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What is heart failure?
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Impaired cardiac pumping
What are the three diseases most closely associated with heart failure?
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CAD, long-standing hypertension and MI
What is the most common cause of hospitalization in people over the age of 65 in the US?
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Heart failure
Which type of ventricular failure (systolic or diastolic) is the most common cause of heart failure?
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Systolic
In _______ ventricular failure, the left ventricle loses its ability to generate enough pressure to eject blood into the aorta. EF is reduced from impaired contractile function (MI), increased afterload (hypertension), cardiomyopathy or mechanical abnormalities.
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Systolic
_______ ventricular failure is characterized by high filling pressures in the ventricles due to stiff or non-compliant ventricles which results in venous engorgement in the pulmonary and vascular systems.
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Diastolic
What are the signs and symptoms indicative of a diastolic cause of heart failure?
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Pulmonary congestion, pulmonary hypertension, ventricular hypertrophy and normal EF
What are the signs and symptoms of a systolic ventricular failure being the cause of heart failure?
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Decreased EF
Systolic or Diastolic Failure? MI, hypertension, Cardiomyopathy, Mechanical abnormality like valvular heart disease
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Systolic...this are all pathologies that contribute
Systolic or Diastolic Failure? Left ventricular hypertrophy from chronic hypertension, aortic stenosis, hypertrophic cardiomyopathy
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Diastolic
Which gender experiences diastolic failure more frequently?
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Women
Chronic or Acute causes of Heart Failure? CAD, hypertension, Rheumatic heart disease, congenital heart disease, Cor pulmonale, cardiomyopathy, anemia, bacterial endocarditis, valvular disorder
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Chronic
Chronic or Acute cause of heart failure? MI, dysrhythmias, pulmonary emboli, thyrotoxicosis, hypertension crisis, Ventricular septal defect, Myocarditis
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Acute
Which drug is only approved for use in African Americans to treat heart failure?
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Isosorbide Dinitrate and hydralazine (BiDil)
Which race is most likely to experience the cough associated with ACE inhibitors?
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Asians
________ is characterized by an extremely poor ejection fraction (less than 35%), high pulmonary pressures, and biventricular failure, low systemic BP, low CO and poor renal perfusion.
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Mixed systolic/diastolic failure, most often caused by Dilated Cardiomyopathy (DCM)
What are the 4 main mechanisms used by the body to compensate for heart failure?
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SNS activation, neurohormonal responses, ventricular dilation and ventricular hypertrophy
What happens when the SNS is activated by low cardiac output from heart failure?
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Catecholamines are released (epinephrine, norepinephrine) to increase heart rate and contractility and peripheral vasoconstriction. Over time, this leads to increased need for oxygen and ultimately leads to poorer ventricular function.
What is the neurohormonal response to low cardiac output from heart failure?
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Kidney release renin to convert angiotensinogen to angiotensin I Lungs release a converting enzyme to change angiotensin I to angiotensin II Adrenal cortex releases aldosterone Posterior pituitary releases ADH Endothelin release is stimulated (from vascular endothelium)
What cytokines are released by cardiac myocytes in response to cardiac injury and what do they do?
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Tumor Necrosis Factor (TNF) and Interleukin-1 (IL-1). They cause cardiac hypertrophy, contractile dysfunction, and myocyte cell death
What causes the cardiac wasting, muscle myopathy and fatigue associated with heart failure?
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The systemic inflammatory response
________ is the enlargement of the chambers of the heart from elevated pressures.
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Dilation: note...usually occurs in the left ventricle
How does dilation eventually lead to reduction in cardiac output?
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The elastic elements of the muscle fibers in the cardiac chambers are overstretched and can no longer contract effectively
________ is an increase in the muscle mass and cardiac wall thickness in response to overwork and strain.
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Hypertrophy
How is hypertrophic heart muscle different from normal heart muscle? (4)
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It requires more oxygen, has poorer contractility, becomes ischemic more readily and is prone to ventricular dysrhythmias
ANP is a hormone that serves as a counterregulatory mechanism. It is produced by...
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The atriums of the heart
BNP is a hormone that serves as a counterregulatory mechanism. It is produced by...
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The ventricles
What effect does ANP and BNP have?
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They promote arterial and venous dilation, block RAAS, promote diuresis by blocking aldosterone and endothelin
What triggers the release of ANP? BNP?
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ANP-released when volumes increase BNP-released when pressures increase
What is the most common form of heart failure?
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Left Ventricular heart failure


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