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44 terms

Heart Failure

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stroke volume is dependent on what three things?
preload, contractility, afterload
stroke volume =
end diastolic volume - end systolic volume
Preload is aka
left-ventricular end-diastolic volume
As preload increases, stroke volume and cardiac output _____.
increases
What curve describes the relationshiph between preload and stroke volume on cardiac output?
Frank-Starling
Increase in total blood volume will _____ preload.
increase
What law deals with tension?
Law of Laplace
Systolic dysfunction is defined as an ejection fraction ________
< 40%
Ejection fraction is the percent of _______ volume that is ejected during systole
left ventricular end-diastolic
4 broad etiologies of systolic heart failure
volume overload, pressure overload, loss of muscle, loss of contractility
Volume overload etiologies
mitral regurgitation, aortic regurgitation, anemia, hyperthyroidism
Pressure overload etiologies
systemic hypertension, pulmonary hypertension, aortic stenosis
Loss of muscle etiologies
myocardial infarction, myocardial ischemia, SLE
Loss of contractility etiologies
cardiomyopathy
Impaired cardiac output secondary to impaired myocardial contractility
systolic dysfunction
impaired relaxation and filling of the left ventricle
diastolic function
Diastolic dysfunction is defined as and ejection fraction ______ and _______.
> 40%, heart failure symptoms
2 broad etiologies of diastolic heart failure
impaired relaxation, impaired filling
impaired relaxation etiologies
hypertension with LVH, IHD, constrictive pericarditis, pericardial tamponade
impaired filling etiologies
mitral stenosis, tricuspid stenosis
If symptoms are a product of fluid accumulating in the peripheral tissues which side is the failure on?
right sided failure
If symptoms are a product of fluid accumulating in the lungs, which side is the failure on?
left sided failure
Right ventricular dysfunction symptoms
abdominal pain, anorexia, nausea, bloating, constipation, ascites
Left Ventricular dysfunction symptoms
DOE, orthopnea, tachypnea, cough, hemoptysis, paroxysmal nocturnal dyspnea
Right ventricular dysfunction signs
peripheral edema, JVD, hepatojugular reflex, hepatomegaly
Left ventricular dysfunction signs
bibasilar rales, PE, S₃gallop, pleural effusion, Cheyne-Stokes respiration
Hormone released from ventricles in response to ventricular stretch
BNP
BNP can be used to distinguish heart failure symptoms from ____ and ____.
COPD exacerbations, pneumonia
BNP levels are considered elevated above _____.
100 pg/mL
NYHA functional class I
ordinary physical activity does NOT cause undue fatigue, dyspnea, or plapitation
NYHA functional class II
able to walk one flight of stairs or one block without fatigue
NYHA functional class III
unable to walk one flight of stairs or one block without fatigue
NYHA functional class IV
Symptoms of congestive heart failure are present even at rest. Increased discomfort is experienced with any physical activity.
ACC/AHA stage A
patients have no identified abnormalities of the heart and have never shown signs or sx of HF
ACC/AHA stage B
Patients who have developed structural heart disease but never shows any signs or sx of HF
ACC/AHA stage C
Patients who have current or prior symptoms of heart failure with underlying structural disease
ACC/AHA stage D
Patients with advanced structural disease and marked sx of HF at rest.
ACC/AHA stage A examples
CAD, hypertension, diabetes, alcohol abuse
ACC/AHA stage B examples
LVH, previous MI
ACC/AHA stage C examples
symptoms due to L VSD
ACC/AHA stage D examples
patients awaiting heart transplant, patients in hospice setting for management of HF
NYHA classification is primarily based on ____ whereas ACC/AHA is based on ___ of heart failure.
functional capacity, structural progression
Diastolic dysfunction exacerbation etiologies
lack of compliance, uncontrolled hypertension, arrhythmias, emotional stress, MI, environmental factors, inadequate therapy, inappropriate meds
Diastolic dysfunction complications
arrhythmias