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34 Cards in this Set
- Front
- Back
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what is the definition of physiological DHF
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filling LV to a normal diastolic volume may only be done at higher pressures
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what are the four phases of diastole
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IVRT
rapid filling diastasis atrial systole |
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what do phases 1 and 2 of diastole depend on
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ATP for calcium sequestration and dissociation of actin and myosin
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which part of diastolic filling depends on pasive ventricular stiffness
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3 (probably 4 too)
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what are two major components of diastolic dysfunction
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impaired relaxation
increased stiffness atria |
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the most severe form of diastolic heart failure is
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restrictive cardiomyopathy
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what common diseases predispose to diastolic HF
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most common chronic diseases
HTN, DM, obesity |
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describe your typical patient with diastolic HF
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elderly women with HTN and obesity of DM who has small thick walled hypertrophied ventricles
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T or F. the majority of patiets with symptomatic HF and normal ejection fraction are severly HTN
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true
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why do atrial arrhythmias and tachys worsen HFpEF
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shortens diastole
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what stressors commonly produce HFpEF sx
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exercise
HTN atrial arrhythmias ischemia tachy (pneumonia, pain, acute illness) |
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T or F. stroke volume is nearly normal in both diastolic dysfunction and systolic dysfunction
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true
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describe EDV in diastolic and systolic dysfunction
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in diastolic-- lower than normal volume at very high pressure
in systolic- higher than normal volume with increased pressure |
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propose a few mechanisms of diastolic dysfunction
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altered Ca2+ handling
increased CA2+ sensitivity change in ECM RAaS activation increased systolic vent stiffness increased arterial stiffness |
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after MI, calcium handling becomes abnormal bc downregulation of ____ which leads to increased diastolic calum levels
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SERCA
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why can DM lead radpily to diastolic dysfunction
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energy depletion
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which two from RAAS are in particular pro fibrotic
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ang II
aldo |
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development of high levels of systolic stiffness will decrease recruitable contractility of _____ -_____ which has direct implications on how hearts handle increases in preload and afterload and stress
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contractile reserve
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what is the idea behind contractile reserve
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arleady contracting max CO at rest and can't do any better
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T or F systolic ventricular stiffness can lead to diastolic dysfunction
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t
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in young people, reflected wave returns during
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diastole to augment diastolic pressure
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in stiff arteries, the reflected wave travels faster and hits during ____ leading to isolated ____ HTN
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systolic
isolated systolic HTN |
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all CV risk factors point to
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stiffening
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in stiuation of ___ ____ diastolic HF patients become much more symptomatic
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a fib
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the best therapy for HFpEF is
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exercise program
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why does exercise help
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increases vagal tone to decrease hr and allow more diastolic fill time
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how can you measure A and E waves
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non invasive ultrasound
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little E big A tells you
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impaired relaxation
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how do you treat impaired relaxation
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slow the rate
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big E little A tells you
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increased stiffness
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do you slow down hr for increased stiffness
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no
early filling is ok and atrial kick is non helpful |
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which is worse in afib-- impaired relaxation or stiffness
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impaired relaxation because very dependent on atrial kick
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T or F. you can speed up increased stiffness to improve
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true
a fib will be ok rapid fill is ok just the increased pressure is messing with things |
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T or F. diastolic function always acompanies systolic dysfunction
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true
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