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M103 T3 > M103 T3 L12 > Flashcards

M103 T3 L12 Flashcards

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1
Q

When does high output HF occur?

A

when the heart can’t provide for the unusually high demand for blood to organs with normal functioning

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2
Q

What conditions result in high output HF? (SATT.PAPP)

A

sepsis, acromegaly, thyrotoxicosis (SAT)

Profound anaemia, Pregnancy, Pagets disease (PAPP)

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3
Q

What are causative conditions of HF?

A 
Cardiomyopathies
Congenital Heart Disease
Coronary Heart Disease
Hypertensive Heart Disease
Myocardial Disease
Valvular Heart Disease
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4
Q

What are the causes of dilated cardiomyopathy?

A 
alcohol, pregnancy
systemic disease 
muscular dystrophies 
Drug toxicity (chemotherapy)
Myocarditis – common viruses
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5
Q

What are the three types of cardiomyopathy? (DHR)

A

dilated
hypertrophic
restrictive

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6
Q

What is the main cause of restrictive cardiomyopathy?

A

amyloid

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7
Q

What does the activation of neurohormonal system involve?

A

the release of noradrenaline
the release of ANP / BNP
the activation of RAAS

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8
Q

Which compensatory mechanisms may successfully restore cardiac output but can also worsen HF?

A

vasoconstriction
Na and water retention
excessive tachycardia

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9
Q

What is excessive tachycardia caused by?

A

→ ↓diastolic filling time → ↓ventricular filling → ↓SV and CO

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10
Q

What are the clinical types of HF?

A 
Left sided, right sided and biventricular 
Acute and chronic
Compensated and decompensated
Systolic and Diastolic
High and Low out put
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11
Q

What happens during left sided HF?

A

blood backs up progressively from the left atrium to the pulmonary circulation

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12
Q

What conditions cause left sided HF? (VIM Him)

A

Valvular heart disease
Ischaemic heart disease
Myocardial disease
Hypertension

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13
Q

How does left ventricular HF cause heavy wet lungs?

A

pulmonary vein pressure is transmitted retrogradely to the capillaries and arteries
< pulmonary congestion and oedema < heavy wet lungs

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14
Q

What conditions cause heavy wet lungs?

A

dyspnoea exaggeration of the normal breathlessness that follows exertion
Orthopnoea
Paroxysmal nocturnal dyspnoea

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15
Q

How does left ventricular HF affect the kidneys?

A

Decreased cardiac output results in decreased renal perfusion
Activation of RAAS
Retention of salt and water with consequent expansion of interstitial fluid and blood volumes

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16
Q

What neurological conditions cause left ventricular failure?

A

Hypoxic encephalopathy
Irritability, Loss of attention, Restlessness
Stupor and coma

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17
Q

What conditions cause right sided HF?

A

usually left sided HF - congestive cardiac failure
cor-pulmonale
valvular heart disease
congenital heart disease

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18
Q

What is cor-pulmonale caused by?

A

increased resistance within the pulmonary circulation due to respiratory disease e.g. COPD or pulmonary emboli
leads to significant pulmonary hypertension
causes right HF

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19
Q

Which parts of the body does HF affect? (PASST)

A

Portal system, Abdomen, Spleen, Subcutaneous Tissue
the liver
the pleural and pericardial space

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20
Q

What conditions does right HF cause in the liver or in the portal system?

A

Congestive hepatomegaly
Centrilobular necrosis when severe
Cardiac cirrhosis

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21
Q

What abdominal condition is caused by right HF?

A

Congestive splenomegaly

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22
Q

How does right HF affect the subcutaneous tissue?

A

Peripheral oedema of dependent portions of the body esp. ankle and pretibial oedema

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23
Q

How does right HF affect the pleural and pericardial space?

A

effusions

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24
Q

What can cause biventricular failure?

A

the same pathological process on each side of the heart

left HF leading to volume overload of the pulmonary circulation and eventually the right ventricle

