chapter 20- HF

Question 1

Heart Failure

Answer 1

complex syndrome of the heart that results from functional or structural impairment of ventricular filling or ejection of blood into the circulation.
*Assoc. with either a reduced or preserved L Ventricular EF

Question 2

Compensatory Ability

Answer 2

• how your body pumps just sitting around vs running a marathon
• CO^: Exercise

Question 3

Cardiac Reserve

Answer 3

how much the heart compensates to increase output during exercise

Question 4

Myocardial Contractility

Answer 4

(inotrophy)

• the contractile performance of the heart (actin and myosin)
• as contractility ^, CO ^

Question 5

Preload

Afterload

Answer 5

P- Amt. of blood in ventricles at the end of diastole

A- measure of force that was required to eject the blood from the ventricles

Question 6

Ejection Fraction

Answer 6

the % of total amount of blood that entered ventricle that is actually moved out. (normal: 60%)

Question 7

Most common causes of HF

Answer 7

coronary artery disease, hypertension, dilated cardiomyopathy, valvular heart disease

Question 8

Efficiency of the heart is determined by:

Answer 8

the volume of blood that ejects each minute

Question 9

Frank Starling Mechanism

Answer 9

*activation of neurohumoral influences: SNS and RAAS,
the naturetic peptides, vasoactive substances, hypertrophy and remodeling of heart

• Firs minutes- hours: SNS keeps heart pumping, RAAS is released to vasoconstrict and retain water
• Weeks: myocardial hypertrophy and remodeling for long-term adaptation to hemodynamic overload.

Question 10

Heart Failure with reduced EF stimulates:

Answer 10

• RAAS pathway
• body retains water and sodium in kidney which ^ vascular volume and venous return to heart
• causes PULMONARY CONGESTION

Question 11

Natriuretic Peptides (NP)

Answer 11

• naturally released in body response to overstretching of atria or ventricles (Heart Failure)
• inhibits SNS, RAAS, and ADH
• ANP & BNP levels are ^ in HF patients

Question 12

A Nat Peptide

B Nat Peptide

Answer 12

A- released from ATRIAL cells in response to stretch, pressure, or fluid overload
B- secreted by VENTRICLES in response to ^ ventricular pressure or fluid overload

Question 13

Both types of NP are released in response to:

Answer 13

^ chamber stretch and pressure
* promotes rapid and transient natriuretesis and diuretics through an increase in glomerular filtration rate and inhibit tubular sodium and water reabsorption

Question 14

NP’s inhibit the natural response to heart failure: ___ and ___

Answer 14

SNS and RAAS (antidiuretic hormone and vasopressin)

Question 15

the activation of SNS releases: ___

Answer 15

Catecholamines

-Epinephrine and Norepinephine to ^ HR and ^ CO

Question 16

Enodthelins

Answer 16

Vasoconstrictors released from endothelium
Induce myocyte hypertrophy and fibrosis
bolster effects of hypoxic kidneys
-counteract BNP and ANP to encourage water and salt absorption in kidney

Question 17

myocardial hypertropohy and remodling

Answer 17

cells change size to keep up with the demand

- last step in heart compensation to HF

Question 18

Concentric Hypertrophy

Eccentric Hypertrophy

Answer 18

Concentric: caused by pressure overload
*myocytes get wider, heart walls get thicker

Eccentric: caused by volume overload
*myocytes get longer, heart walls get thinner

Question 19

Types of Heart Failure:

Answer 19

1. Systolic (HRrEF)
2. Diastolic (HRpEF)
3. Left Sided
4. Right sided

Question 20

Systolic (HRrEF) Failure:

Answer 20

• not pumping out enough during systole (reduced EF) despite a normal BP (EF <40%)
• Causes: volume overload, pressure overload, contractile function impairment

*Effects: Eccentric Hypertrophy, Increased blood volume: Pulmonary Congestion

Question 21

Symptoms of Systolic HF

Answer 21

dyspnea, fatigue, JVD, peripheral edema, orthopnea, Paroxysmal Nocturnal Dyspnea

Question 22

Diastolic (HRpEF)

