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Patho chap 17
heart failure
| Question | Answer |
|---|---|
| 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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