Right Ventricular Failure and Primary Pulmonary Hypertension
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Questions and Answers

What is primarily responsible for right ventricular failure related to left ventricular failure?

  • Increased right ventricular pressure
  • Decreased left atrial pressure
  • Pulmonary vasoconstriction
  • Increased pulmonary vascular resistance (correct)

Which condition is characterized by vasoconstriction due to endothelial dysregulation?

  • Left ventricular hypertrophy
  • Primary pulmonary hypertension (correct)
  • Chronic bronchitis
  • Acute respiratory distress syndrome

What is a common consequence of right ventricular failure?

  • Hepatosplenomegaly (correct)
  • Increased cardiac output
  • Pulmonary vasodilation
  • Decreased jugular venous pressure

What can lead to acute right ventricular failure primarily due to increased afterload?

<p>Pulmonary thromboembolism (A)</p> Signup and view all the answers

Which underlying condition is often associated with hypoxic pulmonary hypertension?

<p>Chronic obstructive pulmonary disease (B)</p> Signup and view all the answers

What is a common complication caused by right ventricular failure due to increased afterload?

<p>Decreased cardiac output (B)</p> Signup and view all the answers

Which of the following is NOT a common etiology of right ventricular failure?

<p>Severe anemia (C)</p> Signup and view all the answers

How does primary pulmonary hypertension lead to right ventricular failure?

<p>By increasing right ventricular hypertrophy (C)</p> Signup and view all the answers

What happens during right ventricular failure that affects systemic blood flow?

<p>Pressure backs up and reduces forward flow (D)</p> Signup and view all the answers

What is a significant factor that can lead to secondary pulmonary hypertension?

<p>Pulmonary vascular obstruction (B)</p> Signup and view all the answers

Which two conditions can contribute to right ventricular failure by increasing afterload?

<p>Pulmonary hypertension and left ventricular failure (A)</p> Signup and view all the answers

Which symptom is likely to manifest due to right ventricular failure?

<p>Increased shortness of breath (A)</p> Signup and view all the answers

What role does chronic pulmonary disease play in right ventricular failure?

<p>It contributes to pulmonary vascular obstruction (D)</p> Signup and view all the answers

What causes peripheral edema in right ventricular failure?

<p>Back up of pressures into lower limb veins (D)</p> Signup and view all the answers

Which clinical manifestation is associated with elevated central venous pressure (CVP) in right ventricular failure?

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

What is a common hemodynamic abnormality in right ventricular failure?

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

Which symptom indicates the potential for decreased cardiac output in a patient with right ventricular failure?

<p>Decreased urine output (D)</p> Signup and view all the answers

What is another name for the swelling caused by fluid retention in tissues due to right ventricular failure?

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

Which of the following is most likely to occur due to increased peripheral capillary pressures?

<p>Peripheral edema (A)</p> Signup and view all the answers

What is a likely cause of tachycardia in patients experiencing right ventricular failure?

<p>Impaired left ventricular function (D)</p> Signup and view all the answers

Which method is commonly used for hemodynamic monitoring in patients with right ventricular failure?

<p>Swan-Ganz catheter (D)</p> Signup and view all the answers

What is a likely consequence of right ventricular failure due to pulmonary hypertension?

<p>Right ventricular hypertrophy (A)</p> Signup and view all the answers

Which condition is most closely associated with the development of secondary pulmonary hypertension?

<p>Chronic obstruction of the airways (B)</p> Signup and view all the answers

How does right ventricular failure typically affect heart function?

<p>It leads to impaired blood flow to the lungs. (C)</p> Signup and view all the answers

Which etiology is classified as primary pulmonary hypertension?

<p>A rare condition with chronic nature (D)</p> Signup and view all the answers

What pathophysiological mechanism can contribute to right ventricular failure from left ventricular failure?

<p>Elevated right ventricular afterload (C)</p> Signup and view all the answers

In the context of right ventricular failure, which symptom is most likely associated with elevated central venous pressure?

<p>Peripheral edema (B)</p> Signup and view all the answers

Which of the following scenarios can directly lead to right ventricular myocardial ischemia?

