symptoms of diminished pulmonary perfusion in congestive heart failure?
1) dyspnea
2) tachypnea
3) diminished gas exchange
4) hypoxia
5) cyanosis
83
What are the signs and symptoms of right sided heart failure?
-weight gain
-abdominal distention
-gastric discomfort/ nausea
-peripheral edema and pitting edema
-anorexia
-ascites
-increased JVP, JVD, hepatojugular reflex
-hepatomegaly
84
What are the 5 causes of congestive heart failure?
1) increased volume (regurgs, hypervolemia, L->R shunts)
2) increased pressure (AS, HOCM, coarctation of the aorta, HTN)
3) myocardial dysfunction (cardiomyopathy, myocarditis, CAD, ischemia/infarction, arrhythmia)
4) filling disorder (mitral ot tricuspid stenosis, cardiac tamponade, restrictive pericarditis)
5) increased metabolic demand (anemia, thyrotoxicosis, beri beri, fever)
85
The blood is not effectively getting to its destination. Effects are a result of hypoperfusion
forward heart failure
86
What are the 4 forward failure effects with left sided heart failure?
1) decreased ejection fraction
2) decreased CO
3) decreased organ perfusion
4) increased RAAs system-> retention of salt and water results in volume overload
87
What are the 4 forward failure effects with right sided heart failure?
1) decreased pulmonary perfusion
2) decreased volume to the left heart
3) decreased CO
4) decreased organ perfusion
88
The congestion that occurs due to blood not moving forward. The effects are a result of congestion
backward heart failure
89
What are the 4 backward failure effects with left heart failure?
1) decreased CO
2) increased preload
3) increased pulmonary venous pressure and volume
4) pulmonary congestion
90
What are the 3 backward failure effects with right heart failure?
1) decreased emptying of RV
2) increased preload
3) increased systemic venous pressure and volume -> venous congestion
91
What are the 2 types of infective endocarditis?
1) subacute bacterial endocarditis
2) acute bacterial endocarditis
92
What is the most common infective endocarditis?
subacute bacterial endocarditis
93
What bacteria causes subacute bacterial endocarditis?
strep viridans and strep epidermis
94
Who is most as risk for subacute bacterial endocarditis?
recent oral surgery or prosthetic valve insertion
95
What bacteria causes acute bacterial endocarditis?
s. aureus or MRSA
96
Who is most at risk for acute bacterial endocarditis?
IV drug users
97
-bacterial infection occurs on the valves and endocardium causing inflammation of the inner heart lining
-abnormal growths/vegetations (bacteria, fibrin, platelets, and WBCs) form on the already damaged/inflamed endothelium or valve leaflets
-vegetations can embolize
infective endocarditis
98
What are the most commonly affected valves in infective endocarditis?
mitral and aortic
99
Which valve is infected with infective endocarditis in patients with history of IV drug use?
tricuspid
100
fever + new regurgitant heart murmur (most commonly the mitral valve) = _______________ until proven otherwise
bacterial endocarditis
101
What are the 5 classic features of infective endocarditis?
1) petachiae
2) splinter hemorrhages on nails
3) osler nodes (painful, erythematous, pea sized, raised lesions on the fingers or toes)
4) janeway lesions (painless, flat, red lesions on the palms and soles
5) roth spots (retinal emboli and hemorrhages, white spot surrounded by hemorrhage)
102
What are osler nodes?
painful, erythematous, pea sized raised lesions on the fingers and toes
103
What are janeway lesions?
painless, flat, red lesions on the palms and soles
104
What are roth spots?
retinal emboli and hemorrhages, white dot surrounded by hemorrhages
105
What are some possible complications with infective endocarditis?
-renal failure
-stroke
-septic shock
-CHF
106
How is infective endocarditis diagnosed?
-at least 3 serial blood cultures
-echocardiogram to show valve function and presence of vegetations
-chest xray
-2 major and 1 minor OR 3 minor signs/symptoms from Duke Criteria
107
What are the 3 major signs under duke criteria for infective endocarditis?
1) 2 positive blood cultures
2) changes on the echo
3) new regurg murmur
108
What are the 4 minor signs under duke criteria for infective endocarditis?
1) fever >100.4 F
2) embolus/pulmonary infarct
3) immune response (glomerulonephritis, osler's nodes, roth spots, etc.)
4) atypical blood culture
109
What is the treatment for infective endocarditis?
-high dose antibiotics for 2-6 weeks
-valve repair
-antibiotic prophylaxis for future invasive procedures
110
Inflammation of the heart muscle, heart thickens and weakens and results in systolic heart failure
myocarditis
111
What is the most common cause of myocarditis?
coxsackievirus
112
-flu like symptoms
-left HF
-chest pain
-palpitations
-elevated troponin
-cardiomegaly
-dilated weak ventricular function visible on echo
myocarditis
113
inflammation of the pericardium with fluid accumulation in the pericardial space
pericarditis
114
What are the 5 types of pericarditis?
1) acute pericarditis (develops quickly, often with infective causes)
2) subacute pericarditis (develops within weeks to months)
3) chronic pericarditis (pericarditis persists for 6+ months, seen with cancers)
4) constrictive pericarditis
5) dressler's syndrome
115
Which pericarditis is seen with cancers?
chronic
116
-due to marked inflammatory and fibrotic thickening of the pericardium
-presents with slowly progressive dyspnea
-chronic inflammation, post surgery, post MI scarring, or post radiation
constrictive pericarditis
117
-between a few days to 2 months after an MI, patient develops chest pain, tachycardia, dyspnea, and orthopnea
-ECG changes appear showing DIFFUSE ELEVATION instead of focal changes
-occurs due to the inflammatory reaction to myocardial necrosis
Dressler's syndrome (a type of pericarditis)
118
-pleural effusion (accumulation of fluid in the pericardial cavity, can be serous, blood, pus, or chyle)
-pleuritic chest pain (better with sitting and leaning forward)
-friction rub
-cardiac tamponade (when a large pericardial effusion impairs cardiac filling leading to a low CO, usually occurs with rapid accumulation rather than slow)
-diffuse ST elevation on ECG
pericarditis
119
What is pericardial effusion?
