Heart Dysfunction Overview
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Questions and Answers

What happens to ejection fraction (EF) and stroke volume (SV) as left ventricular (LV) dysfunction progresses?

  • EF decreases while SV remains constant
  • EF remains constant while SV increases
  • EF increases while SV decreases
  • Both EF and SV decrease (correct)

What is the primary goal for blood pressure management in most patients with hypertension?

  • Below 160/100 mm Hg
  • Below 150/95 mm Hg
  • Below 130/80 mm Hg
  • Below 140/90 mm Hg (correct)

Which medication class is NOT typically used to treat hypertension?

  • Calcium channel blockers
  • Diuretics
  • Antibiotics (correct)
  • Vasopeptidase inhibitors

As end-diastolic volume (EDV) increases, what is the expected effect on filling pressures?

<p>Filling pressures increase (D)</p> Signup and view all the answers

Which treatment is included in pharmacologic therapy for heart failure related symptoms?

<p>Diuretics and ACE inhibitors (D)</p> Signup and view all the answers

What lifestyle factor is described as persons not participating in a regular exercise program or not accumulating 30 minutes of moderate physical activity on most days of the week?

<p>Sedentary lifestyle (B)</p> Signup and view all the answers

Which of the following is a cardiovascular disease risk factor that includes a history of angina or myocardial infarction?

<p>CV disease (C)</p> Signup and view all the answers

What is considered a concerning triglyceride level that indicates a potential health risk?

<p>150 mg/dL (B)</p> Signup and view all the answers

Which of the following groups is identified to have a higher risk of cardiovascular morbidity based on ethnicity?

<p>African Americans (C)</p> Signup and view all the answers

What psychosocial factor is associated with higher cardiovascular risks?

<p>Chronic hostility (A)</p> Signup and view all the answers

What is the recommended alcohol consumption limit for women to avoid health risks?

<p>No consumption or &gt;1 drink per day (C)</p> Signup and view all the answers

Which medical condition is associated with an increased risk of cardiovascular issues?

<p>Rheumatoid arthritis (C)</p> Signup and view all the answers

What role do exogenous estrogens play related to cardiovascular health in postmenopausal women?

<p>Increase risk if started &gt;10 years after menopause (C)</p> Signup and view all the answers

What primarily leads to myocardial ischemia?

<p>Insufficient oxygen supply (B)</p> Signup and view all the answers

Which factor can contribute to reduced blood supply in myocardial ischemia?

<p>Atherosclerotic stenoses (C)</p> Signup and view all the answers

What happens when myocardial oxygen supply and demand are restored?

<p>Myocardial function usually returns to normal (B)</p> Signup and view all the answers

What is one implication of higher left ventricular end diastolic pressure (LV EDP)?

<p>Reduced coronary driving pressure (B)</p> Signup and view all the answers

What metabolic process does the myocardium primarily rely on?

<p>Aerobic metabolism (A)</p> Signup and view all the answers

What condition can occur due to myocardial ischemia if blood flow is compromised?

<p>Myocardial stunning (A)</p> Signup and view all the answers

What is the definition of hypokinesis in the context of myocardial infarction?

<p>Reduced motion of a myocardial wall segment (C)</p> Signup and view all the answers

Which factor can provoke myocardial ischemia during physical activity?

<p>Coronary vasospasm (C)</p> Signup and view all the answers

What do symptoms of myocardial ischemia typically indicate?

<p>Imbalance in oxygen supply and demand (A)</p> Signup and view all the answers

Which of the following symptoms is NOT typically associated with acute myocardial infarction?

<p>Fever and chills (C)</p> Signup and view all the answers

What does the term dyskinesis refer to in a myocardial context?

<p>Paradoxical motion of a myocardial segment (D)</p> Signup and view all the answers

Which enzyme is commonly elevated following a myocardial infarction?

<p>Creatine kinase (CK) (B)</p> Signup and view all the answers

What proportion of myocardial infarctions may occur without any symptoms?

<p>20% to 25% (B)</p> Signup and view all the answers

In patients with ischemic cardiomyopathy, what characterizes the condition?

<p>Diffuse myocardial dilation with reduced contractility (A)</p> Signup and view all the answers

Which of the following is NOT a common clinical manifestation of acute myocardial infarction?

<p>Loss of appetite (C)</p> Signup and view all the answers

What is the likely outcome of akinesis in myocardial function?

<p>Partial or complete loss of myocardial motion (C)</p> Signup and view all the answers

What factor intensifies the risk of coronary artery disease (CAD) in women?

<p>Clustering of novel risk factors like inflammation (C)</p> Signup and view all the answers

Which of the following describes the outcomes of women undergoing coronary angiography with no significant obstructive coronary disease?

<p>They experience more adverse cardiovascular events. (D)</p> Signup and view all the answers

What has research found regarding hormone replacement therapy (HRT) and cardiovascular benefits in women?

<p>HRT has been found to reduce all-cause mortality when started early. (B)</p> Signup and view all the answers

What emotional response do women often exhibit after a cardiac event?