<p>Obstruction of the right coronary artery (C)</p> Signup and view all the answers

What is a common outcome of chronic pulmonary disease related to right ventricular failure?

<p>Right ventricular dilation (A)</p> Signup and view all the answers

Which clinical manifestation is primarily associated with high peripheral capillary pressures in right ventricular failure?

<p>Peripheral edema (A)</p> Signup and view all the answers

What hemodynamic change is often observed in patients with right ventricular failure?

<p>Elevated central venous pressure (CVP) (C)</p> Signup and view all the answers

In the context of right ventricular failure, what does hypotension indicate?

<p>Decreased cardiac output (D)</p> Signup and view all the answers

Which of the following is least likely to contribute to peripheral edema in right ventricular failure?

<p>Decreased plasma protein levels (B)</p> Signup and view all the answers

What systemic effect can result from liver congestion due to right ventricular failure?

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

Which manifestation of right ventricular failure indicates poor tissue perfusion?

<p>Mottled skin appearance (B)</p> Signup and view all the answers

What could potentially lead to increased jugular vein distention in right ventricular failure?

<p>Venous return obstruction (A)</p> Signup and view all the answers

What is the physiological consequence of increased pressure backup into the lower limb veins in right ventricular failure?

<p>Fluid accumulation in extracellular spaces (C)</p> Signup and view all the answers

What genetic characteristic is associated with hypertrophic obstructive cardiomyopathy?

<p>Autosomal dominant inheritance (C)</p> Signup and view all the answers

Which clinical manifestation is least likely to be caused by pulmonary edema?

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

Which of the following conditions is primarily indicated by limited ventricular filling?

<p>Mitral stenosis (C)</p> Signup and view all the answers

What compensatory mechanism is most commonly observed in response to decreased cardiac output?

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

Which symptom is typically associated with both hypoxic respiratory conditions and fluid overload?

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

What characterizes systolic dysfunction in heart failure?

<p>Increased left ventricular end diastolic volume (D)</p> Signup and view all the answers

What is a common outcome for individuals diagnosed with heart failure?

<p>Approximately half will die within five years (A)</p> Signup and view all the answers

Which type of heart failure is primarily characterized by the heart's inability to contract effectively?

<p>Systolic dysfunction (C)</p> Signup and view all the answers

What term describes heart failure that has a gradual onset and long-lasting effects?

<p>Chronic heart failure (D)</p> Signup and view all the answers

Which statistic about heart failure signifies its impact on public health in the U.S.?

<p>Costs approximately $30.7 billion annually (B)</p> Signup and view all the answers

What is the primary reason for increased preload in left ventricular failure?

<p>Increased LV residual volumes (B)</p> Signup and view all the answers

Which neurohormonal compensatory mechanism primarily leads to vasoconstriction in response to decreased cardiac output?

<p>Activation of the renin-angiotensin-aldosterone system (B)</p> Signup and view all the answers

What is a common laboratory indicator of systolic heart failure?

<p>Increased BNP secretion (D)</p> Signup and view all the answers

Which of the following is NOT a common cause of systolic dysfunction in left ventricular failure?

<p>Aortic regurgitation (B)</p> Signup and view all the answers

Which consequence is associated with long-term exposure to compensatory hormones in left ventricular failure?

<p>Ventricular hypertrophy (C)</p> Signup and view all the answers

In patients with left ventricular failure, what hemodynamic change primarily results from elevated pressures in the pulmonary capillaries?

<p>Pulmonary edema (B)</p> Signup and view all the answers

What is a key factor contributing to diastolic dysfunction in left ventricular failure?

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

Which of the following mechanisms does NOT play a role in renal compensation during left ventricular failure?

<p>Inhibition of angiotensin II secretion (C)</p> Signup and view all the answers

What complication can result from chronic exposure to catecholamines in left ventricular failure?

<p>Cardiac fibrosis (B)</p> Signup and view all the answers

What is the role of angiotensin II in the context of left ventricular failure?

