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51 Cards in this Set

  • Front
  • Back
Definition of Heart Failure:
A clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.
Four Symptoms associated with Heart Failure:
-Fluid retention
-Exercise tolerance
-Pulmonary/Peripheral Congestion
How do deaths caused by cancer compare to those by heart failure?
More due to heart failure than cancer.
Why has heart failure increased?
Because the mechanisms for treating heart disease to prolong life have gotten better so hearts with chronic failing are more prominent.
Prognosis of heart failure in a patient diagnosed w/ heart disease:
5 Main results/responses to cardiac injury:
1. Loss of myocytes leads to increased work load per cell
2. Left ventric hypertrophy (parallel replication)
3. Cell elongation (LV dilation)
4. Increased # mitochondria
5. Increased collagen matrix
Function of LVH:
Laplace's relationship - increased wall thickness maintains a normal wall stress so the muscle doesn't experience increased wall stress.
What is the function of LV dilation?
Maintains stroke volume via the Frank Starling mechanism.
So what is Ventricular Remodeling for?
Maintaining function - cardiac output and filling; so the patient may be asymptomatic.
What plays a major role in the adaptive response of the ventricles in heart failure?
Neurohumoral factors
What are the principle neurohumoral factors?
(also vasopressin and endothelin)
Initial effects of SNS activation on cardiac failure:
1. Enhanced contractility
2. Cell hypertrophy
3. Maintainence of perfusion pressure
Longterm adverse effects of increased SNS activity in cardiac failure:
1. Increased afterload
2. Catecholamines are directly toxic to myocardial cells
3. Catecholamines promote arrhythmias
Initial response of the RAS to heart failure:
Release of Renin from the kidney
4 main effects of RAS activation during heart failure:
1. Elevated afterload due to increased vasoconstriction
2. Elevated preload dur to increased water/Na retention
3. Myocyte hypertrophy due to Ang II
4. Interstial fibrosis due to high aldosterone levels
2 Types of drugs that can be used to treat heart failure based on the RAS:
1. ACE inhibitors
2. Ang Receptor blockers
2 types of maladaptive response that occur as patients transition to heart failure:
-Cell apoptosis
Results of Maladaptive responses:
-Decreased contractility
-Excess afterload/preload
-REduced CO
-Fluid retention/edema
How does the PV loop change when contractility is depressed?
It shifts t othe right
-SV is decreased
-Afterload is increased
Because of cardiac output impairment the increased preload can't be pushed out
So the 3 main pathophysiologic features of myocardial failure:
1. Increased preload
2. Increased afterload
3. Depressed contractility
2 major hemodynamic effects of heart failure:
1. Increased atrial pressure
2. Decreased cardiac output
Symptos of increased atrial pressure:
clinical result of increased atrial pressure and reduced cardiac output:
reduced exercise tolerance
4 key signs on physical exam of cardiac failure:
1. Decreased blood pressure
2. Tachycardia
3. Cardiomegaly
4. Cool extremities
2 Consequences of heart failure:
-Excess morbidity
-High mortality
how is excess morbidity reflected?
1. Decreased exercise tolerance
2. Dyspnea
3. Edema
How is high mortality reflected?
50% sudden death
50% progressive CHF
What is the effect of diuretics and venodilators?
Decreased preload
What is the effect of Hydralazine?
Decreased afterload
What is the effect of ACE inhiitors and ARBs?
Decreased afterload and preload
What are the effects of digoxin, dobutamine, and pde inhibitors?
Increased contractility
What is the cornerstone of heart failure drug therapy?
Why are diuretics so useful in treating heart therapy?
1. They effectively reduce congestion
2. They increase exercise tolerance
Drawback of diuretics:
Causes hypokalemia/magnesemia
Causes hyperuricemia/glycemia
Stimulates the RAS
4 Vasodilators:
What do they dilate?
-Nitrates - dilates veins
-Hydralazine - dilates arterioles
What is the function of Captopril or Enalapril?
ACE inhibitors
What is Losartan?
an AngII receptor blocker (ARB)
What are the adverse effects of the increased RAS in heart failure?
-Increased preload
-Increased Aldosterone
-Increased vasoconstriction and afterload
4 positive effects of ace inhibitors:
1. Arteriole/venodilation
2. Decreased preload/aferload
3. Minimal effects on CO
4. Decreased heartrate
5 adverse side effects of ace inhibitors:
1. Decreased aldosterone leading to decreased K loss
2. Reduced sympathetic activity
3. Cough
4. Hypotension and decreased renal function
5. Hyperkalemia
Why are Angiotensin Receptor Blockers given?
Because ACE inhibitors don't completely block Ang II synthesis.
What does Spironolactone do?
Combats the adverse effects of aldosterone and reduces mortality
Why are B-blockers given to heart failure patients?
To block the toxic effects of Norepinephrine.
Positive effects of Digoxin:
Inotropic - influences rate of calcium entry/exit of myocytes;
increased ejection fraction and exercise tolerance.
Adverse effects of Digoxin:
Toxic at its prescribed levels; may cause ventricular arrythmia or heart block.
To whom is Digoxin prescribed?
Only the sickest patients.
What is Debutamine?
A catecholamine that increases HR and contractility.
How do PDE inhibitors work?
By increasing the amt of cAMP in the cell and thus the level of calcium as well.
3 types of mechanical treatments for heart failure:
1. Synchronization
2. Heart transplant
3. Ventricular assist devices
What is synchronization?
Biventricular pacing to correct abnormal conductance due to assymetric electrical and mechanical patterns within the heart.
What are VAD's used for?
Ventric Assist devices serve as a bridge for patients awaiting heart transplants.