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25
In patients with HF, what conditions does excess fluid accumulation cause? (HODA)
Hepatic congestion Orthopnoea, Oedema Dyspnoea, paroxysmal nocturnal dyspnoea Ascites
26
In patients with HF, what does a reduction in HF cause?
Fatigue | Weakness
27
What are the different classes of HF?
Class I: No limitation of physical activity Class II: Slight limitation of ordinary activity Class III: Marked limitation, even during less-than-ordinary activity Class IV: Severe limitation with symptoms at rest
28
What are the clinical signs of HF?
Cool, Ascites, pale (CAP) Peripheral oedema, Displaced apex (PO.DA) cyanotic extremities, Tachycardia (CET) Hepatomegaly, Elevated jugular venous pressure (HEj) the presence of an S3 sound Crackles or decreased breath sounds at bases on chest auscultation
29
What clinical tests are used to pin point HF?
CXR, ECG Blood investigations Echocardiogram / Cardiac MRI or CT / CT-PET CTCA / Coronary angiography
30
What are two examples of loop diuretics?
frusemide | bumetanide
31
What can potent loop diuretics lead to?
electrolyte abnormalities hypovolaemia diminished renal perfusion
32
How are loop diuretics administered?
iv / orally
33
How do loop diuretics work?
Inhibit Na+ re-absorption from the proximal tubule | K+ loss from distal tubule
34
What are two examples of Mineralocorticoid Receptor Antagonists?
EPLERENONE | SPIRONOLACTONE
35
How do Mineralocorticoid Receptor Antagonists work?
they promote Na+ excretion and K+ re-absorption | in distal tubule
36
What is the effect of Mineralocorticoid Receptor Antagonists?
they reduce hypertrophy and fibrosis
37
What are the main side effects of Mineralocorticoid Receptor Antagonists?
Gynaecomastia (esp. Spironolactone) | Electrolyte (K+ high) and renal function abnormalities
38
What are examples of ACE Inhibitors? (RECord Perilous Liars)
``` Ramipril Enalapril Captopril Perindopril Lisinopril ```
39
What do ACE Inhibitors act on?
the activated RAAS
40
How are ACE Inhibitors administered?
given orally in small doses with slow titration
41
How do ACE Inhibitors block the production of angiotensin?
Vasodilatation BP lowering Reduce cardiac work
42
What are the main side effects of ACE inhibitors?
cough hypotension renal impairment
43
What are three examples of beta blockers? (BCM - Back CAR MEeT)
BISOPROLOL CARVEDILOL METOPROLOL
44
How do beta blockers block the action of adr and noradr?
they slow the HR, which reduces BP
45
What is the function of beta blockers?
to block the action of adrenaline and noradrenaline on adrenergic b-receptors
46
How are beta blockers administered?
they are given orally in small doses with slow titration | treat arrhythmias
47
What are the two main side effects of beta blockers?
Bronchospasm | Claudication
48
What is an example of a SA node blockade?
ivabradine
49
How do SA node blockades work?
Slow HR, no effect on BP
50
How are SA node blockades administered?
Given orally with dose titration
51
What is the function of SA node blockades?
blocks the If channel within the SA node
52
What are the two main side effects of SA node blockades?
Visual aura | Bradycardia
53
What is the effect of digoxin?
it increases myocardial contractility | it slows conduction at the AV node
54
What conditions is digoxin used to treat?
acute HF, chronic HF | arrhythmias, AF
55
What happens to digoxin once it has made its way through the body?
it is excreted by kidney
56
What is an example of an ARNI?
SACUBITRIL VALSARTAN
57
What is the function of an ARNI?
it acts on the activated RAAS it blocks the breakdown of ANP/BNP it blocks the production of angiotensin it promotes natriuresis
58
How do ARNIs block the production of angiotensin?
vasodilatation lowers the bp reduces cardiac work
59
What are the main side effects of ARNIs?
hypotension | renal impairment
60
How do ARNIs promote natriuresis?
sodium excretion vasodilatation reduce hypertrophy fibrosis
61
What are other therapies for HF?
Cardiac Resynchronisation Therapy Cardiac transplantation Stem cell therapy
62
What is the difference between standard pacemakers and biventricular pacemakers?
standard - equipped with two leads that conduct pacing signals to specific regions of heart biv - have an additional third lead designed to conduct signals directly into the left ventricle
63
What is an adv of biventricular pacemakers?
the combination of all three leads promotes synchronised pumping of ventricles there is increasing efficiency of each beat pumps more blood on the whole 
64
What is the usual cardiac output at rest?
70mls/kg/min
65
What two things does the Frank Starling law relate to eachother?
Preload | Cardiac Output
66
What does the Frank Starling law state?
that an increase in volume of blood filling the heart stretches the heart muscle fibres causing greater contractile forces which, in turn, increases the stroke volume
67
Why is the Frank Starling law only true up to a certain point?
at some stage the fibres become over-stretched and the force of contraction is reduced
68
What is the effect of noradrenaline?
increases heart rate increases myocardial contractility causes vasoconstriction
69
What does the activated RAAS do and how?
it elevates blood volume by increasing Na and water reabsorption
70
What is the natriuretic peptide system activated by?
increased ventricular wall stretch
71
What is the effect of active BNP?
diuresis | vasodilationinhibits the RAAS and the sympathetic NS
72
What is the half life of active BNP in circulation?
20 mins - very short lived
