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Pathophysiology > Hypertension II > Flashcards

Hypertension II Flashcards

(85 cards)

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1
Q

How does increasing EDV under control condition affect stroke volume?

A

Increase SV

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2
Q

If you keep EDV the same, but allow for sympathetic stimulation, why will SV increase?

A

Increased contractility

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3
Q

True or False: If you were to continously increase EDV + sympathetic stimulation, stroke volume increases

A

True

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4
Q

Inhibition of sympathetics causes a reduction of ____ at rest and when EDV is increased

A

contractility

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5
Q

How is SV calculated using ESV and EDV?

A

ESV-EDV = SV

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6
Q

Which determinants of cardiac performance is depicted here?
A. Afterload
B. Preload
C. Contractility

A

B. Pre-load

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7
Q

True or False: Pre load is changing in this image

A

False - it preload remains CONSTANT

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8
Q

ESPVR (end systolic pressure ratio) assesses:

A

contractility

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9
Q

True or False: EDV is a marker for preload

A

True

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10
Q

Why does stroke volume increase here?

A

Increased contractility

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11
Q

End Systolic Volume is a marker for ___. Therefore, changes in ESV suggest changes in ____

A

afterload

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12
Q

If you see do not changes in EDV or ESV, you could assume changes in ____

A

contractility

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13
Q

There is an increased slope of ESPVR-2 vs. ESPVR-1. What does this indicate?

A

Increased contractility

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14
Q

Which type of HF and accompanying feature is shown?
A. Systolic HF; decreased contractility
B. Systolic HF; decreased compliance
C. Diastolic HF; decreased contractility
D. Diastolic HF; decreased compliance

A

A. Systolic HF; decreased contractility

Note: Decreased in slope of ESPVR (end systolic volume)

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15
Q

How does diastolic HF affect compliance?

A

It decreases compliance, as shown

  • Slight decreased in EDV
  • Increase in End Diastolic Pressure
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16
Q

Is decreased in ESV or ESP a good thing? Why?

A

No - reduced pressure means reduced flow and reduced CO

  • Expelling less blood from
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17
Q

Why do people with systolic HF have a slight increase in EDV?

A

They expel less blood, so they have more left over

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18
Q

True or False: Reduced filling of the heart is seen with disastolic CHF

A

True

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19
Q

Decreased in EDV is associated with ____ while increased EDV is associated with ___

A

Decreased EDV = Diastolic HF

Increased EDV = Systolic HF

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20
Q

True or False: Decreased EDV and EDP are seen in Systolic HF

A

False - Diastolic

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21
Q

Which type of HF impairs venous return, adding resistance, therefore reducing preload?

A

Diastolic HF

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22
Q

HFrEF (HF with reduced EF) is associated with ___ dysfunction
A. Systolic
B. Diastolic

A

A. Systolic

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23
Q

In systolic dysfunction HF, do the ventricles pump out more or less blood than normal?

A

Less

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24
Q

Heart Failure with Preserved Ejection Fraction (HFpEF) is associated with _____ dysfunction
A. Systolic
B. Diastolic

