LECTURE 2: cardiac muscle dysfunction and failure Flashcards
1
Q
what is the most common cause of pulmonary congestion and edema
A
HF
2
Q
if someone has a L sided HF would problem would most likely arise ?
A
lung
3
Q
increased arterial pressure form hypertension causes what on the LV
A
increases work
4
Q
hypertension causes what effect on afterload?
A
increased
5
Q
what happens to the LV during hypertension
A
enlarges and hypertrophies
6
Q
during HTN , the LV enlarges and hypertrophies so then there is an ____ energy expenditure of the mm fibers of the heart
A
increased
7
Q
ECG measure what
A
ejection fraction
8
Q
Doppler measures what
A
blood flow
9
Q
what is the second most common causes of CMD
A
coronary artery disease
10
Q
what is coronary artery disease
A
ischemia due to restriction of blood flow
11
Q
if someone has CAD what happens at the ischemia areas of the ventricle ?
A
scar formation
12
Q
in CAD if someone has scare formation at the ischemia areas of the ventricle what happens to the compliance ? filling ? and contractility?
A
poor compliance
decrease filling and contractility
13
Q
if there is a decreased contractility then there is an _____ ejection fraction
A
decreased
14
Q
someone who has CAD has the possibility of developing _____ ____ during to increased ___ released
A
cardiac arrhythmias due to increase Ca+ released
15
Q
what is irreversible myocardial necrosis
A
myocardial infarction
16
Q
if someone has high levels of CK-MB or troponin I what can we suspect
A
acute myocardial infarction
17
Q
if you are reading a ECG and you see ST elevation what can we suspect
A
acute myocardial infarction
18
Q
Can cardiac arrhythmias causes sudden cardiac arrest even with someone with a normal heart ?
A
yes
19
Q
what is abnormal rate and contraction of atria or ventricles
A
cardiac arrhythmias
20
Q
if someone has cardiac arrthymias that means there is an altered sequence of _____ and it does not allow for proper ____ and ____ of blood from their respective chambers
A
contraction
filling
ejection
21
Q
is the conduction system affected in cardiac arrthmias ?
A
yes
22
Q
if someone has cardiac arrhythmias then they have a ____ cardiac output
A
reduced
23
Q
cardiac arrhythmias can assess what types
A
sick sinus body syndrome
prolonged supraventricular tachycardia
ventricular tachycardia
24
Q
rapid atrial fibrillation or flutter is an example of what
A
prolonged supra ventricular tachycardia
25
which cardiac arrhythmias are deadly
ventricular tachycardia and fibrillation
26
what contributes / exacerbates to CMD due to fluid overload
renal insufficiency
27
one of the main focuses with someone with renal insufficiency is to maintain what
electrolyte balance of Na+ and K+ levels
28
what is azotemia
severe renal insufficiency
29
azotemia is a high blood content of what compounds
urea and creatinine
30
what is causes by decreased glomerular filtration rate and decreased blood flow
renal insufficiency
31
someone with severe renal insufficiency has an _____ SNS to increase what
increased and BP
32
someone with severe renal insufficiency has increase what
BUN
creatinine
water
sodium retention
33
explain the RAAS system
when BP falls renin comes from the kidneys and angiotensinogen is released from the liver and then they react together to form angiotensin 1 and then ACE is released from the lungs and acts on angiotensin 1 to form angiotensin 2 which then stimulates vascontriction of the blood vessels and also acts on adrenal glad to stimulate release of aldosterone to act on the kidneys to stimulate reabsoprtion of water and salt
34
what is the disease of the heart mm itself leading to HF
cardiomyopathy
35
what does cardiomyopathy impair in the heart
contractility and/or relaxation
36
what are primary causes of cardiomyopathy
idiopathic mechanisms
37
secondary cardiomyopathy is causes due to
prolonged HTN
MI
metabolic disorder : DM , thyroid disease
heart valve problems
cardiac arrthymias
38
what are the 3 types of cardiomyopathies
dilated
hypertrophic
restrictive
39
dilated cardiomyopathy causes what type of EF
reduced
40
cardial mm for dilated cardiomyopathy can be due to what
metabolic
toxic
infection
genetic
41
what is known as myocardial mitochondrial dysfunction
dilated cardiomyopathy
42
what type of dysfunction is dilated CM
systolic dysfunction
43
someone with dilated CM has a heart that is a ___ effective pump
less
44
someone with DCM has a ___ EF
decreased
45
someone with DCM has an _____ left ventricular end diastolic volume
increased
46
someone with DMC and an increased LV EDV causes what to the cardiac mm fibers
for them to dilate and stretch
47
why is there decreased contractility of the heart mm fibers with someone with DCM
due to overstretch
48
hypertrophic cardiomyopathies has a ____ EF
preserved
49
hypertrophic CM causes an _____ heart
enlarged
50
what type of dysfunction is a hypertrophic CM
diastolic dysfunction
51
what does it mean if there is a diastolic dysfunction
impaired filling of the ventricles during diastole
52
