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  1. ht failure--systolic dysfunction
    lacks sufficient force pump all blood (decreased CO) to meet body's O2 demands (decreased tissue perfusion)
  2. ht failure--diastolic dysfunction
    filling disfunction (vent dev a stiffness and fails to relax enough between contractions
  3. (HF) When CO fails--compensatory mechanisms activated to maintain tissue and organ perfusion:
    • hr and stroke vol increase
    • arterial and venous vasoconstriction--increasing venous return
  4. Fall in CO activates what?
    renin-angiotensin-aldosterone system

    • -vasoconstriction and salt and H2O retention
    • -salt and H2O help restore CO
    • -overtime--mus cells enlarge--vent hypertropy and HF
  5. Biventricular failure
    • both vents function inadequately
    • little to no cardiac reserve
    • pr awakes at night SOB;eduma during day is reabsorbed into circulation at night and gives fluid overload and pulm congestion
  6. Atrial Natriuretic Factor (Peptide)
    • synthesized in atrial muscle
    • used to preduct CHF (chronic= decreased) (acute= increased)
  7. Brain Natiuretic Peptide
    • Neurohormone secreted primarily by bets d/t vol expansion and pressure overload
  8. Hemodynamic monitoring
    • pg 98
    • assess CV function and response to treatment
    • norm: 2-8 cm
    • eval fl balence, vent function, and effects of interventions (drugs)
  9. Peripheral arterial line
    measures arterial BP
  10. (HF) morphine
    • acute pulm edema
    • reduces anxiety, improves breathing and vasodilation
    • reduces venous return and lowers rt atrial pressure
  11. (HF) digitalis glycosides
    pos inotropic agents and neg chronotropic
  12. (HF) sympathomimetic agents
    Dopamine (inotropin)

    • low dose 1-4 mcg/min>>>> increased renal bl flow
    • 5-10 mcg/min>>>>> increased contractility
    • over 10 mcg/min>>>>>> increased contractility and caused vasoconstriction (inc afterload)
  13. (HF) sympathomimetic agents (2)
    • Dobutamine (Dobutrex)
    • preferred over dopamine
  14. phosphodiesterase inhibitors
    inhibits phosphodiesterase to improve myocardial contractility and vasodilate

    • Amrinone (Inocor)
    • Milrinone (Primacor)
  15. Atrial Natiuretic peptide hormone
    Nesiritide (Natrecor) /Vasodilator

    used for serious, acutely decompensated HF

    increased Na+ loss
  16. Angiotensin-converting enzyme inhibitor
    • inhibits formation of angiotensin II (potent vasoconstrictor) and blocks release aldosterone (so increase Na+ excretion and K+ retention)
    • end in "pril"

    • improves CO and tissue perfusion
    • lowers peripheral resistance= decreased afterload
    • inc renal perfucion
    • increased tolerance to activity
  17. Side effects of ACEI
    • chronic cough, swelling face/eyes/throat (angioedema, neutropenia)
    • initial dose may cause hypotension, dizziness, tachycardia, and faiting--lay down is they occur--do not DC bc this is normal for 1st dose
  18. Angiotensin II receptor antagonists (blocker) ARBS
    • end in "sartan"
    • try ARB after ACE

    • Valsartan (Diovan) approved for pt who can't tolerate ACE inhibitors
    • losartan (corzaar)

    prevent release aldosterone (Na+ retaining hormone) and block angiotensin II from receptors in many tissues. Causes vasodilation and dec afterload
  19. Beta-Adrenergic Blocking Agents
    • Inhibit cardiac response to sympathetic nerve stimulation
    • Dec renin-angiotensin-aldosterone system which would cause inc vasoconstriction and Na retention
    • commonly used w ACEI
  20. Diet and Activity w HF
    Restricted Na+ 1.5- 2 g/day
  21. Dynamic cardiomyoplasty
    • improved functioning in existing heart
    • -wrapping skeletal muscle graft around ht to support
    • -grafted skeletal muscle stimulated to contract w heart muscle--more forceful contraction and inc CO
  22. Cardiac transplant
    type 1
    type 2
    1-heart removed and replaced w donor heart

    2. piggyback transplant--ht left in place and donor ht sutured to it. both function but most work done by donor heart.
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