<p>Greater psychosocial distress and avoidance of social burden. (D)</p> Signup and view all the answers

What risk factor is linked to the increased likelihood of cardiovascular disease in women taking HRT?

<p>Risk of cardiovascular events primarily in the first year of treatment (C)</p> Signup and view all the answers

How are women typically classified in terms of risk for cardiovascular disease despite their profiles?

<p>As lower risk and less likely to receive proper care (C)</p> Signup and view all the answers

What condition is associated with women who present persistent chest pain despite normal coronary angiograms?

<p>Higher levels of endothelial dysfunction (A)</p> Signup and view all the answers

According to research, what is a significant outcome for women beginning hormone replacement therapy during menopause?

<p>Possibility of reduced cardiovascular mortality when started early (B)</p> Signup and view all the answers

What is the primary effect of ischemia on myocardial function?

<p>Depressed contractile function (D)</p> Signup and view all the answers

Which of the following factors is correlated with myocardial oxygen demand?

<p>Heart rate (C)</p> Signup and view all the answers

What characterizes angina pectoris?

<p>Pressure or heaviness in the chest (C)</p> Signup and view all the answers

What can trigger angina pectoris?

<p>Exertion and emotional stress (C)</p> Signup and view all the answers

When does myocardial hibernation typically occur?

<p>With repeated episodes of ischemia-reperfusion (A)</p> Signup and view all the answers

What is an indicator of impaired diastolic function?

<p>Increased left ventricular end-diastolic pressure (C)</p> Signup and view all the answers

Which condition arises from an imbalance between myocardial oxygen supply and demand?

<p>Myocardial ischemia (D)</p> Signup and view all the answers

What is a hallmark of myocardial oxygen supply?

<p>Oxygen saturation (A)</p> Signup and view all the answers

Which of the following is NOT a symptom of myocardial ischemia?

<p>Improved blood circulation (C)</p> Signup and view all the answers

What occurs when there is luminal narrowing of more than 65% to 70% in an epicardial coronary artery?

<p>Impaired oxygen delivery to the myocardium (B)</p> Signup and view all the answers

Flashcards

Stroke Volume (SV)

The volume of blood pumped out of the left ventricle with each heartbeat.

Ejection Fraction (EF)

The percentage of blood ejected from the left ventricle with each heartbeat.

End-Systolic Volume (ESV)

The volume of blood remaining in the left ventricle after contraction.

End-Diastolic Volume (EDV)

The volume of blood in the left ventricle at the end of relaxation.

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End-Diastolic Pressure (EDP)

The pressure inside the left ventricle at the end of relaxation.

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Sedentary Lifestyle

A lifestyle that lacks regular exercise and doesn't meet the minimal recommended physical activity of 30 minutes of moderate exercise most days of the week.

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CV Disease

A history of heart-related conditions like angina, heart attacks, peripheral artery disease, mini-strokes, or ischemic strokes.

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High Triglycerides

A high level of triglycerides (a type of fat) in the blood, above 150 mg/dL.

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Thrombogenic/Hemostatic Factors

Elevated levels of proteins in the blood that are involved in blood clotting.

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Inflammation

A high level of C-reactive protein (CRP) in the blood, above 3 mg/L.

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Psychosocial Factors

Depression, stress, hostility, social isolation, or a lack of perceived social support.

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Exogenous Estrogens

Hormone replacement therapy (HRT) started more than 10 years after menopause.

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Alcohol Consumption

Drinking no alcohol or more than 1 drink per day for women (2 drinks for men).

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Hypokinesis

Reduced movement of a section of the heart muscle.

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Akinesis

Complete lack of movement in a section of the heart muscle.

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Dyskinesis

Paradoxic motion of a section of the heart muscle, moving in the opposite direction to normal.

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Ischemic Cardiomyopathy

A condition where the heart muscle weakens and stretches, often due to severe coronary artery disease.

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Myocardial Infarction (MI)

A condition where the heart muscle is damaged, often by a lack of blood supply, causing the heart to lose its ability to pump blood effectively.

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Silent MI

A heart attack that does not produce any noticeable symptoms.

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Crushing chest pain

Pain in the chest that feels like crushing or pressure.

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Diaphoresis

The condition of sweating profusely.

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Microvascular coronary flow reserve

It is a condition characterized by abnormal blood flow in the small blood vessels of the heart, often found in women with chest pain but normal coronary angiograms.

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Endothelial dysfunction

It is a condition where the inner lining of the arteries doesn't function properly, affecting blood flow and increasing the risk of cardiovascular events.

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Hormone replacement therapy (HRT)

HRT involves replacing hormones typically declining after menopause. It has been studied for its impact on cardiovascular health, with some studies showing potential benefits while others suggest risks.

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Metabolic syndrome

A group of risk factors that cluster together and increase the likelihood of developing cardiovascular disease. It often includes high blood sugar, high blood pressure, excess abdominal fat, and abnormal cholesterol levels.

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High-sensitivity C-reactive protein (hs-CRP)

It is a measure of inflammation in the body, with higher levels often associated with increased risk of heart disease.

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Coronary flow reserve

It is a measure of how well the heart muscle is able to contract and relax. Abnormalities in this can indicate problems with heart function.

