CHF tutorial Exam 4

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kbryant86
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238733
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CHF tutorial Exam 4
Updated:
2013-10-04 17:14:22
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from CHF tutorial for exam 4
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  1. preload
    the volume of blood stretching the resting heart muscle and is determined by the venous return to the heart
  2. afterload
    the force that the contracting heart must generate to eject blood from the filled heart
  3. Heart failure is recognized by these charateristics
    is recognized by a characteristic pattern of haemodynamic, renal, neural, and hormonal responses
  4. causes of HF
    §Myocardial Infarction (MI) 

    §Long standing pressure or volume overload

    §Myocyte damage caused by a viral infection

    §Damage caused by replacement of normal myocardium by infiltrative diseases
  5. Which conditions can result in damage to the myocardium? 

    Unstable Atherosclerotic plaques
    Rheumatic Heart Disease
    Raynaud’s Disease
    • Unstable Atherosclerotic plaques 
    • Rheumatic Heart Disease 

    but NOT Raynaud’s Disease
  6. right vs left HF:

    1. fatigue and exercise intolerance
    2. Cachexia and malnutrition
    3. Cyanosis
    • 1. Left sided b/c of reduced CO
    • 2. Right sided b/c is impairs digestion giving the feeling of being full
    • 3. both sides
  7. Brain  natriuretic peptide (BNP)
    is synthesized and released by ventricular myocytes and fibroblasts in response to myocardial stretching
  8. Right sided HF causes an increase in pressure in which of the following areas?

    Right atrium ?
    Right ventricular end diastolic ?
    Systemic venous ?
    All 3
  9. Which of the following manifestations occur with left-sided heart failure?

    1.Chronic dry cough 
    2. Dyspnea 
    3. Right upper quadrant discomfort 
    4. Lack of appetite and bloating 
    5. Paroxysmal nocturnal dyspnea
    1, 2, and 5
  10. The cardiac reserve is maintained initially through systemic neurohormonal activation of the ____________  and ________________-
    sympathetic nervous system and the renin-angiotensin-aldosterone mechanism
  11. The net effect of these neurohormonal responses is to: 1-3
    §1. Produce arterial  vasoconstriction (to help maintain arterial pressure) 

    §2. Venous constriction (to increase venous pressure)

    §3. Increased blood volume
  12. When blood flow to the kidneys decreases, what directly turns on the Na⁺/K⁺ ATPase in the kidneys?
    Aldosterone
  13. 5 Sx caused by ALPHA receptor activation by the SNS
    • pupils dilate
    • gut motility decreased
    • vasoconstriction in kidneys causing decreased urine
    • hair on skin stands up
    • pallor, cold skin
  14. 5 Sx caused by BETA receptor activation by the SNS
    • stored fat released into bld stream
    • stronger heart beat
    • HR increases
    • Bronchioles dilate
    • increase metabolic rate
  15. Causes of Cardiac Remodeling
    §Hemodynamic Factors 

       Pressure overload

       Volume overload

    §Neurohormonal Factors

       Angiotensin II

       Catecholamines

       Cytokines (tumor necrosis factor-a)

       Endothelin
  16. Angiotensin 2 does what?
    it is a powerful vasoconstrictor
  17. Who should receive ACE Inhibitors?
    • §When there is any degree of symptomatic heart failure 
    • §Asymptomatic patients with left ventricular (LV) dysfunction 
    • §In patients at risk for developing LV dysfunction
  18. Contraindications of ACE Inhibitors
    • §Angioedema 
    • §Hypersensitivity (cough that’s intolerable) 
    • §Symptomatic hypotension 
    • §Worsening renal function
  19. Who should receive Beta Blockers?
    • §In the presence of ACE inhibitor therapy. 
    • §Symptomatic  left ventricular (LV) systolic function. 
    • §Post-infarct time period (even with normal LV systolic function).
  20. Contraindications for Beta blockers
    • §Sinus node or conduction system disease with bradycardia 
    • §True reactive airway disease (COPD, asthma, etc.) 
    • §Abrupt discontinuation of Beta blockers 
    • §Cardiogenic shock 
    • §Pulmonary edema

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