patho
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| heart failure is a complication of... | MI
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| cardiac arrest: | when the heart stops beating
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| is heart failure a complication of cardiac arrest? | no, but cardiac arrest can be from a complication of heart failure
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| left ventricular ejection fraction (LVEF): | defines heart failure; the % of blood propelled out of the left ventricle with each contraction
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| normal LVEF: | 55-70%
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| LVEF that indicates heart failure: | less than 40%
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| cardiac output (CO): | the amount of blood pumped out of the LV per minute
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| equation to find CO: | SV x HR
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| normal CO: | 5000mls/min
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| preload: | -the volume of blood in the heart at the end of diastole (EDV)
-amount of blood returning to heart from the body per beat
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| an increase in EDV leads to... | an increase in SV
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| afterload: | amount of resistance the LV has to push against in order to pump blood out of the heart and throughout our body
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| increased afterload reduces... | CO
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| stroke volume: | the volume of blood pumped out of the LV during each systolic contraction
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| heart rate: | the number of heart beats per minute
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| inotropic: | things that affect the force of contraction, is influenced by amount of calcium available
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| positive inotropic agents (3): | -calcium and SNS
-Digitalis
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| chronotropic: | things that affect HR
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| negative chronotropic agents (2): | digitalis and beta blockers
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| positive chronotropic agents (2): | epinephrine and SNS; increases HR AND force
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| hydrostatic pressure: | pushes fluid out of the capillary pores into the interstitial and intracellular spaces
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| oncotic pressure: | pulls fluid from the interstitial and intracellular spaces back into the capillary
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| explain RAAS: | -renin released into blood
-renin reaches liver
-angiotensin converts renin into is converted to angiotensin I and it circulates blood
-when angiotensin I reaches the lungs, it is converted into angiotensin II by ACE
-angiotensin raises BP
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| explain the 3 ways angiotensin II raises BP: | -adrenal release of aldosterone
-ventricular remodeling
-vasoconstriction
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| ANP is released when... | atria senses too much fluid
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| BNP is released when... | ventricles sense too much fluid
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| list the 3 ways ANP and BNP decrease BP: | -stimulates diuresis
-blocks renin and aldosterone release
-vasodilates
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| what inflammatory mediator has a negative impact on inotropic function? | TNF alpha
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| list the causes of left-sided ventricular heart failure (6): | -HTN
-CAD
-angina
-MI
-mitral valvular disease
-aortic valvular disease
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| causes of right-sided ventricular heart failure (9): | -left sided ventricular heart failure
-MI
-pulmonary problems (COPD, fibrosis)
-tricuspid valvular disease
-pulmonic valvular disease
-endocarditis
-myocarditis
-pericarditis
-dysrhythmias
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| cardiomyopathy: | disease that targets the myocardium and can lead to heart failure
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| ischemic cardiomyopathy: | myocardial fibrosis due to CAD or MI
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| dilated cardiomyopathy: | -ventricles hypertrophy and become floppy/stretched out due to chronic injury
-decreases contractility
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| restrictive cardiomyopathy: | ventricle is restricted and unable to fill during diastole due to myocardial fibrosis or pericardial effusion
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| hypertrophic cardiomyopathy | -septum in LV hypertrophies and stiffens due to genetics or chronic HTN
-obstructs blood flow out of the heart
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| acute heart failure: | rapid, sudden development after a big MI or cardiogenic shock
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| chronic heart failure: | more common; heart weakens over time from something like HTN
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| systolic heart failure: | heart is UNABLE to pump blood due to stretched/weak LV
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| what EF value indicates systolic heart failure? | less than 40%
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| HFpEF (diastolic) heart failure: | ventricles are UNABLE to fill with blood
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| HFpEF (heart failure with preserved ejection fraction): | EF can be normal because the EDV is reduced
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| what EF value indicates diastolic heart failure? | > 50%
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| why is the EF value for diastolic heart failure high? | because there is less blood in the ventricle to begin with anyways
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| all types of heart failure result in... (2) | -decrease in CO
-RAAS and SNS kick in
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| high output heart failure: | when CO cannot meet high circulatory needs
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| low output heart failure: | heart is unable to pump out an appropriate amount of blood to tissues and lungs
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| systolic LVHF occurs from... | damage to the heart (i.e. MI), preventing adequate pressure generation
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| diastolic LVFH occurs from... | HTN
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| how do backward effects of LVFH occur? | from blood backing up in the heart due to a weak pump
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| how to forward effects of LVFH occur? | blood cannot move out of the heart effectively to perfuse to the body
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| how does body compensate for forward effects of LVHF? | activating SNS, RAAS, and ADH
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| RVHF causes... | fluid backup from our right ventricle to the right atrium and then backup in the vena cavas and the rest of our body
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| backward effects of LVHF (6): | -dyspnea
-orthopnea
-paroxysmal nocturnal disease
-cough
-frothy sputum
-crackles heard in lungs
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| forward effects of LVHF (7): | -CONFUSION
-memory loss
-anxiety
-GI tract ischemia
-muscle weakness
-oliguria
-cold and pale extremities
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| backward effects of RVHF (8): | -JVD
-hepatomegaly
-splenomegaly
-ascites leading to abdominal distention
-nausea
-anorexia
-peripheral edema
-weight gain
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| a weight gain of __-__ pounds in 1 week is concerning for a heart failure patient | 2-3
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| labs/diagnosis for heart failure (6): | -elevated BNP
-echocardiogram
-EKG
-diluted electrolytes from fluid retention
-CXR
-weight gain
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| what information can we get from echocardiograms? (3) | -presence of LVEF
-presence of valvular disorders
-size of heart chambers
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| causes of high output heart failure (4): | -hyperthyroidism
-anemia
-obesity
-sepsis
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| COPD and tricuspid regurgitation are causes of... | RVHF
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| right-sided heart failure caused by pulmonary issues is called... | cor pulmonale
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| HF is caused by ______ hydrostatic pressure | low
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| HFrEF (systolic) heart failure: | pump problem
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