Heart Failure I - patho Flashcards Preview

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Flashcards in Heart Failure I - patho Deck (18):
1

Heart failure involves ____ failure and _____ failure

forward failure (low flow)

and backward failure (congestion)
- typically in response to low flow

2

forward failure

Heart failure is the inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body

3

backward failure

ability to do so only if the cardiac filling pressures are abnormally high

4

what controls CO?
What controls SV?

HR x SV

SV controlled by:
Inotropy of the ventricles (+)
Preload of the ventricles (+)
Afterload of the ventricles (-)

5

Sum up Frank-starlin curve in 1 sentence

If you stretch the heart out more in diastole, it will contract more in systole.

6

Determinants of Inotropy

Catecholaminergic/adrenergic stimulation

Calcium

7

Describe the following axis for PV loops:
x-axis
y-axis
unlabled axis

x: volume inside the ventricles
y: pressure inside the ventricles

unlabeled axis: time

8

Major divisions of HF

systolic HF
Diastolic HF
Left-sided
Right-sided

*note: systolic is usually accompanied by diastolic dysfunction and vice versa
- and LV failure often causes RV failure

9

Types of ventricular remodeling and what type of HF does it typically result in?

Hypertrophied heart
- diastolic HF

Dilated heart
- systolic HF

10

A weak/damaged myocardium = what type of HF?

Systolic failure due to loss of contractility

11

Systolic dysfunction
what is it a problem in?
what is the hallmark?

A problem with squeeze
- ↓contraction / ↓ inotropy

Hallmark is:
1. Decreased ejection fraction
“HF with reduced ejection fraction” = HFrEF
“left ventricular systolic dysfunction” = LVSD

2. Ventricular enlargement
“dilated cardiomyopathy” = DCM

- note: these are all the same terms. multiple names

12

3 primary causes of systolic heart failure

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

13

Diastolic dysfunction
what is it a problem in?
what is the hallmark?

Impaired filling
- ↓lusitropy / decrease in relaxation

Hallmark is
1. Normal ejection fraction
“HF with preserved ejection fraction” = HFpEF
“preserved systolic function” = PSF
2. Ventricular wall thickening
“left ventricular hypertrophy” = LVH

14

Right-sided heart failure
- what is it
- what does it cause

Stresses to the RV can cause it to fail to adequately pump blood through the lungs, which causes
↓ circulating blood flow (forward RV HF)
↑ venous pressures (backward RV HF)

15

HFrEF

HFpEF

Heart failure with reduced ejection fraction
- systolic HF

heart failure with preserved ejection fraction
- diastolic HF

16

↓ LV filling leads to ↓ CO
- what two structures senses this?
- how do they compensate?

Juxtaglomerular apparatus in kidney senses lower flow
--> Renin-
Angiotensin-Aldosterone (RAAS) activation

Carotid sinus / aortic baroreceptors sense lower pressure
--> Autonomic nervous system / adrenergic activation

17

What does RAAS activation result in?
What about ANS/adrenergic activation?

RAAS: ↑ Sodium retention (↑ volume) + vasoconstriction

ANS/adrenergic activation: ↑ HR

- note: this is good short term compensatory mechanism, but is a double edge sword --> HF without intervention in the long run

18

How is SV preserved?
What adverse side effects can result from ↑ volume?

STROKE VOLUME PRESERVED BY INCREASED
END-DIASTOLIC FILLING / PRESSURE (↑ contractility + preload)

↓ LV squeeze (systolic HF)
AND/OR ↑ stiffness (diastolic HF)

Supranormal filling pressures