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What cause HF?
inadequate pump function of the heart
What does HF lead to?
congestion from fluid in the lungs and peripheral tissue
Physical exam findings of LV failure
Inc HR and RR, pales, sweaty, HF, pulses alternans, rales, 3rd and 4th heart sounds, displaced apical impulse
Etiology of LV failure
volume overload, pressure overload, restricted filling, myocyte loss, decreased myocyte contractility
HFrEF is what kind of problem
systolic: pump
HFpEF is what kind of problem
diastolic: filling
What kind of changes will appear in LV failure?
hemodynamic,neuro-hormonal, cellular
HFrEF results in the the contractility of the P-V loop to shift down and to the left. What does this cause?
reduces SV → decreases CO
What drug is used to stop/slow the release of catecholamines?
Beta Blockers
How does the heart compensate for HFrEF in an attempt to maintain CO?
Inc preload → inc contraction → inc EDV
Inc catecholamine release → inc HR → inc CO
Inc hypertrophy and ventricular volume → shifts compliance to the right
HFpEF causes the compliance curve to shift up and to the left. What does this cause?
increase in LV end-diastolic pressure → reduced filling
HFpEF can be present in any disease that causes:
decreased relaxation
decreased elastic recoil
increased ventricle stiffness
Severe ischemia leads to …
MI
Most patients have what kind of HF?
combination of HFrEF and HFpEF
What type of neuro-hormonal changes are seen in LV failure?
SNS activated, RAAS activated, vasopressin release, cytokine release
What kind of cellular changes are seen in LV failure?
inefficient intracellular Ca handling, adrenergic desensitization, myocyte hypertrophy, re-expression of fetal phenotype proteins, cell death, fibrosis
Over time, near-hormonal changes meant to maintain CO in heart failure lead to ___ of cardiac function.
progressive deterioration
Which hormone causes efferent glomerular arteriolar vasoconstriction to help maintain GFR despite a reduced CO?
Angio II
Which neurotransmitter may accelerate myocyte hypertrophy?
Interleukins (ILs)
Which neurotransmitter has an important role in the cycle of myocyte hypertrophy and cell death?
tumor necrosis factor (TNF)
Which neurotransmitter is released from endothelial cells and linked to pulmonary hypertension?
endothelin
In HF delivery and reuptake of Ca2+ are ___
slowed
What receptors are important for the induction of myocardial hypertrophy?
a1-adrenergic
Due to chronic sympathetic activation in HF, there is significant ____ of the B-adrenergic receptors.
desensitization
Constant turnover of the contractile proteins of sarcomeres lead to myocyte hypertrophy and re-expression of what?
fetal and neonatal forms of myosin and troponin
What does hypertrophy of the heart due to hemodynamic stress lead to?
LV remodeling
An increase in fibrous tissue in interstitial space of the heart ____ contractility
decreases
HF is associated with gradual ___ of the ventricle
dilation
Clinical manifestations of LV failure
SOB, orthopnea, PND, fatigue, confusion, nocturia, chest pain
Clinical manifestations of RV failure
SOB, pedal edema, abdominal pain, anasarca, ascites, hepatojugular reflux
What is the most common cause of RV failure?
LV failure
physical exam findings of RV failure
third heart sound at sternal border, sustained systolic heave, elevated JVP, LV failure signs
Etiology of RV failure
LV failure, congenital/idiopath Pul HTN → inc afterload, pulmonary disease, RV ischemia
A MI in the inferior wall will lead to ischemia and damage to what area of the heart?
RV
How does isolated RV failure contribute to LV failure?
inc in RV pressure → IVS bow into LV → reduced filling
What causes JVP? (besides HF)
pericardial tamponade, constrictive pericarditis, massive PE
If a pt has LV failure, their SOB is due to
pulmonary edema
If a pt has RV failure, their SOB is due to
pulmonary disease
A reduction of right sided CO results in what?
acidosis, hypoxia, air hunger
If RV failure is due to a defect on the left side (mitral stenosis), onset of RV failure decreases the load on LV and thereby ___
lessens symptoms of pulmonary edema
What are the 3 ways the heart remodels itself in cardiomyopathies?
dilate, hypertrophy, restrictive
What physiological cause leads to myocardial hypertrophy?
heart pumping more efficiently in highly trained athletes
What pathological causes lead to myocardial hypertrophy?
hemodynamic overload, MI, valvular insufficiency
Which form of cardiac remodeling lead to thin heart layers?
cardiac dilation
Which form of cardiac remodeling leads to small chambers and thick walls?
pathological
Which form of cardiac remodeling will return to normal when no longer necessary?
physiological
What is the most common type of cardiomyopathy?
dilated cardiomyopathy
What form of cardiomyopathy is the cause behind many cases of cardiac transplants?
Idiopathic DCM (primary)
What form of cardiomyopathy is a result from injury to the cardiac myocytes?
Secondary DCM
characteristics of DCM
biventricular, dilation, impaired contraction, eventual CHF
Non heart disease causes of DCM
alcohol, genetics, viral infection
DCM causes the contractile elements to not align which decreases the hearts ability to what?
effectively contract
Why do pts with DCM often need a defibrillator?
pts are susceptible to sudden death to to atrial or ventricular arrhythmias
What form of CM is characterized by a thickened, hyperkinetic ventricular muscle mass?
Hypertrophic obstructive CM (HOCM)
In HOCM what area is most affected by hypertrophy?
septum
What cardiomyopathy is the #1 cause of sudden death in young athletes?
HOCM
What causes HOCM?
genetic abnormalities and abnormal sarcomere proteins
What is unique about the cardiac cells in HOCM?
cells are disorganized: appear as whorls
characteristics of HOCM
inappropriate LV response, hyper dynamic LV contractility, stiff non-compliant LV
How does HOCM cause sudden death?
strenuous activity proves outflow obstruction: septum blocks aortic valve
What is the rarest form of CM and characterized by a stiff, fibrotic ventricle?
restrictive
restrictive CM is due to a ___ issue
filling
What % of pts with RCM survive past 10 years?
10%
RCM usually presents secondary to what diseases?
infiltrative: sarcoidosis, amyloidosis, hemochromatosis