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Heart Failure Causes Symptoms Therapy

Heart unable to pump Neurohormonal derangements: Dyspnea Immediate stabilization of acute


adequate output to meet the - Norepi patients
demands of the tissues - Renin-Angiotension-Aldosterone system Fatigue - Most have volume
- Endothelin overload requiring
Or it does so from - TNF Fluid Retention diuretics
abnormally elevated - Natriuretic peptides - Oxygen
ventricular diastolic volume - Control dysrhythmias
Increased Preload - Reduce preload, afterload
Associated w/ inflammation - Increased circulating hormone - Remove causative factors
and imbalance of hormones - Mitral insufficiency
released by the bodys - Aortic insufficiency Hallmarks of Therapy
defense system - Vasoconstrictors - ACE-inhibitors
- Atrial kick - B-blockers
Overcompensate for poor - Cholesterol-lowering
heart function Increased Afterload agents
- Aortic stenosis - Diuretics (fluid retention;
Progressive deterioration of - Peripheral arteriolar vasoconstriction not mono: dioxin to
cardiac structure, function - Hypertension improve clinical status,
- Polycythemia use w/ A & B)
- Arteriolar vasoconstrictor drugs

Decreased Contractility
- Hypoxia (oxygen saturation <50%)
- Hypercapnia
- Cardiac muscle disease
- MI
- Decreased HR
- Metabolic acidosis

Physiologic Compensation
- Increased peripheral vascular disease
- Tachycardia
- Ventricular remodeling
- Renal sodium/water retention
Type of Heart Failure Causes Symptoms
Left Ventricular Systolic CAD Weakness, fatigue
Dysfunction Hypertension Changes in exercise tolerance
Dilated Cardiomyopathy Changes in sensorium (lightheaded, confusion)
Impairment of left ventricular Aortic insufficiency Dyspnea, DOE, PND
contraction Dysrhythmias Tachypnea
Electrolyte disorders Diaphoresis
Insufficient blood ejected to Thyroid disease Sacral edema
meet tissue needs Drug abuse Crackles, ronchi
Nocturia
Cyanosis (late)
Left Ventricular Diastolic CAD Due to increased filling pressures:
Dysfunction Hypertension - Dyspnea, orthopneabld backup
Valvular Disease - Tachypnea
Impairment of ventricular Cardiomyopathy; hypertrophic, infiltrative, restrictive - Pulmonary edema
relaxation LVH - Exercise tolerance
Impaired filling Diabetes, Age - Signs of R-sided HF
Right-Sided HF Peripheral edema
Hepatomegaly
Ascites
JVD
Fatigue, weakness
Anorexia, N/V
Left-Sided HF Dyspnea, orthopnea
PND
Fatigue, weakness
Acute HF Sudden appearance of dyspnea
Acute cardiogenic pulmonary edema
Cardiogenic shock
Acute decompensation from CHF
Chronic HF BP stable
May have peripheral edema
Stable level of exercise tolerance
Type of Heart Failure Causes Symptoms
High Output HF Thyrotoxicosis
Sepsis
Exercise demand Anemia
Cirrhosis
Impaired filling AV malformation
Low Output HF Dilated cardiomyopathy
Myocardial ischemia
Poor systolic function Valvular heart disease
Toxins (EtOH)
Low ejection fraction Dysrhythmias

Acute Decompensated Most/all current therapies activate detrimental


Chronic HF neurohormones

Further activiation of Short term exposure to -agonists and PDEI can


compensatory mechanisms greatly increase apoptosis
that:

Enhance sodium and water


retentionbc CO, you will
see and in RASvicious
cycle

Increase preload, increase


afterload (you see
vasoconstrx bc SYM sec to
COharder for heart to
push against and stress on
heart)

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