-accumulation of fluid in the pericardial cavity
-can be serous, blood, pus, or chyle
120
-when a large pericardial effusion impairs cardiac filling leading to a low CO
-usually occurs with rapid accumulation rather than slow
-acute with trauma
-life threatening
-beck's triad: JVD, muffled heart sounds, hypotension
cardiac tamponade
121
What is beck's triad for cardiac tamponade?
JVD, muffled heart sounds, hypotension
122
What are the treatments for pericarditis?
-pericardiocentesis (to relieve the fluid accumulation and obtain cells for culture/biopsy)
-pericardial window (for recurrent effusions/tamponade)
-NSAIDs/ steroids (for inflammation)
-antibiotics (for bacteria)
-percardiectomy (to relieve constrictive pericarditis)
123
Delayed autoimmune complication of an infection with Group A beta hemolytic strep (strep pharyngitis/tonsillitis). It can affect many tissues in the body
rheumatic fever
124
A condition in which the heart valves have been permanently damaged due to rheumatic fever
rheumatic heart disease
125
What causes rheumatic fever and rheumatic heart disease?
group A beta hemolytic strep through a pharyngitis infection
126
How is rheumatic heart disease diagnosed?
through culture/rapid strep test and 2 major Jones criteria or 1 major and 2 minor
127
What are the 5 major signs under jones criteria for rheumatic heart disease?
CASES
C= carditis (myocarditis, endocarditis, pericarditis, or pancarditis)
A= arthritis (poly and migratory)
S= sydenham's chorea (involuntary muscle spasms)
E= erythema marginatum (skin rash on trunk and limbs)
S= subcutaneous nodules (painless swelling over bony prominencies)
128
What are the 4 minor signs under jones criteria for rheumatic heart disease?
1) fever
2) arthralgia
3) elevated ESR/ CRP
4) prolonged PR segment
129
In chronic rheumatic heart disease there is a cardiac murmur (typically mitral or aortic stenosis or regurg) and the patient has an increased risk of developing?
infective endocarditis
130
Diseases of the heart muscle and result in heart failure=
cardiomyopathies
131
What 3 factors determine myocardial performance?
1) preload
2) afterload
3) contractility
132
What are the 4 types of cardiomyopathy?
1) dilated
2) hypertrophic
3) restrictive
4) stress
133
What is the primary cause of cardiomyopathy?
inherited/congenital defect in the heart
134
What are the signs and symptoms of cardiomyopathy?
congestive heart failure
135
What is the most common cardiomyopathy?
dilated
136
-progressive dilation of ventricles, impaired contraction, decreased ejection fraction
-systolic heart failure
-can be unilateral or bilateral
-S3 gallop
-mitral/tricuspid regurg
dilated cardiomyopathy
137
What is a major cause of dilated cardiomyopathy?
alcoholism
138
What is the most common primary (congenital) cardiomyopathy?
hypertrophic cardiomyopathy
139
-ventricular hypertrophy, decreased chamber size and decreased ventricular filling
-diastolic dysfunction
-LV hypertrophy without ventricular dilation
-S4 gallop
hypertrophic cardiomyopathy
140
-asymmetrical septal thickening causes an outflow obstruction from the left ventricle
-there will be a harsh systolic murmur at the right upper sternal border
-this murmur is softened with squatting and exacerbated with standing or valsalva maneuver
hypertrophic obstructive cardiomyopathy (HOCM)
141
What are the 2 secondary causes of hypertrophic cardiomyopathy?
chronic HTN and aortic stenosis (non-obstructive hypertrophic cardiomyopathy)
142
How is hypertrophic cardiomyopathy diagnosed?
EKG shows deep Q waves= LV hypertrophy
echo shows decreased LV cavity size, thickened walls, and decreased ejection fraction
143
What are the other names for takotsubo cardiomyopathy?
-stress cardiomyopathy
-apical ballooning syndrome
-broken heart syndrome
144
-preceded by stressful/traumatic event (emotional or physical)
-theory: extreme stress causes sympathetic stimulation and increase catecholamine release which basically tases the heart
-the catecholamines increase vasoconstriction, contractility, and HR which appears to look like an MI
takotsubo cardiomyopathy
145
How is takotsubo cardiomyopathy diagnosed?
-increased troponin
-ekg shows ST-T elevation
-angiogram has no occlusion
-echo shows apical balloning
146
What is the worst cardiomyopathy?
restrictive cardiomyopathy
147
-stiffening of the myocardium which causes the ventricles to fail to relax and dilate, this decreases filling and CO
-diastolic heart failure with systolic dysfunction
-idiopathic cause
-ventricles are normal size and hold normal volume
restrictive cardiomyopathy
148
What are the 2 possible problems with restrictive cardiomyopathy?
1) fibrous/scarring of cardiac muscle
2) infiltration
149
Which cardiomyopathy requires a heart transplant basically immediately?
restrictive cardiomyopathy
150
Pancarditis=
Inflammation in all of the heart layers