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Coronary angiography

A procedure that involves visualizing the coronary arteries using a contrast dye injected into the blood vessels.

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Obstructive coronary artery disease (CAD)

It is a condition where the arteries supplying the heart become narrowed or blocked, often leading to chest pain and other cardiovascular symptoms.

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Myocardial ischemia

A state where the heart muscle isn't getting enough oxygen, often caused by narrowed coronary arteries.

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Impaired diastolic function

Reduced ability of the heart muscle to relax and fill with blood between beats.

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Impaired systolic function

Reduced ability of the heart muscle to contract and pump blood effectively.

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Myocardial hibernation

A condition where the heart muscle, although weakened, is still alive and can potentially recover if blood flow is restored.

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Angina pectoris

Chest pain or discomfort caused by myocardial ischemia.

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Myocardial oxygen demand

Factors that influence how much oxygen the heart needs, such as heart rate, contractility, and wall stress.

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Myocardial oxygen supply

Factors that determine how much oxygen the heart receives, such as blood flow, perfusion pressure, and vascular resistance.

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Oxygen content of blood

Factors that determine the amount of oxygen in the blood, such as hemoglobin levels and oxygen saturation.

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Perfusion pressure

The pressure that pushes blood through the coronary arteries.

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Vascular resistance

The resistance to blood flow in the coronary arteries.

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What is Myocardial Ischemia?

Myocardial ischemia happens when the heart muscle doesn't get enough oxygen to meet its needs. This can be caused by reduced blood supply due to blockages in the coronary arteries, or by the heart working too hard and demanding more oxygen than it can get.

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How does atherosclerosis affect myocardial ischemia?

Atherosclerosis, or hardening of the arteries, is a major cause of reduced blood flow to the heart. It happens when fatty deposits build up inside the arteries, narrowing them and making it harder for blood to pass through.

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What is coronary vasospasm?

Coronary vasospasm is a sudden narrowing of the coronary arteries, usually caused by a temporary spasm of the artery walls. This can restrict blood flow to the heart and trigger chest pain (angina).

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How does myocardial ischemia affect heart function?

In myocardial ischemia, the heart muscle can become weak and inefficient, leading to decreased pumping capacity and increased pressure inside the heart chamber. This is why it is called heart failure.

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How does increased activity trigger myocardial ischemia?

Increased activity or stress puts a greater demand on the heart, requiring more oxygen. If the coronary arteries are narrowed, the heart may not be able to meet this increased demand, leading to ischemia.

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What is myocardial stunning?

Myocardial stunning happens when the heart muscle is temporarily damaged by ischemia and takes time to recover even after blood flow is restored. This is because the heart muscle is injured and needs time to heal.

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What is reperfusion injury?

Reperfusion injury happens when blood flow is restored to the heart muscle after a period of ischemia, but the re-introduced blood can damage the heart tissue. This is because of inflammation, free radical damage, and other factors.

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Why is the heart muscle sensitive to oxygen deprivation?

The heart muscle is especially sensitive to oxygen deprivation and relies on aerobic metabolism. When the heart is deprived of oxygen, it can't produce energy efficiently, leading to dysfunction and heart failure.

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Study Notes

Left Ventricular Diastolic Dysfunction

  • Impaired relaxation of the left ventricle
  • Leads to a less compliant (stiffer) ventricle
  • Prolonged relaxation time
  • Reduced LV filling rate
  • Decreased end-diastolic volume (EDV)
  • Increased dependence on atrial contraction
  • Clinical manifestations include dyspnea on exertion, cough, and exercise intolerance.
  • Other symptoms: pulmonary edema, JVD, peripheral edema, weight gain.

Left Ventricular Systolic Dysfunction

  • Impaired pumping function of the left ventricle
  • Reduced ejection fraction (EF) and stroke volume (SV)
  • Increased end-systolic volume (ESV)
  • Increased end-diastolic volume and pressure
  • Reduced CO (Cardiac Output)
  • Systemic venous pressure increases
  • Clinical manifestations include dyspnea and fatigue.
  • Symptoms worsen with exercise
  • Pulmonary edema, peripheral edema, and weight gain are possible.

Hypertensive Heart Disease

  • Chronic condition
  • Early development of diastolic dysfunction
  • Myocardial ischemia develops
  • Pathophysiological effects on lungs and right ventricle
  • Clinical manifestations associated with the various events.
  • Hypertension related to CVD risk.
  • Clinical manifestations are noted, including exertional dyspnea and fatigue.

Clinical Implications for Physical Therapy

  • Resting BP values should be obtained greater than age 35 and obese patients.
  • Clinical monitoring is indicated during activity.
  • Normal or abnormal BP response to activity can occur
  • Exercise tolerance can be impaired.
  • HTN patients should be questioned regarding prior knowledge, prescribed medications, and current medication adherence.

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Description

This quiz explores key concepts of left ventricular diastolic and systolic dysfunctions, along with hypertensive heart disease. Participants will learn about clinical manifestations, symptoms, and the physiological implications of these conditions. Test your knowledge on heart diseases and their effects on overall health.

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