someone with HCM has a diastolic dysfunction which does not allow the myocardium to do what
relax to allow filling
53
HCM causes an _____ left atrial , pulmonary artery , and pulmonary capillary pressure
increased
54
what are causes for HCM
genetic or prolonged HTN
55
who is HCM a common cause for sudden cardiac arrest
young athletes
56
can HCM lead to fatal arrhythmias
yes
57
which CM is considered to be myocardial fibrosis
restrictive cardiomyopathies
58
someone with restrictive CM has a defect in what
myocardial relaxation
59
what kind of dysfunction is RCM
diastolic
60
what Causes these things
• Cardiac amyloidosis
• Diseases of the heart lining (endocardium), such as endomyocardial fibrosis
• Iron overload (hemochromatosis)
• Sarcoidosis
• Scarring after radiation or chemotherapy • Scleroderma
• Tumors of the heart
RCM
61
what is it called when the heart contracts more forcefully to expel the cardiac output
heart valve abnormalities
62
what does heart valve abnormalities induce
myocardial hypertrophy
63
what can be caused by mitral valve prolapse
valvular insufficiency
64
blocked valves are called what
valvar stenosis
65
what causes regurgitation of the blood to fill the atria and ventricles forcefully
valvular incompetence
66
valvular incompetence causes myocardial ____ and _____
dilation and hypertrophy
67
mitral valve prolapse leads to what
shortness of breath and S3 heart sounds
68
valvular incompetence produces ___ due to impaired relaxation of myocardium
CMD
69
atrioventricualr valve incompetency affects what valves
mitral and tricuspid
70
what incompetency dilates the left atria
mitral
71
triscupsid valve incompetency dilates what
right atria
72
ventricular valve incompetency affects what
aortic and pulmonic
73
aortic valve incompetency dilates what
LV
74
which incompetency dilates the RV
pulmonic valve
75
active valve dysfunction leads to __ CO due to what
Decreased CO due to regurgitant blood
76
acute valve dysfunction can produce ____ edema
pulmonary
77
what is it called if there is fluid that may compress that heart
pericardial effusion
78
what is defined as inflammation of the pericardium due to injury or infection
parcarditis
79
what is charactized as elevated intracardiac pressures , progressively limited ventricular diastolic filling , and reduced stroke volume?
cardiac tamponade
80
what produced cardiac tamponade
increased intrapericardial pressure from pericardial effusion
81
what is CMD from elevated pulmonary artery pressure
pulmonary embolism
82
pulmonary embolism causes ___ right ventricular demand
increased
83
does elevated pulmonary artery pressure causes disease lung tissue and decreased lung surface to perfusion ratio
yes
84
if right pulmonary embolism progresses to left ventricular failure what does that do to the coronary blood flow
decreases it
85
pulmonary embolism may causes ____ infarction due to decreased right ventricular blood flow
lung
86
pulmonary embolism causes ___ pulmonary hypertension which further increase the work for the ___ ventricular and causes ____
increased
right
hypertrophy
87
Pulmonary hypertension causes a ____ right ventricular SV thus ____ the LV SV and CO
decrease 2x
88
what is pulmonary hypertension defined as
mean pulmonary arterial pressure
89
when is mPAP considered abnormal
if someone has primary PH and mPAP is >20 or someone with COPD >20
90
what is the development of PH in COPD causes by
hypoxia
91
hypoxia is associated with an ___ in pulmonary vascular resistance
increased
92
The World Health Organization (WHO)
• Group __ - Pulmonary arterial hypertension (PAH)
• Group ___ - Pulmonary hypertension due to left-sided heart disease
• Group ___ - Pulmonary hypertension due to lung diseases and/or hypoxia
• Group ___ - Chronic thromboembolic pulmonary hypertension (CTEPH)
• Group __ - Pulmonary hypertension with unclear or multifactorial etiologies:
1-5
93
if pressure increases in the pulmonary arteries what odes it causes the right ventricular to do
pump harder to provide blood to the lungs for oxygenation
94
if someone has PH it can lead to increase girth ventricular work which can lead to what
hypertrophy
cor pulmonale (r side HF)
95
what causes a pathological decreases in cardiac output
congestive heart failure
96
CHF is a __ ventricular failure leading to ____ congestion
left
pulmonary
97
For example, left-sided HF is frequently the result of left ventricular insult (e.g., myocardial infarction, hypertension, aortic valve disease), which causes fluid to accumulate behind the left ventricle ([LV], left atrium, pulmonary veins, pulmonary capillaries, lungs). If the left-sided failure is severe, there is progressive accumulation beyond the lungs, leading to pulmonary hypertension (PH) and subsequently as right-sided failure. 7 Thus right-sided HF may occur because of left-sided HF or because of right ventricular failure (e.g., secondary to PH, pulmonary embolus, right ventricular infarction). In either case, fluid backs up behind the right ventricle and produces the accumulation of fluid in the liver, abdomen, and bilateral ankles and hands.
