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Define heart failure.
Hearts inability to increase the CO sufficiently to meet the bodies metabolic needs.
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What are the causes of heart failure?
- Elevated systemic and pulmonary vascular resistance
- MI
- Infection
- Anemia
- Beriberi
- Cardiomyopathy
- CAD
- Valvular heart disease
- Restrictive Pericarditis
- Persistent tachy/bradyarrhythmias
- Loss of atrial kick
- HTN
- Hyperthyroidism
- Collagen-Vascular Disease-SLE
- Infiltrative Diseases- Tumors, Sarcoidosis
- Iatrogenic Factors- Drugs
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What are the 4 categories of causes of heart failure and an example of each?
- 1.Decrease in contractility - MI
- 2. Decrease in preload- A FIB
- 3. Increase in afterload- HTN
- 4. Alterations in ratio of oxygen supply to demand- CAD
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What is the primary dysfunction in heart failure?
inability of heart to function as a pump
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Define ejection fraction and what is a normal value?
- ventricular volume ejected during systoleNormal = 66% or 2/3
- During HF can fall to 10-15%
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What are the 4 types of heart failure?
- 1. Left ventricular
- 2. Right ventricular
- 3. Biventricular Failure
- 4. high-output failure
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What is cardiac reserve?
an increase in CO during increased activities EXCEPT with heart failure this may occur at rest.
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What are the 4 types of compensatory mechanisms for heart failure? (cardiac reserve maintained by...)
- 1. Frank-Starling Mechanism
- 2. Activation of Sympathetic Nervous System
- 3. Renal Compensation
- 4. Ventricular Hypertrophy
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Considering the Frank-Starling Mechanism: how do you increase stroke volume?
by an increase in ventricular end-diastolic pressure --> increase SV --> increase in force of next contraction (rubber band)
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What is the earliest response to a decrease in CO and BP?
Activation of sympathetic nervous system.
leads to increase in: HR, SV, CO, vasoconstriction, PVR, venous return, ventricular filling.
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Which compensatory mechanism triggers an increased aldosterone production and increases absorption of ___ and ___.
- renal compensation.
- na and h2o
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Describe the compensatory mechanism ventricular hypertrophy
increase in wall thickness in ventricles
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Define Right heart failure (right ventricular failure)
persistent elevation of the LVEDP from left-heart failure that eventually leads to RHF, which is charcterized by venous congestions in systemic circulation
Cor pulmonale- when RHF occurs independently from LHF
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Define Left Heart Failure (Left ventricular failure)
any sustained elevation in the LVEDP will increase left atrial pressure, which is transmitted to the pulmonary vascular bed.
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Define Bi-Ventricular Heart failure
Heart failure that involves both the left and the right ventricles. Also called low output failure.
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Define High-output heart failure
inability of the heart to adequately supply the body with oxygen and nutrients despite adequate volume and normal or elevated myocardial contractility.
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May be the result of pulmonary disease.
Right sided heart failure
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Also called low-output heart failure.
Biventricular heart failure
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caused commonly by cardiomyopathies.
Biventricular heart failure
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caused commonly by anemia, hyperthyroid, or septicemia.
high-output heart failure
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Adequate blood volume and contractility.
high-output heart failure
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Pink, frothy sputum and decreased urinary output.
Left heart failure
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Elevated JVP, peripheral edema, hepatomegaly are symptoms of which type of heart failure
Right heart failure
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Hypotension, tachycardia, cold clammy skin are symptoms of which type of heart failure
Left heart failure
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Ascites, weight gain, splenomegaly are symptoms of which type of heart failiure?
Right heart failure.
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List 5 common treatments of heart failure.
- 1. Determine and treat the cause
- 2. Reduce pulmonary HTN and increase arterial O2 content
- 3. Decrease circulating volume: diuretics, restrict Na and H20
- 4. Enhance myocardial contractility: inotropic drugs
- 5. Decreased workload: bedrest
- 6. O2, cardiac monitoring, electrolyte balance.
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Cor Pulmonale:
- Right sided heart failure.
- when right sided heart failure results independently of left heart failure. commonly result of chronic pulmonary disease: COPD, Cystic fibrosis, pulmonary HTN, pulmonary fibrosis
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