<p>Promotes sodium and water retention (A)</p> Signup and view all the answers

What is the genetic characteristic of hypertrophic obstructive cardiomyopathy?

<p>Autosomal dominant (B)</p> Signup and view all the answers

Which clinical manifestation is commonly associated with pulmonary edema?

<p>Bibasilar crackles (C)</p> Signup and view all the answers

Which condition is primarily related to limited ventricular filling?

<p>Mitral stenosis (B)</p> Signup and view all the answers

What change in urine output may occur as a compensatory mechanism in heart failure?

<p>Decreased urine output (D)</p> Signup and view all the answers

What physiological condition can lead to hypoxemia, tachypnea, and dyspnea?

<p>Fluid overload (A)</p> Signup and view all the answers

What is characterized by the heart's inability to contract effectively, leading to reduced ejection fraction?

<p>Systolic dysfunction (D)</p> Signup and view all the answers

Which of the following is a consequence of left ventricular failure?

<p>Congestive heart failure (C)</p> Signup and view all the answers

Which condition typically leads to acute heart failure?

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

What is the typical duration of onset for chronic heart failure?

<p>Gradually progresses over months to years (A)</p> Signup and view all the answers

What is the primary statistical significance of heart failure in the U.S. population as mentioned in the data?

<p>Contributes to 1 in 9 deaths each year (D)</p> Signup and view all the answers

What is the primary consequence of increased residual volumes in the left ventricle due to left ventricular failure?

<p>Decreased cardiac output (B)</p> Signup and view all the answers

Which compensatory mechanism is activated in response to decreased cardiac output?

<p>Increased peripheral resistance (B)</p> Signup and view all the answers

How does pulmonary edema develop in left ventricular failure?

<p>Increased hydrostatic pressures in pulmonary capillaries (B)</p> Signup and view all the answers

What is one of the main detrimental effects of long-term exposure to compensatory hormones in LVF?

<p>Ventricular hypertrophy and interstitial fibrosis (A)</p> Signup and view all the answers

Which laboratory indicator is elevated in cases of systolic heart failure?

<p>Elevated Natriuretic Peptide (BNP) (D)</p> Signup and view all the answers

What primarily causes diastolic dysfunction in patients with heart failure?

<p>Myocardial ischemia leading to stiffening of the heart muscle (A)</p> Signup and view all the answers

What underlying factor contributes to the development of systolic dysfunction?

<p>Atherosclerosis in the coronary arteries (A)</p> Signup and view all the answers

What is a common cause of both systolic and diastolic dysfunction?

<p>Myocardial infarction (B)</p> Signup and view all the answers

Which of the following describes the role of aldosterone in cardiac compensation?

<p>Increases sodium and water reabsorption (B)</p> Signup and view all the answers

What characteristic is typically observed in patients with diastolic dysfunction?

<p>Normal ejection fraction (D)</p> Signup and view all the answers

Flashcards

Right Ventricular Failure (RVF)

A condition where the right ventricle of the heart struggles to pump blood effectively.

RVF Cause: Pulmonary Hypertension

High blood pressure in the blood vessels of the lungs forces the right ventricle to work harder, potentially leading to failure.

RVF Cause: Pulmonary Embolism

A blood clot in the lungs creates sudden, increased resistance to blood flow, straining the right ventricle.

RVF Symptom: Elevated Venous Pressure

Increased pressure in the large veins returning blood to the heart shows reduced blood flow.

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RVF Symptom: Edema

Fluid buildup in the body's tissues, often noticeable as swelling in the legs and ankles.

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Right Ventricular Failure

A condition where the right ventricle of the heart can't pump blood efficiently, causing back-up of pressure in the circulatory system.

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RV Hypertrophy Cause

Increased pressure from pulmonary diseases (like pulmonary hypertension or COPD) forces the right ventricle to work harder, leading to thickening and enlargement.

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RV Failure Effect: Venous Pressure

Increased pressure in the veins leading back to the heart, caused by the right ventricle's inability to pump effectively.

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RV Failure Effect: Edema

Fluid buildup in the tissues due to increased pressure in the veins, often seen as swelling in legs and ankles.