just know
98
what is the result of low cardiac output at rest or during exertion
HF with reduced ejection fraction
99
what usually results from impaired relaxation of the LV and passive LV compliance resulting in stiffness and increased diastolic pressure
HF with preserved EF
100
The impaired contraction of the ventricles during systole that produces an inefficient expulsion of blood (low stroke volume) is termed what
systolic HF
101
The impaired filling and inability of the ventricles to accept the blood ejected from the atria during rest or diastole is termed what
diastolic HF
102
LV failure will lead to ___ congestion
pulmonary
103
someone with CHF will have ____ edema due to _____ pulmonary capillary pressure
pulmonary
increased
104
If BNP is increased what can we predict
CHF
105
if someone has right CHF where is fluid backed up into
right atrium / periphery
106
Left CHF causes fluid build up into what
lungs
107
what type of EF does someone with a systolic dysfunction have
reduced
108
what type of EF does someone with a diastolic dysfunction have
preserved
109
how does Sympathetic nerve impulses affected the myocardial contractility
positively
110
how does Circulating epinephrine affected the myocardial contractility
positively
111
how does the use of digitalis and lanoxin effected the myocardial contractility
positively
112
what type of pharmacological agent is digitalis
positive iontropic which increased contractility
113
how does the loss of myocardial cell affect the myocardial contractility
bad
114
how does Pharmacologic depressants (Beta Blockers) affect the myocardial contractility
neg
115
what is hypercapina
increased CO2 and decreased O2
116
how does anoxia affect the myocardial contractility
neg
117
what is the overall affect of the RAAS system
increase CO and BP by sodium and water retention
118
why is there a decreased pulmonary function in CHF
fluid build up
119
which stage of fluid accumulation in the pulmonary system is liquid build up compromises small airways of lung. Ventilation / perfusion mismatch. Produces hypoxemia and tachypnea
2
120
which stage of fluid accumulation in the pulmonary system is increased lymph flow w/o net gain in interstitial fluid. Gas exchange is improved. Increased lymph flow increases liquid into the lung
1
121
which stage of fluid accumulation in the pulmonary system is pulmonary edema increases, increased pulmonary capillary wedge pressure that floods the alveoli. Compromises gas exchange. Produces severe hypercapnea and hypoxemia
3
122
what kinf of receptor is myocardial iontrophy and chontropyy
beta 1
123
what type of receptor is vasodilation of capillary beds and bronchdilation
beta 2
124
what type of receptors is vasoconstriction of vascular beds of GI, kidney and brain
alpha 1
125
which type of receptors is arterial vasodilation
alpha 2
126
which receptor wants to increase HR and force of contraction
beta 1
127
which receptor is more of a relaxer
beta 2
128
which receptor is a positive iontropic ? negative?
alpha 1
alpha 2
129
if you down regular beta 1 then waht happens to myocardial contractile force and heart rate
decreased
130
what is the purpose of beta blockers
slows heart rate and lowers BP
131
hematologic function and CHF is due to deacreased ___ concentration in the blood due to either right or left heard failure
oxygen
132
if diastolic is less than 40 then what does that indicate
HF
133
hematologic function and CHF causes an ____ red blood cell production from ___ ____ which then produces _____
increase
bone marrow polycythemia
134
what is anemia
low hematocrit/ hemoglobin
135
which way does anemia shift the SaOz curve
to the right
136
how can u exercise a patient with skeletal muscle activity and CHF w/o cardiomyopathy
low/moderate intensity for longer periods
137
how should you exercise your patient with skeletal mm activity and CHF with cardiomyopathy
aerobic but for a little
138
dysfunctional heart relies on what as a primary fuel source
glucose
139
what does CHF do for pancreatic function
impairs insulin ferreting and glucose tolerance