Answer 22

• preserved EF- reduced/abnormal filling of ventricle
• EF (>50%) but ventricle doesn’t fill all the way to EF goes down
• causes of diastolic HF: pericardial effusion, constrictive pericarditis, myocardial hypertrophy (^ wall thickness), AGING, HYPERTENSION

Question 23

Systolic failure vs Diastolic failure

Answer 23

S: impaired ability to eject blood at a rate commensurate with the metabolic needs of the tissue

D: resistant to filling of one or both ventricles leading to symptoms of congestion

Question 24

Diastolic HF can be aggravated by ____

Answer 24

tachycardia (wont let the ventricles fill all the way)

Question 25

Symptoms of Diastolic HF

Answer 25

pulmonary congestion, decrease in lung compliance, ^ in workload and breathing: dyspnea.

Question 26

____ determines how much time there is for ventricular filling.

Answer 26

Heart Rate

Question 27

Left-Sided Heart Failure

Answer 27

Diastolic: LV doesn't accept enough blood from lungs Systolic: LV doesn't pump enough blood to body

Question 28

in Left Sided HF, the blood backs up from__ to:

Answer 28

LV --> pulmonary veins --> Lungs --> pulmonary arteries --> right atria/ventricles --> body

Question 29

Left-sided HF causes:

Answer 29

* pulmonary edema, dyspnea | * Paroxysmal Nocturnal Edema- trouble breathing when sleeping due to ^ fluid in the lungs

Question 30

Left-sided HF is attributed to:

Answer 30

1. Hypertension 2. Acute MI 3. Valvular Defects

Question 31

Right-Sided Heart Failure

Answer 31

Diastolic: RV doesn't accept enough blood from body Systolic: RV doesn't pump enough blood to lungs

Question 32

In Right Sided HF, the blood backs up from ___ to:

Answer 32

RV --> Inferior/Superior Vena Cava --> LV ---> lungs

Question 33

Right-Sided HF causes:

Answer 33

1. Left sided heart failure- L ventricular filling 2. isolated R side failure- not common, occurs in ppl with lung disease or pulmonary hypertension, tricuspid valve disease, R ventricular infarction, or cardiomyopathy

Question 34

Cor Pulmonale

Answer 34

Right Ventricular HF that occurs in response to chronic pulmonary disease

Question 35

Right-Sided HF symptoms:

Answer 35

1. ^ in RV diastolic and end-diastolic: EDEMA 2. back up of blood in Inferior and Superior Vena Cava: Hepatomegaly & Splenomegaly 3. Congestion of GI tract: anorexia and discomfort 4. JVD- can be seen sitting down or standing up

Question 36

Symptoms of HF for both sides: (5)

Answer 36

1. Edema 2. Dyspnea- (Cheyne-stokes) respiration 3. Cachexia- malnutrition & tissue wasting that occurs at end stage HF 4. Cyanosis- blue coloring of skin and mucous membranes 5 Arrhythmia & sudden cardiac death- A fib

Question 37

Diagnosis of HF

Answer 37

- History - Physical Exa - Lab testing ( ^BNP, ^ electrolytes - Imaging- electrocardiogram

Question 38

Acute HF treatment | Chronic HF treatment

Answer 38

A- stop the underlying cause | C- relieve symptoms, reduce further damage/reverse damage thats happened. Long term plan

Question 39

Treatment for all HF

Answer 39

- Exercise - Drugs (diuretics, B-adrenergic inhibitors, ACE inhibitors) - Oxygen (CPAP force air into cells/lungs) - Invasive Methods: LVAD Left Ventricular Assist Device

Question 40

Increased electrolytes in HF signifies:

Answer 40

- impaired renal function - higher than normal electrolyte levels means kidneys are reabsorbing water and sodium - HF

Question 41

cardiac output is the ___ each minute

Answer 41

blood pumped

Question 42

in shock, one of the best indicators of blood flow to vital organs is:

Answer 42

urine output

Question 43

A common symptom of ischemia associated with gastrointestinal redistribution of blood flow is:

Answer 43

gastric bleeding

Question 44

which type of shock might intravenous therapy be distributed for?

Answer 44

Distributive shock