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RV Failure: Hepatosplenomegaly

Enlarged liver and spleen caused by back-up of pressure in the veins that drain the digestive system.

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RV Failure: Decreased Cardiac Output (CO)

Reduced blood flow from the heart due to the right ventricle's weakened pumping ability.

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RV Failure Symptom: Hypotension

Low blood pressure caused by decreased cardiac output, resulting in insufficient blood flow to vital organs.

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RV Failure Symptom: Tachycardia

Rapid heart rate as the body tries to compensate for the decreased blood flow by pumping faster.

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RVF Etiology: MI

A heart attack affecting the right ventricle directly weakens the heart muscle, impairing its pumping ability.

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RVF Etiology: LVF

Left ventricular failure (LVF) leads to a backup of blood in the lungs, increasing pressure and straining the right ventricle.

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What is afterload?

The resistance the heart encounters while pumping blood out. Increased afterload means the heart has to work harder.

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RVF Etiology: Pulmonary Hypertension (HTN)

High blood pressure in the pulmonary arteries forces the right ventricle to work harder to pump blood through the lungs.

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RVF Etiology: Pulmonary Embolism (PE)

A blood clot in the lungs creates a blockage, causing increased resistance to blood flow and making the right ventricle work harder.

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RVF Etiology: Pulmonary Disease

Chronic lung conditions like COPD and cystic fibrosis can lead to pulmonary hypertension, eventually causing right ventricular failure.

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RVF Etiology: Primary Pulmonary Hypertension (PPH)

A rare condition characterized by high blood pressure in the lungs, leading to right ventricular hypertrophy and eventually failure.

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RVF

Right ventricular failure is a condition where the right ventricle of the heart struggles to effectively pump blood, leading to a build-up of pressure and fluid in the body.

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RV hypertrophy from pulmonary disease

When conditions like pulmonary hypertension or COPD cause the lungs to resist blood flow, the right ventricle needs to work harder, making its muscle thicken and enlarge.

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What causes venous pressure back-up in RVF?

RVF causes a build-up of pressure in the veins as the right ventricle struggles to pump blood efficiently.

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What is edema in RVF?

Edema is fluid buildup in the body's tissues, often seen as swelling in the legs and ankles, due to increased pressure in veins from RVF.

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What is hepatosplenomegaly in RVF?

In RVF, the liver and spleen enlarge because of increased pressure in the veins that drain the digestive system.

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How does decreased CO manifest in RVF?

Decreased cardiac output (CO) in RVF means less blood flow from the heart, leading to symptoms like low blood pressure (hypotension), fast heart rate (tachycardia), and reduced urination (decreased urine output).

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What is elevated CVP and jugular vein distention in RVF?

Elevated central venous pressure (CVP) indicates increased pressure in the veins leading back to the heart. This can cause the jugular vein in the neck to bulge.

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What is peripheral edema in RVF?

Peripheral edema is swelling in the extremities (legs and ankles), often accompanied by weight gain, due to fluid buildup caused by RVF.

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What is right ventricular failure?

A condition where the right ventricle of the heart can't effectively pump blood, leading to a backup of pressure in the circulatory system.

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What are some causes of right ventricular failure?

Common causes include right ventricular myocardial infarction (MI), left ventricular failure (LVF), pulmonary hypertension (HTN), primary pulmonary hypertension (PPH), secondary pulmonary hypertension due to pulmonary vascular obstruction, and chronic pulmonary diseases like COPD and cystic fibrosis.

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How does left ventricular failure cause right ventricular failure?

When the left ventricle fails, blood backs up in the lungs, increasing pressure. The right ventricle then has to work harder to pump blood through the lungs, eventually leading to failure.

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What is pulmonary hypertension?

High blood pressure in the arteries of the lungs. It places extra strain on the right ventricle.

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How do pulmonary diseases like COPD and cystic fibrosis lead to right ventricular failure?

These chronic diseases cause damage to the lungs, leading to pulmonary hypertension, which strains the right ventricle, ultimately causing it to fail.

