Heart failure (6 points)-path.pharm II- exam 3

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nika.steffan
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Heart failure (6 points)-path.pharm II- exam 3
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2012-10-29 17:45:21
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Heart failure points path pharm II exam
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Heart failure (6 points)-path.pharm II- exam 3
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  1. Define heart failure.
    Hearts inability to increase the CO sufficiently to meet the bodies metabolic needs.
  2. What are the causes of heart failure?
    • Elevated systemic and pulmonary vascular resistance
    • MI
    • Infection
    • Anemia
    • Beriberi
    • Cardiomyopathy
    • CAD
    • Valvular heart disease
    • Restrictive Pericarditis
    • Persistent tachy/bradyarrhythmias
    • Loss of atrial kick
    • HTN
    • Hyperthyroidism
    • Collagen-Vascular Disease-SLE
    • Infiltrative Diseases- Tumors, Sarcoidosis
    • Iatrogenic Factors- Drugs
  3. What are the 4 categories of causes of heart failure and an example of each?
    • 1.Decrease in contractility - MI
    • 2. Decrease in preload- A FIB
    • 3. Increase in afterload- HTN
    • 4. Alterations in ratio of oxygen supply to demand- CAD
  4. What is the primary dysfunction in heart failure? 
    inability of heart to function as a pump
  5. Define ejection fraction and what is a normal value?
    • ventricular volume ejected during systole
    • Normal = 66% or 2/3
    • During HF can fall to 10-15%
  6. What are the 4 types of heart failure?
    • 1. Left ventricular 
    • 2. Right ventricular
    • 3. Biventricular Failure
    • 4. high-output failure
  7. What is cardiac reserve? 
    an increase in CO during increased activities EXCEPT with heart failure this may occur at rest.
  8. What are the 4 types of compensatory mechanisms for heart failure? (cardiac reserve maintained by...)
    • 1. Frank-Starling Mechanism
    • 2. Activation of Sympathetic Nervous System
    • 3. Renal Compensation
    • 4. Ventricular Hypertrophy
  9. Considering the Frank-Starling Mechanism: how do you increase stroke volume? 
    by an increase in ventricular end-diastolic pressure --> increase SV --> increase in force of next contraction (rubber band) 
  10. What is the earliest response to a decrease in CO and BP? 
    Activation of sympathetic nervous system. 

    leads to increase in: HR, SV, CO, vasoconstriction, PVR, venous return, ventricular filling. 
  11. Which compensatory mechanism triggers an increased aldosterone production and increases absorption of ___ and ___. 
    • renal compensation. 
    • na and h2o
  12. Describe the compensatory mechanism ventricular hypertrophy
    increase in wall thickness in ventricles 
  13. Define Right heart failure (right ventricular failure)
    persistent elevation of the LVEDP from left-heart failure that eventually leads to RHF, which is charcterized by venous congestions in systemic circulation

    Cor pulmonale- when RHF occurs independently from LHF
  14. Define Left Heart Failure (Left ventricular failure)
    any sustained elevation in the LVEDP will increase left atrial pressure, which is transmitted to the pulmonary vascular bed.
  15. Define Bi-Ventricular Heart failure
    Heart failure that involves both the left and the right ventricles. Also called low output failure.
  16. Define High-output heart failure
    inability of the heart to adequately supply the body with oxygen and nutrients despite adequate volume and normal or elevated myocardial contractility.
  17. May be the result of pulmonary disease.
    Right sided heart failure
  18. Also called low-output heart failure.
    Biventricular heart failure
  19. caused commonly by cardiomyopathies.
    Biventricular heart failure
  20. caused commonly by anemia, hyperthyroid, or septicemia.
    high-output heart failure
  21. Adequate blood volume and contractility.
    high-output heart failure
  22. Pink, frothy sputum and decreased urinary output.
    Left heart failure
  23. Elevated JVP, peripheral edema, hepatomegaly are symptoms of which type of heart failure
    Right heart failure
  24. Hypotension, tachycardia, cold clammy skin are symptoms of which type of heart failure
    Left heart failure
  25. Ascites, weight gain, splenomegaly are symptoms of which type of heart failiure? 
    Right heart failure. 
  26. List 5 common treatments of heart failure. 
    • 1. Determine and treat the cause
    • 2. Reduce pulmonary HTN and increase arterial O2 content
    • 3. Decrease circulating volume: diuretics, restrict Na and H20
    • 4. Enhance myocardial contractility: inotropic drugs
    • 5. Decreased workload: bedrest
    • 6. O2, cardiac monitoring, electrolyte balance. 
  27. Cor Pulmonale:
    • Right sided heart failure. 
    • when right sided heart failure results independently of left heart failure. commonly result of chronic pulmonary disease: COPD, Cystic fibrosis, pulmonary HTN, pulmonary fibrosis

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