A

B. Diastolic

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25
True or False: If there is diastolic dysfunction, ventricles fill with more blood than normal
False - fill with LESS blood than normal
26
Impaired filling is characteristic of: A. HFpEF B. HFrEF
A. HFpEF
27
The underlying cause of myocardial depression results in ____ deficiencies
contractility
28
How is cardiac m. affected by myocardial depression?
Unable to efficiently respond to increased in length (EDV) or load (afterload)
29
In heart failure, normal improvement of contractility in exercise is attenuated or prevented due to reductions in: 1. 2. 3.
* Cardiac NE stores * Beta-adrenergic receptor density * Catecholamine sensitivity
30
True or False: If you increase contractility in a normal person, there will be an increased of ventricular performance at rest and during exercise due to SNS stimulation. What will not change?
True - EDV will not change
31
Why does a patient with CHF have ~ normal CO and performance at rest?
Frank-Starling mechanism
32
Why might one with CHF experience dyspnea while trying to exercise?
High pulmonary capillary pressure caused by high EDV/EDP
33
HF is classified based on:
Ejection Fraction Limitations in physical activity Structural disease/symptoms
34
What are the five etiologies of CHF?
1. Hemodynamic overload 2. CAD 3. Cardiomyopathy 4. Hypertrophy – diastolic dysfunction 5. Electrophysiological (Tachy- or brady arrhythmias)
35
As HF progresses, there is an increase in EDV that leads to ___ in EF and SV
decrease
36
Arterial hypertension could increased ___, leading to HF Aortic valve regurgitation can increase ___, leading to HF
pressure; volume
37
True or False: ETOH, Diabetes, Viral Myocarditis can lead to HF
True
38
Advanced aortic stenosis and uncontrolled HTN will reduced EF and ___ afterload (systolic dysfunction)
Increase
39
CAD, Aortic/Mitral Regurgitation, and cardiomyopathies impair ____, leading to reduced EF (systolic dysfunction) A. Afterload B. Preload C. Contractility
C. Contractility
40
Dilated cardiomyopathy is an example of what type of hypertrophy?
Eccentric Hypertrophy
41
Which 5 factors impair diastolic filling, leading to HF with preserved EF (diastolic dysfunction)?
42
True or False: CAD, HTN, Diabetes, Age, and Obesity are risk factors for HF
True
43
____: A consequence of heart failure, in which problems occur from REDUCED CO and fall in ARTERIAL PRESSURE ____:
Forward Failure Backwards Failure
44
True or False: In Backward Failure, tissues become underperfused, which leads to hypoxia and altered metabolism
False - Forward Failure!
45
____: A consequence of heart failure, in which problems result from REDUCED ability to transfer blood from the VENOUS to the ARTERIAL circulation A. Forward Failure B. Backward Failure
B. Backward Failure
46
Which Failure leads to pulmonary and systemic congestion? A. Forward Failure B. Backward Failure
B. Backward Failure
47
Which type of HF?
Concentric HF - Increased LV pressure
48
True or False: Right HF is associated with lung edema
False - left lung pressure
49
True or False: There is right ventricle hypertrophy in Right HF, which increased afterload
True
50
True or False: Venous pressure increased in left heart failure
False - right HF
51
Peripheral Edema is associated with: A. Left HF B. Right HF
B. Right HF
52
***How does the Frank-Starling mechanism sustain cardiac performance (SV)?
Increases preload Increases CO
53
Which three neurohumoral mechanisms are activated to defend BP?
1. Sympathetic - Vaso/venoconstriction - Increased HR 2. RAAS 3. Vasopressin
54
Is contractility reduced in HF (LV)?
Yes - reduced slow from 1 to 3
55
Why is there exponential increased in preload reserve?
Because it has a limit
56
One way for compensating for cardiac failure is increasing ____
preload
57
Increased EDV will increase ____
preload
58
True or False: Chronic stimulation of SNS is a compensatory mechanism in HF
True - plasma NE correlated with extent of ventricular dysfunction - basal levels can predict survival probability
59
How does ANP affect preload and afterload?
Reduces
60
True or False: Chamber dilation, wall thickening, or reduction in wall tension is a compensatory mechanism in CHF
True
61
True or False: Pressure overload increases LV pressure, left ventricular mass index, and left ventricle wall thickness significantly. By contrast, volume overload increases all of the above as well, but to a lesser extent.
True
62
What causes arterial mechanoreceptor unloading?
Decreased ventricular work, SV, and CO
63
What is the affect of arterial mechanoreceptor unloading?
Affects hypothalamus => increased ADH => increased TPR => change pressure gradient
64
What causes RUQ discomfort in HF?
Liver congestion
65
___ is the primary symptom of heart failure
Fatigue (exertional)
66
What causes peripheral edema in CHF?
Elevated venous pressure
67
Is peripheral edema associated with left or right HF?
Right HF
68
How does peripheral edema in R HF affect venous, capillary, and right atrial pressure?
Increases venous, capillary, and right atrial pressure
69
Left HF leads to ___ edema
pulmonary
70
True or False: Sweating and tachy, as seen in HF, are due to increased PNS activity
False - SNS activity
71
What causes clinical manifestation of hepatomegaly, jugular venous distention, and peripheral edema?
Venous congestion
72
True or False: Elevated troponin suggests cardiac injury
True
73
Which of the following increases with high atrial and ventricular filling pressures? A. CRP B. BNP C. CBC
B. BNP
74
Which of the following may be slightly elevated with acute myocardial infarction? A. CRP B. BNP C. CBC
A. CRP - note: not cardiac specific!
75
Which imaging is the most useful test for identification of ejection fraction? A. Electrocardiogram B. Chest X-Ray C.2DEchocardiography/Doppler
C. 2D-Echocardiography/Doppler
76
Which drug class reduce blood volume? A. ACE Inhibitors B. Aldosterone Receptor Antagonists C. Diuretics
B. Aldosterone Receptor Antagonists
77
Which drug classes reduces systemic and pulmonary congestion? A. ACE Inhibitors B. Aldosterone Receptor Antagonists C. Diuretics
C. Diuretics
78
Which drug class reduces preload and afterload AND has beneficial effects on remodeling? A. ACE Inhibitors B. Aldosterone Receptor Antagonists C. Diuretics
A. ACE Inhibitors
79
Which drug class reduces inflammatory cytokine production, decreases frequency of ventricular premature beats, and has beneficial effects on ventricular remodeling? A. ACE Inhibitors B. Aldosterone Receptor Antagonists C. Diuretics D. Beta-adrenergic receptor antagonists
D. Beta-adrenergic receptor antagonists
80
True or False: Venous Vasodilators will decrease preload and pulmonary congestion while Arteriolar Vasodilators decrease systemic vascular resistance/afterload
True
81
Dopamine, Dobutamine and PDE Inhibitors are ____
Inotropes
82
How do Intropes affect CO, SV, and F-S Curve?
- Shift FS up - Increase CO/SV
83
How does Nesiritide decreased afterload and preload?
Vasodilation
84
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85
Benefit of exercise training?
Increased maximal exercise tolerance

Pathophysiology (26 decks)

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