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What is the difference between primary pulmonary hypertension (PPH) and secondary pulmonary hypertension?

PPH is a rare condition with unknown causes, while secondary pulmonary hypertension is caused by other conditions, like pulmonary vascular obstruction.

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How does a pulmonary embolism (PE) cause right ventricular failure?

A PE blocks blood flow in the lungs, increasing pressure and forcing the right ventricle to work harder, eventually leading to failure.

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What is the role of the right ventricle in the heart?

The right ventricle is responsible for pumping blood from the heart to the lungs to be oxygenated.

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Heart Failure

A condition where the heart cannot pump blood effectively, leading to a decrease in blood flow and oxygen delivery to the body.

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Systolic Dysfunction

A type of heart failure where the ventricle cannot contract forcefully, leading to decreased ejection fraction and increased blood volume in the ventricle.

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Diastolic Dysfunction

A type of heart failure where the ventricle cannot relax properly and fill with blood, leading to reduced blood flow.

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Left Ventricular Failure

The most common type of heart failure, characterized by an inability of the left ventricle to pump blood effectively, leading to congestion in the lungs.

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Hypertrophic Obstructive Cardiomyopathy

A genetic heart disease where the heart muscle, especially the ventricular wall and septum, thickens abnormally, causing a blockage to blood flow. This is often due to collagen deposition, a stiffening protein, in the heart muscle.

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Restrictive Cardiomyopathy

A type of heart disease where the heart muscle stiffens and loses its ability to relax, making it difficult for the heart to fill with blood.

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Mitral Stenosis

A narrowing of the mitral valve, which is located between the left atrium and left ventricle, restricting blood flow from the atrium to the ventricle.

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What are some clinical manifestations of fluid overload?

Fluid overload, usually due to conditions like renal failure, can lead to a variety of symptoms such as pulmonary edema (fluid buildup in the lungs), hyoxemia (low blood oxygen levels), tachypnea (fast breathing), dyspnea (shortness of breath), and bibasilar crackles (sounds heard in the lungs).

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What are some compensatory mechanisms for fluid overload?

The body tries to compensate for fluid overload by increasing heart rate (tachycardia), constricting blood vessels, and reducing urine output, but it can also lead to mental status changes, weakness, and pale and mottled skin.

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Left Ventricular Failure (LVF)

A condition where the left ventricle of the heart is unable to pump blood efficiently leading to reduced blood flow and congestion in the lungs.

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What causes the increased preload in LVF?

The weakened left ventricle fails to pump effectively, resulting in a buildup of blood in the ventricle, causing increased pressure known as preload.

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What is the impact of pulmonary edema?

Increased hydrostatic pressure in pulmonary capillaries due to LVF leads to fluid leakage into the lung tissues, causing pulmonary edema, a common symptom of heart failure.

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Why does sympathetic nervous system get activated in LVF?

The body tries to compensate for decreased cardiac output in LVF by activating the sympathetic nervous system, leading to increased heart rate and vasoconstriction.

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What is the role of renin-angiotensin-aldosterone system (RAAS) in LVF?

The RAAS activation in LVF leads to vasoconstriction and increased sodium and water retention in the body, further aggravating the congestion.

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What is the role of BNP in LVF?

Brain natriuretic peptide (BNP) is released in response to ventricular stretch in LVF, acting as a marker for the severity of heart failure.

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How do compensatory hormones contribute to long-term damage in LVF?

Prolonged exposure to compensatory hormones, such as catecholamines, angiotensin II, and aldosterone, can lead to detrimental effects on cardiac muscles, causing hypertrophy and fibrosis.

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What is systolic dysfunction?

A type of heart failure where the left ventricle cannot contract forcefully enough to pump blood efficiently, leading to decreased ejection fraction and increased blood volume in the ventricle.

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What are examples of causes for systolic dysfunction?

Systolic dysfunction can be caused by underlying conditions like coronary artery disease (CAD), myocardial infarction (MI), and dilated cardiomyopathy, all affecting the heart's ability to contract effectively.

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What is diastolic dysfunction?