73
What does high NT-proBNP indicate?
increased risk of HF
74
What are the effects of the natriuretic peptide system?
Increase GFR decrease bp increased water & sodium excretion in urine
75
What happens when the natriuretic peptide system is activated?
pro-BNP is released | is cleaved
76
What is pro-BNP cleaved into?
active BNP | NT-proBNP
77
From where is NT-proBNP excreted?
renally
78
What is the half life of NT-proBNP in circulation?
2 hrs
79
Why is sympathetic NS activity counter productive in a HF situation?
increased cardiac, vascular and renal sympathetic activity
80
Why is increased cardiac sympathetic activity counter productive in a HF situation?
myocytes hypertrophy increased arrhythmia increased ischaemic demand
81
Why is increased vascular sympathetic activity counter productive in a HF situation?
vasoconstriction mediated by the peripheral vascular circulation
82
Why is increased renal sympathetic activity counter productive in a HF situation?
causes sodium retention | further activates the RAAS - RAAS activates this sympathetic NS and vice versa
83
What happens during decompensated HF?
occurs when patients have ended up with worsening symptoms | often admitted to hospital
84
What causes decompensated HF?
an additional medical condition - puts extra pressure on the balance of their HF disease progression / further cardiac insult
85
When is Cardiac Resynchronisation Therapy (CRT) offered to a HF patient?
when the patient is deemed to be at risk of sudden cardiac death
86
When is Dialysis & Ultrafiltration used on a HF patient?
when the patient become resistant to diuretics
87
What treatments are used on HF patients who are very unstable and extremely unwell with cardiogenic shock?
Ventricular Assist Device (LVAD/RVAD) | Intra-aortic balloon pump
88
What are the two types of defibrillator?
System ICD | Transveous ICD
89
How is the Transveous ICD positioned?
a lead inside the heart is connected to a pulse generator under the skin
90
How does a Transveous ICD work?
an electrical shock wave is passed through the heart from the generator to the lead and back this reverts unstable ventricular arrhythmias back to sinus rhythm
91
What is an advs of using a Transveous ICD?
can be achieved completely subcutaneously | avoids the need for placing electrodes within the circulation or within the heart itself
92
How is the System ICD positioned?
the lead is placed to the left of the sternum
93
What is Cor pulmonale otherwise known as?
right-sided HF
94
What is cardiac cirrhosis caused by?
right sided HF
95
What is S3 otherwise known as?
the third heart sound | ventricular gallop
96
What is a displaced apex caused by?
LV enlargement
97
What medication may work for swelling when other medications have not?
bumetanide
98
What is frusemide used to treat?
hypertension | fluid build-up due to HF, cirrhosis, or kidney disease
99
What is bumetanide used to treat?
swelling (cardiac AAR of HF) and hypertension
100
What is Eplerenone used to treat?
HF, hyperaldosteronism | reduces the risk other heart problems / a stroke
101
Is Gynaecomastia benign?
usually but breast cancer can develop in about 1% of cases
102
What causes Gynaecomastia?
an imbalanced ratio of oestrogen and androgen activity
103
What causes high output HF?
when CO is higher than normal due to increased peripheral demand
104
What conditions an result from high output HF?
a circulatory overload pulmonary oedema secondary elevated diastolic pressure (left ventricle)
105
What is claudication usually a symptom of?
peripheral artery disease caused by atherosclerosis
106
When does claudication occur?
when there is too little blood flow to the limbs due to atherosclerosis
107
What is peripheral artery disease usually caused by?
atherosclerosis
108
What is a symptom of claudication?
pain in the limbs associated with walking or using the arms
109
What is the difference between angina and chest pain?
Not all angina is chest pain | angina is pain caused by narrowed coronary arteries
110
What conditions is ivabradine used to treat?
the symptoms of stable heart-related chest pain | HF not fully managed by beta blockers
111
What do the cardiac glycosides affect?
they ics the force of the heart and its rate of contractions
112
How do the cardiac glycosides work?
by acting on the cellular Na/K ATPase pump
113
What is digoxin used for?
to control some heart problems
114
How does neprilysin work to inactivate peptide-based hormones?
they cleave peptides at the amino side of hydrophobic residues
115
What are examples of peptide hormones that are inactivated by neprilysin? (GES NOB)
glucagon, enkephalins, substance P, neurotensin, oxytocin, and bradykinin.
116
When are ARNIs used?
when other treatments for HF aren't working in certain cases / patients
117
Where is B-type natriuretic peptide made?
inside the pumping chambers of the heart
118
When is B-type natriuretic peptide made?
when pressure builds up from HF
119
What substance serves as an indicator of HF?
B-type natriuretic peptide
120
What does CRT involve?
implanting a small pacemaker just below the collarbone three leads are connected to a device that monitors the heart rate to detect heart rate irregularities and emit tiny pulses of electricity to correct them
121
What gender(s) is androgen present in?
both genders
122
What is the role of androgen?
contributes to male traits and reproductive activity
123
What are the two main androgens?
testosterone and androstenedione

M103 T3 (21 decks)

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