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define heart failure
hearts inability to pump adequate amts of blood to meet the metabolic needs of the body
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CHF is which side of the heart
(congestive heart failure)
left sided heart failure or left ventricular failure
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Cor pulmonale is which side of the heart
right sided heart failure or right ventricular failure
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results in pulmonary edema (fluid in the lungs)
CHF
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risk factors of CHF
- hypertension
- diabetes
- smoking
- obesity
- high fat diet
- fam history or heart disease
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term is used to describe right heart enlargement, also pumps against pulm arteries
cor pulmonale
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5 types of causes of cor pulmonale
- massive pulm embolism
- ards
- copd
- bilateral pneumotoraces
- pulm hypertension
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normal range or pulm artery pressure
25/10 mmHg
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which results in more dramatic symptoms? left or right heart failure
CHF
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how much ventricular volume is being ejected during a contraction of the ventricles
70%
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in a pt w/ severe heart failure, ejection fraction may fall to as low as
20%
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myocardial fibers are stretched by increasing end-diastolic ventricular pressure and volume, the fibers contract with greater response. (acts like a rubber band) what do you call this type of response
frank-starling response
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release of norepinephrine by the sympathetic nervous system causes
- increase hr
- increase in force of contraction
- improved cardiac output
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increase in size of an organ or structure is called:
hypertrophy
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enlargement of the heart is called:
cardiomegaly
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difficulty in breathing while laying down is called:
orthopnea
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chemicals that alter the force of contractility of the heart is called:
inotropes
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alteration of blood flow away from the kidneys and cutaneous tissues toward the brain and the heart during heart failure results in
increased systemic vascular resistance due to increase sodium and h20 reabsorption
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right heart failure leads to
- portal hypertension
- liver engorgement
- reduced lymph duct drainage
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left hear failure leads to
- pulm congestion, esp towards the upper lung zones
- pulm hypertension
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an enzyme released by the kidneys that causes the release of angiotensin I is called:
renin
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a vasopressor substance produced when renin is released by the kidneys is called:
angiotensin
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physiologically INACTIVE form of angiotensin
angiotensin I
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physiologically ACTIVE form of angiotensin
angiotensin II
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reduces blood pressure, causes vasodilation is called;
angiotensin converting enzyme also a angiotensin II blockers
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hormone that functions in the regulation of metabolism of sodium, chloride, and potassium is called:
aldosterone
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a hormone produced by stretch receptor cells in the atria is called:
atrial natriuuretic peptide (ANP)
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increased aldosterone causes the kidneys to retain
sodium (na)
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increased blood pressure causes increased levels of ANP to stimulate the kidneys to :
excrete sodium
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renin causes release of:
angiotensin I
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angiotensin I is converted to:
angiotensin II in the pulm circulation
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angiotensin II stimulates sodium reabsorption, causes:
vasoconstriction and stimulates aldosterone secretion
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aldosterone induces:
kidneys to further retain sodium
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Atrial natreiretic peptide ANP stimulates the kidneys to:
excrete Na
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right heart failure results in what type of edema:
peripheral edema - increased cap blood pressure and inc systemic venous blood press
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left heart failure results in what type of edema:
pulmonary edema - increased pulm blood press
-fluid accumulates around the alveoli, small airways and pleural spaces (goes back to the lungs)
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typical signs and symp associated with CHF
- dyspnea
- adventitious b/s (ins-exp)
- cough
- reduced exercise tolerance
- anxiety
- delirium
- orthopnea
- diaphoresis
- cyanosis
- cool skin
- comp tachycardia
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typical signs and symp associated with right side failure
- distended jugular viens
- abdominal distention
- peripheral edema
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xray that shows a butterfly of batwing is which type of heart failure
CHF
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x ray that shows cardiomegaly, an enlargement of the heart is which type of heart failure
cor pulmonale (right side)
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lab findings for cor pulmonale:
- increased hematocrit
- increased hemoglobin
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lab findings for chf
- elevated atrial natriuretic peptide (ANP)
- --kidneys to excrete sodium
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hemodynamic values for CHF
- 1- INCREASED Pulm Cap Wedge Pressure (PCWP)
- >25 mmHg pulm edema
note: wedge is always a picture on the left side
- 2. pulm art pressure PAP may be normal
- - will increase as severity of CHF increases
- 3. central venous pressure CVP may be normal
- - will inc as severe changes
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hemodynamic values for Cor Pulmonale
PCWP normal
- 1- PAP elevated
- 2- CVP elevated
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5 vasodilators to treat CHF
- morphine
- adrenergic blockers
- angiotensin II blockers
- calcium channel blockers
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perpheral vasodilator
reduces anxiety
is what type of drug?
morphine
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decreases the vasoconstrictive effects of norepineephrine
is what type of drug?
adrenergic blockers
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reduces blood pressure, causes vasodilation
ace inhibitor
is what type of drug?
angiotensin II blockers
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diltiazem, cardizem
inhibit the action of vasoconstriction machanisms
help control tacharrhmias
what type of drugs?
calcium channel blockers
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what type of oxygen therapy to treat CHF
- CPAP
- BIPAP
- Intubation and controlled mechanical vent w/ addition of PEEP
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