A type of heart failure where the left ventricle cannot relax and fill with blood properly, leading to reduced cardiac output despite normal ejection fraction.

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LVF: Increased Preload

LVF leads to a buildup of blood in the left ventricle as it struggles to pump. This increased pressure is called preload.

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LVF: Pulmonary Edema

The increased pressure in the left ventricle causes pressure to back up into the lungs, leading to fluid leakage into the lung tissues. This is pulmonary edema.

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LVF: Sympathetic Response

To compensate for the weakened heart, the body activates the sympathetic nervous system. This causes increased heart rate and blood vessel constriction.

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LVF: Renin-Angiotensin-Aldosterone System (RAAS)

The RAAS is activated in LVF. This leads to vasoconstriction and increased sodium and water retention by the body, further worsening congestion.

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LVF: Brain Natriuretic Peptide (BNP)

BNP is released in response to ventricular stretch in LVF. Increased BNP levels are used to diagnose the severity of heart failure.

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LVF: Compensatory Hormone Damage

Long-term exposure to compensatory hormones (like those from the RAAS) can damage the heart muscle, leading to thickening and scarring.

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Causes of Systolic Dysfunction

Conditions like coronary artery disease (CAD), myocardial infarction (MI), and dilated cardiomyopathy can all lead to systolic dysfunction.

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Pulmonary Edema

Fluid buildup in the lung tissues due to increased pressure in the pulmonary capillaries, often caused by heart failure.

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Study Notes

Right Ventricular Failure

  • Refers to primary dysfunction of the right ventricle (RV).
  • Etiologies and Pathophysiology:
    • Right Ventricular Myocardial Ischemia or Infarct
  • Left Ventricular Failure:
    • Increased left ventricular and atrial pressures are reflected back into pulmonary circulation.
    • This leads to increased pulmonary vascular resistance (PVR) and pulmonary artery pressures.
    • RV hypertrophy leads to RV dysfunction (similar to LV dysfunction caused by hypertension).

Primary Pulmonary Hypertension (PPH)/Pulmonary Arterial Hypertension (PAH)

  • PPH is caused by vasoconstriction due to endothelial dysregulation and/or fibrosis of the pulmonary arteries.
  • Causes/etiologies are unknown.
  • Hypertrophy of smooth muscle in vessel walls causes increased pulmonary vascular resistance (PVR).
    • This leads to RV hypertrophy.
  • High pulmonary artery pressure leads to increased RV afterload.
  • This further leads to myocardial hypertrophy, increased wall thickness and decreased ventricular compliance, and decreased filling volumes.
  • If RV afterload exceeds pressure generated during systole, this causes RV dilation and systolic dysfunction.
  • Pulmonary Vasculature Obstruction:
    • Causes include pulmonary thromboembolism or thrombi.
    • A massive increase in RV afterload often causes RV dilation and failure, and is a common cause of acute RVF.

Hypoxic Pulmonary Hypertension due to Chronic Pulmonary Disease

  • A common cause of death in patients with chronic or severe acute respiratory disease.
  • Reduced gas exchange in the lungs (decreased oxygen delivery to the heart) causes alveolar hypoxia and hypoxemia.
  • This leads to vasoconstriction of pulmonary arterioles/arteries, increased PVR, RV dilation/hypertrophy.
  • Decreased CO (cardiac output)/EF (ejection fraction) from the RV results from decreased blood flow from the RV to the LV, decreased CO from the LV, and thus LV failure.
  • Increased residual volumes in the RV leads to increased RV preload.
  • Resulting backward pressure causes increased hydrostatic pressure in peripheral capillaries, and this results in peripheral edema.

Clinical Consequences

  • Elevated central venous pressure, jugular venous distention.
  • Dependent pitting edema with weight gain.

Hepatosplenomegaly

  • A consequence of decreased CO from the left ventricle (LV).

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Description

This quiz explores the etiology and pathophysiology of right ventricular failure and primary pulmonary hypertension. It covers the relationship between right and left ventricular dysfunctions and their impacts on pulmonary circulation. Test your understanding of these complex cardiovascular conditions.

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