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Flashcards in Systems Pathology: Heart Failure Deck (11)
0

RAA

Renewing converts angiotensinogen to angiotensin I
ACE converts angiotensin I to II
Aldosterone release
Na retention-> increased blood volume
Vasoconstriction
Cardiac and vascular Hypertrophy

1

Definition of heart failure

Condition caused by failure of the hearts function as a pump
-> fails to maintain circulation to meet metabolic needs
Clinical manifestations-> fluid congestion and inadequate tissue blood flow
Acute-> failure events happen rapidly
Chronic-> failure compensatory mechanisms

2

Classification of heart failure

Class I -> no limitation of physical activity
Class II -> slight limitation of activity-> breathlessness/fatigue
Class III -> marked limitation of activity-> breathless on minimal exercise
Class IV -> severe-> symptoms at rest

3

Cardiac remodelling, molecular changes

Hypertrophy in response to increased demands
Cardiac damage-> ventricular dysfunction
-> cytokines-> heart remodelling
-> Neuroendocrine response-> heart remodelling and symptoms
Pump failure although initially increase output
Adrenergic-> increase contractility and Hypertrophy-> myocycte apoptosis, myocycte toxicity
Angiotensin II-> Hypertrophy-> changed expression of contractile proteins
Cytokines-> Hypertrophy-> remodelling of matrix dilation, dilation-> bad

4

Left ventricular failure causes

Acute ventricular dysrhythmias
Myocardial infarction and Ischaemic heart disease
Longstanding hypertension
Valve disease
Cardiomyopathies and drugs
Congenital heart disease
-> either increase demand or damage heart
-> insufficient pump power or obstruction of blood flow-> aortic stenosis

5

Consequences of LVF

Chambers fail to empty at systole-> become dilated
-> progressive rise in pressure in LV which is reflected back into the LA-> Pulmonary veins-> pulmonary capillaries
-> forces fluid out of capillaries-> pulmonary edema-> breathlessness
Also not enough blood pumped out into aorta and arterial system-> hypotension, poor tissue perfusion and poor oxygenation

6

Clinical examples of LVF

Acute myocardial infarction
Hypertensive heart disease
Chronic rheumatic valve disease

7

Causes of right ventricular failure

Most common cause is LVF
Acute-> pulmonary thromboembolism
Chronic-> chronic lung disease and pulmonary hypertension
Valve disease is rare

8

Consequences of RVF

Right chambers dilate-> chambers fail to empty-> raised end diastolic pressure-> increased right arterial and jugular venous pressure-> raised systemic venous pressure
-> tender, large, congested liver
-> peripheral oedema

9

Clinical examples or RVF

Emphysema-> cor pulmonale
-> destroys alveolar walls-> loss of lung capillaries-> failure of lung ventilation-> hypoxia constricts pulmonary arteries-> pulmonary hypertension

10

Congestive cardiac failure

Failure of both sides
Most commonly Ischaemic heart disease
LVF then RVF so LVF causes
Cardiomyopathies and drugs
LV aneurysm
Congestive cardiomyopathy

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