Pathophysiology Of Heart Disease Flashcards Preview

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Flashcards in Pathophysiology Of Heart Disease Deck (25):
1

What is the basis of heart failure?

Abnormality of cardiac function
Failure to maintain adequate circulation

2

What is the primary cause of systolic heart failure?

Ischaemic heart disease

3

What are some other causes of systolic HF? (other than IHD)

Hypertension
Dilated cardiomyopathy
Valvular disease
Pericardial disease
Arrhythmias

4

What are the classes of heart disease?

Class I -> Class IV
Asymptomatic -> severe

5

What is the ejection fraction usually?

50% plus

6

What happens in systolic dysfunction?

Increased LV capacity
Reduced LV output
Thinning of myocardial wall
Mitral valve incompetence
Arrhythmias

7

What is the main neuro-hormonal activation in HF?

Sympathetic NS
Renin-Angiotensin-Aldosterone System
Natriuretic hormones

8

Describe the baroreceptor mediated response at the start of HF

Early compensatory mechanism to increase cardiac output (SNS)
Increased contractility
Increased rate
Vasoconstriction
But has long-term negative effects

9

What negative effects does the increased SNS response at the beginning of HF lead to?

Beta receptors down-regulated
Up-regulation of RAAS
Myocyte damage
Decreased contractility
Myocardial hypertrophy

10

Which mediator can bradykinin increase the levels of?

Nitric oxide - vasodilation

11

Activation of angiotensin II type 2 receptors can increase the levels of which mediator?

Nitric oxide

12

How can the angiotensin II type 1 receptor contribute to organ damage?

Vasoconstriction
Vascular hypertrophy
Endothelial dysfunction
Fibrosis and remodelling (in heart)
Decreased GFR
Increased proteinuria
Increase aldosterone release

13

What are the effects of elevated angiotensin II?

Vasoconstriction
Na+ and water retention
Aldosterone release
Left ventricular hypertrophy and myocyte dysfunction
(Can make fluid overload in HF worse)

14

What is the effect of natriuretic hormones?

Decrease reabsorption of Na+
Decrease fluid overload
Inhibit secretion of renin and aldosterone
Balances the effects of RAAS on vascular tone and fluid levels

15

What causes the release of natriuretic hormones?

Stretch or increase in cardiac chamber volume

16

What are the effects of endothelin?

Effects are like angiotensin II except more aggressive
Activates RAAS
Vasoconstriction

17

What is the effect of prostaglandins?

Vasodilators on renal arterioles

18

Why shouldn't HF patients take NSAIDs?

NSAIDs block prostaglandin synthesis
Prevents prostaglandin-induced vasodilation

19

What happens in the kidney during HF?

GFR maintained during early HF by haemodynamic changes
In severe HF, blood flow falls, GFR falls and rise in serum urea and creatinine

20

Describe diastolic dysfunction

Concentric ventricular hypertrophy
Reduced ventricular compliance
Impaired relaxation
Impaired diastolic filling
Low cardiac output

21

What are the 3 broad types of heart failure?

Right sided
Left sided
Congestive (both sides)

22

What are the signs/symptoms of left heart failure?

Fatigue
Dyspnoea on exertion
Orthopnoea
Gets up a lot at night
Can progress to: tachycardia, cardiomegaly, pulmonary oedema, peripheral oedema

23

What are the common causes of right heart failure?

Secondary to left heart failure
Chronic lung disease
Pulmonary embolism/hypertension
Tricuspid/pulmonary valvular disease
Left tot right shunts

24

What are the signs/symptoms of right heart failure?

Fatigue
Dyspnoea
Nausea
Peripheral oedema
Increased JVP
Hepatomegaly
Pleural effusion

25

Name some medications that can be prescribed for HF

Diuretics
ACE inhibitors
Beta blockers
Spironolactone
Anti-arrhythmics
Angiotensin type 1 blockers