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Patho chap 17

heart failure

QuestionAnswer
normal EF 55-70%
EF that is considered heart failure less than 40%
cardiac output amount of blood pumped by LV per minute
preload amount heart is filled with per beat (blood returning to the heart)
afterload resistance that heart pumps against (resistance of LV)
stroke volume the volume of blood pumped out of the LV of the heart
heart rate number of contractions of the heart per minute
how do you calculate CO SV x HR
average CO at rest 4,900 L/min
contractility the force of the heart's contraction
increased preload does what to contractility increase contractility or stroke volume (to a point)
increased afterload does what to contractility reduces contractility or cardiac output
hydrostatic pressure pushes fluid out of the capillary pores into the interstitial and intracellular spaces
oncotic pressure pulls fluid from the interstitial and intracellular spaces back into the capillary
process of RAAS from JG cells of kidneys in response to low pressure/ perfusion, converted to angiotensin I to angiotensin II (in lungs) by ACE, angiotensin II stimulates adrenal gland aldosterone (NA & h2o absorption), ventricular remodeling & vasoconstriciton
ANP increases urine output, blocks renin and aldosterone release decreases vasoconstriction
BNP released from ventricles when over stretched high levels associated with heart failure
natriuretic peptides increase urine output in response to elevated blood volume
endothelin stimulates vasoconstriction and if prolonged leads to ventricular remodeling
TNF - alpha inflammatory mediator, negative impact on intropic function (contractility)
nitric oxide potent vasodilator, regulates blood flow to tissues
ADH decrease urine output and increase blood volume
ANA SNS beta -1 adrenergic receptors and increases HR and contractility; vasoconstriction
ANA PNS cholinergic receptors; decreases HR and contractility
causes of heart failure left sided heart failure, right sided heart failure, cardiomyopathies, cardiac infections, dysrhythmias
risk factors for heart failure hypertension, coronary artery disease, myocardial infarction, obesity, anabolic steroids, viral myocarditis, alcohol abuse, kidney conditions
acute heart failure rapid onset- ventricles can't pump
chronic heart failure more common- long term condition where heart is unable to pump efficiently
systolic heart failure (heart failure with reduced ejection fraction) pump problem, EF < 40%
diastolic heart failure (heart failure with preserved ejection fraction) difficulty filling, EF > 50%
high output heart failure can't meet high circulatory needs
low output heart failure problem with our left or right side of the heart, poor output to the tissues and lungs
describe the process of the backward effects of LV HF blood backs up in the heart due to the weak pump --> hydrostatic pressure backs up into pulmonary circulation (pulmonary edema)
describe the 3 things that occur during the forward effects of LV HF 1. blood cannot move out of heart effectively to perfuse the body 2.decreased perfusion 3. active SNS, RAAS, ADH to compensate
describe the process of right sided heart failure failure of one side of the heart leads to damage on the other side --> combined left and right sided heart failure
signs/ symptoms backward effects of left sided HF orthopenea, cough with frothy sputum, paroxysmal nocturnal dyspnea
signs/ symptoms forward effects of left sided HF confusion, fatigue, low urine output, cool extremities
signs/ symptoms backward effects of right sided HF weight gain, abdominal distention, hepatomegaly/ splenomegaly, JVD, peripheral edema
signs/ symptoms forward effects of right sided HF hypoxia, weakness, fatigue
what weight gain is concerning for a HF patient 2 pounds in a day, 5 pounds in a week
what diagnostic tools may be used to evaluate heart failure? elevated BNP and echocardiogram - main ones can also use EKG, chest X ray, cardiac cauterization, angiography
Created by: sammy.e7
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