Valvular Disorders
what is caused by infective endocarditis (IV drug) and causes right HF symptoms
tricuspid stenosis
Role of endothelin and Nitric oxide
Normal EF:
HF is less than:
rapid onset (after MI/cariogenic shock) vs. ventricles weakening overtime
Acute v. Chronic
Patient comes in with frothy pink sputum, pulmonary edema, dyspnea, Paroxysmal nocturnal dyspnea, orthopnea, cough, crackles heard on auscultation.
Backward effects of Left sided HF
what is caused by narrowing of pulmonic valve and causes JVD, ascites, hepatomegaly, splenomegaly, edema
pulmonic stenosis
Role of ANP/BNP
ANP: relased when atria is stretched and stimulates kidneys to increase urine output, block renin/aldosterone release and decrease vasoconstriction
BNP: released when ventricles are stretched
amount of blood pumped by LV per minute + average + equation
cardiac output. 4,900mL. HRxSV
chambers stretched thin making LV work harder. difficulty getting blood to body. EF is less than 40
Patient comes in with dizziness, confusion, memory loss, anxiety, low BF to GI tract, muscle weakness, poor urinary output, cold and pale extremities
Left sided HF forward effects
what is caused by endocarditis and dissection of aorta and causes increased cough, dyspnea, PND, orthopnea
aortic regurguitation
TNF-alpha
cytokines stimulate (inflammatory mediator) = hypertrophy, fibrotic changes and apoptosis
amount of blood is filled w per beat. resistance heart pumps against.
preload. afterload
problem with relaxing. stiff cannot expand fully to fill up adequately. EF greater than 50
Diastolic (HRpEF)
Patient comes in with ascites, hepatomegaly, splenomegaly, peripheral edema, JVD, abdominal dissention, N, anorexia, weight gain
Backward effects of right sided HF
what is caused by aortic sclerosis, RHD, congenital valve defect and causes chest pain, fatigue, exertional dyspnea, exertional synscope
aortic stenosis
ADH
not good BF to brain --> decrease urine output and increase BF
force of heart contraction
stroke volume
heart output cannot meet high circulatory needs of body
high output
Patient comes in with hypoxia, possible cyanosis, fatigue and weakness.
Forward effects of right sided HF
Mitral regurgitation/Stenosis causes and Symptoms
symptoms: dyspnea, paroxysmal nocturnal dyspnea, orthopnea, confusion, weakness, cool extremities, decreased urine output
MR: after MI
MS: rheumatic fever and mitral annular calcification
ANS (SNS/PNS)
SNS: increased HR, vasoconstriction, beta-1 receptors
PNS:lowers HR/ contractibility
RAAS System
kidneys reconize low BP --> release renin which changes angiotension from liver into angiotension I --> lungs changes it to angiotension II by ACE --> angiotension II stimulates vasocontriction and adrenal gland to release aldosterone --> aldosterone tells kidneys to reabsorpt H2O/NA --> increased BP
problem with L/R side. poor output to tissues
low output
Diagnostic tools for HF
elevated BNP and echocardiogram