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Terms in this set (29)
CHF is characterized by
ventricular dysfunction, reduced excercise tolerance, diminished quality of life, and shortened life expectancy
congestive heart failure
abnormal condition involving impaired cardiac pumping. this is associated with many diseases esp long standing hypertension and coronary artery disease.
CHF can be either
systolic or diastolic failure
systolic failure results from
inability of heart to pump blood and results in decreased cardiac output
systolic failure is caused by
caused by: impaired contractile function, increased afterload, cardiomyopathy, and mechanical abnormalities.
diastolic failure results from
impaired ability of ventricles to fill
and results in decreased stroke volume and decreased cardiac output.
diastolic failure is characterized by
smaller ventricular chamber, ventricular hypertophy, poor ability to stretch/compliance.
list the compensatory mechanisms of heart failure?
ventricular dilation, ventricular hypertrophy, sympathetic nervous system activation, neurohormonal responses
ventricular dilation compensatory mechanism
chambers enlarge when pressure is elevated over time and muscle fibers stretch and which cause actin/myosin fibers to not contract properly or allow for proper ejection of blood.
ventricular hypertrophy compensatory mechanism
heart grows in size in response to overwork which will lead to increased CO but demands more oxygen, has poor contractility, and is poorly vascularized, and is prone to dysrhythmias.
sympathetic nervous system activation compensatory mechanism
inadequate stroke volume and CO results in sympa NS activation. as a result, increased heart rate, myocardial contractility, and peripheral vascular constriction. detrimental over time and o2 needs are increased as well as preload.
neurohormonal response compensatory mechanism
-decrease of blood flow to kidneys causes released of renin which causes conversion of angiotension I to II resulting in adrenal cortex to release aldosterone which increased sodium retention and peripheral vasoconstriction.
-low CO to the brain causes increase of ADH from post pit which increases water reabsorption in renal tubes and increases preload.
what are the two types of CHF?
led and right sided failure
left sided failure pathogenesis
left ventricle fails and unable to pump adequate blood coming from the lungs. increases pressure in pulmonary circulation and causes fluid to be forced into pulmonary tissues (edema and crackles)
signs and symptoms of left sided failure
decreases in CO
increase in left atrial and left ventricle end diastolic pressures.
congestion in the pulmonary circulation.
most common causes of left sided heart failure
acute myocardial infarction and cardiomyopathy
right sided heart failure pathogenesis and s/s
venous congestion in systemic circulation results in peripheral edema, hepatomegaly, splenomegaly, vascular congestion of GI tract, jugular venous distention.
causes of right sided heart failure?
left sided heart failure, 2nd primary pulmonary hypertension, 3rd right ventricle AMI
examples of clinical manifestations of CHF
edema, nocturia, pulmonary edema, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, frothy sputum, fatigue, tachycardia, anxiety and restlessness, weight loss, skin changes, and malnutrition
complications of CHF
left ventricular thrombus
broad clincal manifestations of heart failure
fluid retention and edema
fatigue and limited exercise tolerance
cachexia and malnutrition
see seitz slides for more explanation
management of heart failure
chest xray (CXR)
pharmocologic therapy for heart failure
prevents production of angiotension I to II and aldosterone by blocking and results in systemic vasodilation. decreased preload and afterload in pts with CHF.
increases force of myocardial contaction, decreases conduction through SA/AV nodes, slows heart rate and increases diastolic filling time. increases CO but slows down heart rate. good at reducing symptoms but does not improve survival time. digoxin.
promotes excretion of edema fluid and helps sustain cardiac output and tissue perfusion by reducing preload. (thiazides, loop, potassium sparing)
shown to improve survival by reducing circulating volume by decreasing preload and also increases coronary artery circulation by dilating coronary arteries.
beta adrenergic blockers
blocks sympathetic nervous system's negative effects on the failing heart such as increased heart reat
supportive care of CHF
supplemental oxygen, rest, daily weights, sodium restricted diets
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