The Heart 2 Flashcards
(43 cards)
Congestive heart failure (CHF) is characterized by inadequate pump function that causes _____ build-up in the lungs and/or peripheral tissue (congestion).
fluid
_________ (systolic or diastolic) dysfunction is the most common form of CHF, due to progressive deterioration of myocardial contractile function due to IHD or hypertension.
Systolic
Is CHF is the frequent end-point of many heart conditions like ischemic heart disease, hypertension, pulmonary diseases, and valve diseases?
Yeah
What happens in CHF with diastolic dysfunction? In which populations is it most common?
Contraction is OK but relaxation (filling) is abnormal. Common in older people, females with hypertension, and people with diabetes mellitus.
What three compensatory responses of the heart are seen in CHF?
- Activation of neurohumoral systems
- Frank-Starling mechanism
- Structural changes (e.g. hypertrophy)
Name three examples of hormones that are released during the “activation of neurohumoral systems” compensatory response to CHF.
- Norepinephrine release from the SNS.
- Activation of renin-angiotensin-aldosterone system.
(both increase cardiac output) - Atrial natriuretic peptide (ANP) release –> vasodilation and diuresis to alleviate hypertension.
What is meant by “compensated heart failure,” and “decompensated heart failure?”
In compensated heart failure, the dilated ventricle is able to maintain sufficient cardiac output via increased sarcomere stretch (Frank-Starling).
In decompensated failure, the ventricle is dilated too much to generate sufficient force to perfuse the body.
What are the two major types of hypertrophic changes that can occur in CHF? Explain each.
- Concentric hypertrophy: Happens in pressure overload states like hypertension or valve disease. Diameter of muscle fibers increase causing an increase in ventricular wall thickness without an increase in chamber size.
- Eccentric hypertrophy: Happens in volume overload states like valvular regurgitation and abnormal shunts. The length of muscle fibers increases leading to an increase in heart size and wall thickness.
Name four bio-molecules that cause the hypertrophic myocardial response.
- Angiotensin II
- Endothelin-1
- Insulin-like GF 1
- TGF-beta
Does hypertrophy of the myocardium increase metabolic demand, putting the heart at risk for ischemic injury?
Yeah
Name five of the most common causes of left-sided heart failure.
- Ischemic heart disease
- Hypertension
- Mitral valve disease
- Aortic valve disease
- Primary myocardial diseases
The morphologic and clinical effects of left-sided heart failure are due to the progressive ________ of blood within the pulmonary circulation and the consequences of diminished peripheral _______ _________ and _____.
due to progressive damming of blood in the pulmonary circulation and the consequences of diminished peripheral blood pressure and flow.
What five morphological changes are seen in lungs with pulmonary congestion?
- Lungs are heavy and soggy
- Perivascular and interstitial transudate
- Alveolar septal edema
- Intra-alveolar edema
- Presence of “heart failure cells”
What is a “heart failure cell?”
Macrophages loaded with hemosiderin (from extravasated RBCs) found in lungs with pulmonary congestion - in the intra-alveolar exudate.
What is typically the earliest and most significant complaint/symptom of left-sided heart failure?
Dyspnea (breathlessness)
What is orthopnea?
Dyspnea in a supine position - happens with advanced left heart failure due to increased pulmonary capillary pressure from increased venous return from the lower extremities.
How can left ventricular failure cause right heart failure?
LV failure causes an increase in pulmonary circulation pressure, putting increased demand on the RV –> hypertrophy, etc.
What is “cor pulmonale?”
A term used to describe purely right-sided heart failure in patients with one of a variety of disorders affecting the lungs that involve pulmonary hypertension.
Explain how right sided heart failure causes engorgement of the systemic and portal venous system, which produces distension of neck veins, nutmeg liver, and congestive splenomegaly.
Inability of the right heart to pump blood backs it up in the systemic and portal systems (increased pressure) and that screws everything up.
Are most cases of CHF characterized by right heart failure, left heart failure, or biventricular failure?
biventricular
CHF is characterized by various degrees of decreased cardiac output and tissue purfusion (known as _______ failure) and pooling of blood in the venous system (known as _______ failure).
decreased cardiac output and tissue purfusion is forward failure and pooling of blood in the venous system is backward failure.
Are many clinical features and morphologic changes noted in CHF secondary to injuries induced by hypoxia and congestion of tissues distant from the heart?
Yeah
What is the main cause of hypertensive heart disease?
Hypertension (either pulmonary - causing RV hypertrophy, or systemic - causing LV hypertrophy)
Name five morphological changes of systemic hypertensive heart disease.
- Thickened LV (>2cm)
- Increased heart weight (>500 grams)
- Enlarged myocytes and nuclei
- Diffuse interstitial fibrosis
- Focal myocyte atrophy and degeneration
