CHF Prework Powerpoint
advertisement
Circulation Review Preload Pressure filling the left ventricle Afterload Pressure theHigh heart has to pump against pressure Low pressure Heart Failure • The heart cannot pump enough blood to meet the need. • This is not the same as a heart attack • This is not the same as coronary artery disease • Those things are just one of many causes of heart failure Systolic vs Diastolic Heart Failure Systole: When the heart is pumping Corresponds to Systolic blood pressure 160 ml 140 / 90 Systolic Heart Failure is failure of the heart to Pump Pump Systolic vs Diastolic Heart Failure Diastole: When the heart is relaxing / filling Corresponds to Diastolic blood pressure 160 ml 140 / 90 Diastolic Heart Failure is failure of the heart to Relax Relax Systolic vs. Diastolic Dysfunction (round 2) Normal Heart Normal Muscle Thickness Normal Amount of blood at the end of diastole Normal Heart Ejection Fraction EF 70/120 55 -65% Normal amount ejected Normal Cardiac Output (around 5 L/min) Systolic Dysfunction Thin Heart Muscle Much larger amount at the end Normal Amount of diastole in of blood at the end Systolic Dysfunction of diastole Big, floppy heart , more than 50% of the chest cavity Systolic Dysfunction Systolic Dysfunction Ejection Fraction EF 70/120 25 58 %% Small amount ejected Reduced Cardiac Output Diastolic Dysfunction Thickened (hypertrophied) Normalamount Amount Smaller at of blood the endin the end ofatdiastole Diastolic Dysfunction of diastole Heart Muscle Diastolic Dysfunction Normal Cardiac Silhoutte Diastolic Dysfunction Diastolic Dysfunction EF EF 70/120 70% 58 % Small amount ejected Similar Cardiac Output to Systolic Dysfunction OUTLINE DIPIRO USE DIPIRO SLIDES Other Neuroendocrine mediators Arginine Vasopressin (ADH) Stimulated by extreme low kidney perfusion, just like Aldosterone. Causes free water retention and hyponatremia Receptor Site Effect V1a Vascular smooth muscle Platelets Cardiac muscle Vasoconstriction Platelet aggregation Positive intropism V1b Anterior pituitary V2 Renal collecting dugs Release of ACTH and Beta endorphins Increased water absorption Tolvaptan, (V2 antagonist), Conivaptan (V1a and V2 antagonist) Other Neuroendocrine mediators Endothelin One of the absolute most potent vasoconstrictors. Endothelin antagonists in the works Atrial and B-type Natriuretic peptide Stimulated by stretch of the atria and the ventricles and cause sodium and water excretion. Sort like a counterregulatory hormone to aldosterone CHF: Compensation Cardiac Output Cardiac Output (Compensated) SNS Kidney Perfusion Preload Na+ & H2O retention Renin Angiotensin Aldosterone CHF: Compensation Cardiac Output CHF: Compensation Cardiac Output Kidney Perfusion CHF: Compensation Cardiac Output Kidney Perfusion Renin Angiotensin Aldosterone CHF: Compensation Cardiac Output Kidney Perfusion Na+ and H2O retention Renin Angiotensin Aldosterone CHF: Compensation Cardiac Output Kidney Perfusion Preload Na+ and H2O retention Renin Angiotensin Aldosterone CHF: Compensation Cardiac Output Cardiac Output (Compensated) Kidney Perfusion Preload Na+ and H2O retention Renin Angiotensin Aldosterone CHF: Compensation Cardiac Output Cardiac Output (Compensated) Kidney Perfusion Preload Na+ and H2O retention Renin Angiotensin Aldosterone CHF: Compensation Cardiac Output Cardiac Output (Compensated) Preload Na+ and H2O retention SNS Kidney Perfusion Renin Angiotensin Aldosterone CHF: Cardiac Output WHY? CHF: Cardiac Output WHY? Systolic Dilated Cardiomyopathy CAD HTN CHF Cardiac Output WHY? Diastolic Hypertension CAD Hypertrophic Cardiomyopathy Systolic Dilated Cardiomyopathy CAD HTN CHF: The Viscious Cycle Cardiac Output Kidney Perfusion Renin Angiotensin Aldosterone CHF: The Viscious Cycle Cardiac Output Vasoconstriction SNS Kidney Perfusion Renin Angiotensin Aldosterone CHF: The Viscious Cycle Cardiac Output Afterload Vasoconstriction SNS Kidney Perfusion Renin Angiotensin Aldosterone CHF: The Viscious Cycle Cardiac Output Kidney Perfusion Renin Angiotensin Aldosterone CHF: The Vicious Cycle Cardiac Output Kidney Perfusion Na+ and H2O retention Renin Angiotensin Aldosterone CHF: Vicious Cycle Cardiac Output Preload and Pulmonary Edema Na+ and H2O retention Kidney Perfusion Renin Angiotensin Aldosterone CHF: Vicious Cycle Strain Cardiac Output Preload and Pulmonary Edema Na+ and H2O retention However Kidney Perfusion Renin Angiotensin Aldosterone CHF: Symptoms Strain Cardiac Output Fluid Overload Preload and Pulmonary Edema Na+ and H2O retention Low Perfusion Kidney Perfusion Renin Angiotensin Aldosterone
