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39 Cards in this Set
- Front
- Back
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What is congestive heart failure?
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Heart cannot pump enough blood to supply the body's oxygen and nutrient requirements
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What is a low-output failure?
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Heart cannot pump enough blood by volume to supply the body's oxygen and nutrient requirements
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What is a low-output failure?
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Heart cannot pump enough blood by volume to supply the body's oxygen and nutrient requirements
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What is a high-output failure?
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Heart pumps adequate blood, but the blood itself is inadequate (anemia, high metabolic needs, etc.)
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What is forward failure?
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Inadequate cardiac output
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What is backward failure?
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Congestion of venous circulation
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What is compensated heart failure?
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Dilation and Frank-Starling compensate to maintain sufficient perfusion of organs
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What are 3 mechanisms of compensation for heart failure?
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Neurohumoral systems
Frank-Starling Mycardial hypertrophy |
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How do neurohumoral systems compensate for heart failure? (3)
(CONFUSED ON THIS ONE) |
1. NE released --> increases heart rate and contractility
2. RAAS system activates Ang II --> Increases peripheral resistance and blood volume 3. ANP (from atria) --> vasodilation, naturiuresis, diuresis |
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How does the Frank-Starling mechanism help compensate for heart failure?
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End-diastolic pressure is increased --> cardiac myocytes stretched --> increases strength of contraction
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How does myocardial hypertrophy compensate for congestive heart failure?
Concentric? Eccentric? |
Size of the myocyte increases --> more pumping
Concentric = result of increased pressure; increase in size of heart is due to increase in diameter of myocytes Eccentric = overload of heart due to volume; increases length of myocytes |
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What are 4 causes of left-sided heart failure?
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1. ischemic heart disease
2. systemic hypertension 3. mitral or aortic valve disease 4. primary disease of the myocardium |
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What are 2 causes of right-sided heart failure?
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1. Left-sided heart failure
2. Intrinsic diseases of pulmonary parenchyma or vaculature |
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What are the symptoms of left-sided heart failure? (4)
Pathophysiology of these symptoms? |
Dyspnea, cough, orthopnea, paroxysmal nocturnal dyspnea
Pulmonary venous congestion --> leakage of RBCs into alveoli --> pulmonary symptoms |
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What are heart failure cells?
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Macrophages with hemosiderin (from extravasated rbcs in the alveoli) seen in left sided heart failure
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What are two problems seen in any left-sided heart failure?
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pulmonary congestion
edema |
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What are 4 symptoms of right-sided heart failure?
Pathophys? |
peripheral edema
ascites (fluid in peritoneum) hepatosplenomegaly (nutmeg) pleural effusions (fluid in pleural cavities) Congest in areas draining to right side of the heart |
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What are 2 forms of hypertension?
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1. systemic - body except lungs
2. pulmonary |
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What is the criteria for diagnosis of systemic hypertensive heart disease?
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LV hypertrophy with no other cause and a history of or pathological evidence of hypertension (hyaline arteriosclerosis)
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What is the morphology of systemic hypertensive heart disease (in the heart)?
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LV hypertrophy without dilation
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What are the possible clinical features of systemic hypertensive heart disease? (5)
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1. asymptomatic (possible)
2. ischemic heart disease (atherosclerosis, hypertrophy) 3. Progressive renal failure 4. cerebrovascular hemorrhage 5. heart failure |
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What is cor pulmonale?
Criteria for pathologic diagnosis? |
pulmonary hypertensive heart disease
Right ventricular hypertrophy and dilation caused by primary disorders of pulmonary parenchyma or vasculature |
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What is acute vs. chronic cor pulmonale?
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acute: symptoms follow pulmonary thromboemboli that obstruct >50% of vasculature - more abrupt
chronic: prolonged pressure overload on RV or obliteration of pulmonary septal capillaries - more insidious |
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What are the 4 clinical syndromes composing the general category of ischemic heart disease?
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1. angina pectoris (stable, unstable, prinzmetal)
2. acute myocardial infarct 3. chronic ischemic heart disease 4. sudden cardiac death |
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What are the causes of chronic ischemic heart disease?
acute? |
chronic = atherosclerosis
acute = vasospasm of a vessel, hemorrhage into the plaque, thrombosis |
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How does the amount a vessel is occluded correspond to ischemia?
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<70-75% occlusion - no ischemia
>70-75% ischemia on exercise 90% ischemia |
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What are the 3 parts of acute coronary syndrome?
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unstable angina, acute MI, sudden cardiac death
Caused by sudden change in plaque that alters degree of stenosis |
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How can an acute plaque change lead to thrombosis?
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1. Rupture --> expose atherosclerotic core --> thrombogenic
2. Neovascularized plaque hemorrages either into plaque (increases size of plaque) or into lumen (thrombosis) |
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What are vulnerable plaques?
What are 2 other factors affecting plaque stability? |
Plaques with a thin fibrous cap and a thick core, more likely to rupture
Collagen (strength of fibrous cap), adrenergics (hypertension or vasospasm) |
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What are 3 factors affecting the development of ischemic heart disease?
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1. Inflammation --> development of atherosclerosis
2. Thrombus --> occlusion, increases size of plaque 3. Vasoconstriction --> stenosis |
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What is angina pectoris?
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Chest pain due to non-sustained and reversible myocardial ischemia
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What is stable angina?
clinical findings |
occurs with exertion, due to fixed plaque producing <75% occlusion
Crushing or squeezing feeling |
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What is unstable angina?
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Occurs at rest and at exercise, inconsistent frequency
Due to acute plaque change --> pre-infarction |
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What is prinzmetal angina?
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Chest pain that occurs at rest, due to vasospasm of vessel
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What is myocardial infarction
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Irreversible ischemic injury
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MI
Symptoms |
Crushing substernal chest pain, weak pulse, nausea, dyspnea, shock
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MI
EKG |
Q wave --> transmural defect
ST abnormalities and T-wave inversion --> myocardial repolarization abnormalities |
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MI
Lab tests |
CK-MB/total CK ratio is high
troponin I for acute MI (not completely specific) |
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What is chronic ischemic heart disease?
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Heart failure as a result of ischemic injury
--> dilated and hypertrophied heart + coronary atherosclerosis |
