3.5 CHF Pathophysiology

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3.5 CHF Pathophysiology
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2014-01-23 23:52:54
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  1. What can increase contractility?
    • Increased sympathetic stimuli
    • Hormones - Epinephrine and Thyroxine
    • Ca2+ and some drugs
    • Intra- and extracellular ion concentrations must be maintained for normal heart function
  2. Sympathetic stimulation of contractility releases what and initiates what system?
    • Releases Norepinephrine
    • Initiates a cAMP second-messenger system
  3. What cells release Renin?
    Juxtaglomerular Cells
  4. Where is Angiotensinogen released from?
    Liver
  5. Where does ACE come from?
    Lungs
  6. Is Angiotensin II a vasoconstrictor or vasodilator?
    Vasoconstrictor
  7. What does Angiotensin II help release?
    • Aldosterone
    • Argenine Vasopressin (ADH)
  8. What does Aldosterone do?
    Na and Water Retention
  9. What does ADH do?
    • Vasoconstrictor
    • Water Retention
  10. What 4 things determine cardiac function?
    • Contractile state of the heart muscle
    • Preload (end-diastolic volume and the resulting length of the cardiomyofibers prior to the onset of contraction)
    • Afterload (resistance to the ventricular ejection of blood)
    • Heart rate
  11. What are the cardiac characteristics of a Left Sided Heart Failure?
    • Ineffective left ventricular contractility
    • Decreased LV pump
    • Decreased SV
    • Decreased CO
    • Increased HR
    • Back up of volume in LA and back to lungs
  12. What are the symptoms of left sided heart failure?
    • Paroxysmal Nocturnal Dyspnea - can't sleep at night when lying flat
    • Elevated Pulmonary Capillary Wedge Pressure
    • Pulmonary congestion (Cough, Crackles, Wheezes, Blood-Tinged Sputum, Tachypnea)
    • Dyspnea
    • Pulmonary edema
    • Restlessness
    • Confusion
    • Orthopnea
    • Tachycardia
    • Exertional Dyspnea
    • Fatigue
    • Cyanosis
  13. What are the cardiac characteristics of a Right Sided Heart Failure?
    • Ineffective right ventricular contractility
    • Decreased RV pump
    • Decreased SV
    • Decreased CO
    • Increased HR
    • Back up of volume on venous side
  14. What are the symptoms of Right Sided Heart Failure?
    • Weight gain
    • Edema
    • Back up to vital organs - liver, spleen
    • Fatigue
    • ↑ Peripheral Venous Pressure
    • Ascites
    • May be secondary to chronic pulmonary problems
    • Distended Jugular Veins
    • Anorexia and Complaints of GI Distress
    • Dependent Edema
  15. What is a systolic dysfunction?
    • Ventricular Chambers are large
    • Lack of good Starling Effect, won't pump with good contractile force
  16. What is a diastolic dysfunction?
    • Problem with filling of stiffened ventricles
    • Due to remodeling became stiffened
  17. What are the causes of Systolic Dysfunction?
    • Coronary Artery Disease (CAD)
    • Hypertension
    • Dilated cardiomyopathy
  18. What are the causes of Diastolic Dysfunction?
    • Ventricular Hypertrophy
    • Restrictive Cardiomyopathy
    • Myocarditis
    • Coronary Artery Disease
  19. What is preload?
    Volume of blood in ventricles at end of diastole (end diastolic pressure)
  20. When is preload increased?
    • Hypervolemia
    • Regurgitation of cardiac valves
    • Heart failure
  21. What is afterload?
    Resistance left ventricle must overcome to circulate blood
  22. When is afterload increased?
    • Hypertension
    • Vasoconstriction
  23. What are 3 causes of CHF?
    • Decreased contractility
    • Increased afterload
    • Decreased preload
  24. What drugs do you give to increase contractility and how does it work?
    • Digoxin 
    • Inhibits Na/K ATPase Pump
  25. What are the symptoms for Digitalis Toxicity?
    • Confusion
    • Irregular pulse
    • Loss of appetite
    • Nausea, vomiting, diarrhea
    • Palpitations
    • Vision changes (unusual), including blind spots, blurred vision, changes in how colors look, or seeing spots. Halos of white and green colors
  26. What happens if you slow down the Na/ K ATPase Pump?
    • Hypokalemia
    • Metabolic alkalosis
  27. How do you decrease preload?
    • ↓ Salt intake
    • ↓ water intake (1200 mls/day)
    • Give diuretics to decrease edema. Give K+ sparing (over K+ wasting) due to possibility of hypokalemia
  28. How do you decrease afterload?
    • Give β-blockers - reduces BP caused by body trying to ↑ CO
    • Will ↓ BP
    • Give ACE inhibitors to ↓ angiotensin II formation
    • Give diuretics to ↓ BP
  29. What do you give when CHP is due to Coronary Artery Disease and how does it work?
    • Nitroglycerin
    • Vasodilate the coronary arteries and ↑ oxygenation to the myocardium which will ↑ contractility and ↓ preload and afterload
  30. What is an acronym to treat CHF?
    UNLOAD FAST

    • Upright Position
    • Nitrates
    • Lasix
    • Oxygen
    • ACE inhibitors
    • Digoxin

    • Fluids (↓)
    • Afterload (↓)
    • Sodium Restriction
    • Test (Dig level, ABGs, K+ levels)
  31. What are symptoms of late stages of CHF?
    • Dilated pupils
    • Skin pale, gray, or cyanotic
    • Dyspnea, Orthopnea, Crackles, wheeze, cough
    • ↓ BP
    • Nausea and vomiting
    • Ascites
    • Dependent, pitting edema
    • Anxiety, Confusion
    • Falling O2 saturation
    • Jugular vein distention
    • Infarct
    • Fatigue
    • S3 gallop, tachycardia
    • Enlarged spleen and liver
    • Decreased urine output
    • Weak pulse
    • Cool, moist skin
  32. Why does the heart hypertrophy during CHF?
    • According to the Law of Laplace, best way to ↓ LVP is to ↑ the wall thickness
    • Denominator is ↓ the LVP value
    • ↓ Radius helps offset the effects of an ↑ LVP

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