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Heart Failure

Heart Failure and Circulatory Shock

What is the difference between heart failure and circulatory shock? (Define each) Heart Failure- heart is not able to keep up with the demands put on it. Circulatory Shock - heart failure that has been going on so long, it becomes circulatory shock.
*Muscles as a rule have to be stretched to the correct length in order to work - they can't contract if there's too much slack in the system. yeah.
What is the amount of initial stretch a myocardial cell has before it contracts? (Just at the end of diastole) Preload
What is the amount of blood in each chamber at the very end of diastole? End Diastolic Volume (EDV)
How is preload related to EDV? Direct: the more preload (stretch), the more volume.
What is Starling's Law? Up to a point, the more preload (the greater the EDV), the better the contraction in myocardial cells and the higher the cardiac output. (starlings law is the relationship between stroke volume and EDV)
What happens during CHF to Starlings law? The relationsship between stroke volume and EDV is lost - more blood wants to come into the heart than the heart can pump out.
After a point, more preload produces no increase in ____________ and the high pressures which lead to the increase in preload produce _____________________? Cardiac output; produce pulmonary or systemic congestion and/or edema.
What type of medications help with CHF? Positive inotropic agents (like digoxin)
What is an inotrope? what do they do? A drug that effects the force of muscular contractions. They increase the force of contraction.
What is the amount of tension that myocardial cells have to produce in order to get blood out of the heart and into the aorta or pulmonary artery (at the end of systole)? Afterload
Is there much afterload in the atria? RV? LV? no, there is not much afterload in the atria. Fair amount of work in the R ventricle and lots of work in the L ventricles.
Heart failure happens when the heart cannot meet its obligations in terms of ______________________. Tissue perfusion (reduced cardiac output, reduced pressure, or both).
________________ refers to the problems specifically with the muscles of the heart. ______________ refers to the system as a whole. Myocardial failure; circulatory failure.
3 Things that cause heart failure (over the long haul): Increased preload (volume things, like regurgitation). Increased afterload (pressure things, like stenosis of blood vessels, peripheral vascular disease). Reduced myocardial contractility (infections that weaken muscles like survived heart attacks).
What are 4 things to do when symptoms of CHF arrive? 1) Restrict salt to lower fluid retention/CV volume (lower preload). 2) diuretics to increase volume reductions (lower preload). 3) Enhance contraction with inotropic drugs. 4) Reduce resistance in periphery - vasodilators.
How can you reduce afterload? Reducing resistance in periphery (vasodilators, or ACE inhibitors which "disinhibit" arteriolar contraction).
What is shock the result of? Failure to adequately perfuse tissues. Less oxygen delivery (hypoxia), less clearance of waste. Tissue metabolism becomes anaerobic which produces a lot of lactic acid.
3 basic stages of shock: 1) Compensated. 2) Progressive. 3) Irreversible.
What is the first stage of shock? Compensated - compensatory mechanisms put the system in a state of (temporary) non-progression.
What is the 2nd stage of shock? Progressive - things get worse as a result of hypoperfusion and organ damage/dysfunction (but still time to help if heart gets restarted)
What is the 3rd stage of shock? Irreversible. You will die. Cells have been damaged to the point of no return.
Shock can result from what 4 things? 1) Obstructions in blood supply. 2) Heart problems (not enough volume/pressure being put into the system) 3) Circulatory volume problems (bleeding, V/D) 4) Blood distribution problems (peripheral vasoconstriction, etc..)
Cardiogenic shock is characterized by _____________. This happens a lot in what? Left ventricle dysfunction. Happens a lot in MI.
What are some mechanical defects that can lead to shock? Acute mitral regurgitation (large amount of reflux) or septal defects (blood flowing where it shouldn't). These reduce amount of pressure/volume available for tissue perfusion --> shock.
2 modes of treatment for patients in shock: 1) balloons inserted into aorta - rapidly inflate/deflate to effect changes in systemic pressure and flow. 2) Bypass the heart and lungs w/ a machine that oxygenates bloods and pumps it through body.
Created by: sam_melillo
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