AE2 EXAM 2 STUDY GUIDE.docx - A&E II SPRING 2019 \u2013 EXAM 2 REVIEW 4 APRIL 2019 T BERNABE FORMAT 50 MC TEXTBOOK CHAPTERS CH 34(week 5 CH 51 54(week 6 CH

AE2 EXAM 2 STUDY GUIDE.docx - A&E II SPRING 2019 u2013...

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A&E II SPRING 2019 – EXAM 2 REVIEW4 APRIL 2019T. BERNABEFORMAT50 MCTEXTBOOK CHAPTERSCH 34 (week 5), CH 51, 54 (week 6), CH 44, 45, 46 (week 7), CH 40, 14 (week 8)WEEK 5: HEART FAILURE (10-12 questions)HEART FAILURE: an overview-Abnormal condition involving impaired cardiac pumping-HF (aka CHF) is not a disease but a “complex clinical syndrome”-Associated with long-standing HTN & CAD-Results from the heart’s inability to pump adequate amount of oxygenated blood needed to meet metabolic requirements of body-Involves diastolic or systolic dysfunctionHF in the US-About 6.5 millionpeople in the United States have heart failure.-One in 9 deaths in 2009 included heart failure as contributing cause.-About halfof people who develop heart failure die within 5 yearsof diagnosis.-Heart failure costs the nation an estimated $40 billioneach year. This total includes the cost of health care services, medications to treat heart failure, and missed days of work.Risk factors-CAD & its risk factorsoSmoking, obesity, sedentary lifestyle-Age – most common reason for hospitalization for those >65 y/o -HypertensionoTo compensate for ↑ B/P the heart muscle thickensoOver time force of heart muscle contraction weakens preventing normal filling of heart with blood-High cholesterol-African American descentoRelated to the higher incidence of HTN & DMoHave a 30% higher mortality rateEtiology & Pathophysiology-May be caused by an interference with normal mechanisms regulating cardiac output (CO)oCO = HR X SV (amount of blood pumped from LV with each contraction)-CO influenced byoPreload – volume of blood in ventricle at end of diastoleoAfterload – force ventricle must develop to eject blood into circulatory systemoMyocardial contractilityoHeart rate – metabolic state of individual-Systolic Failure– inability of heart to pump blood efficiently (caused by impaired contractile function [e.g. MI], increased afterload [e.g. HTN], mechanical abnormalities [valvular heart disease]) oMost common cause of CHF: MI - Heart wall weakens from extra workloado“Squeeze” of ventricles is issueoLV loses ability to generate enough pressure to eject blood forwardDifficulty emptying The hallmark is a ↓ LV ejection fractionWith L side failure it usually EF falls below 40% (50 – 75% is considered normal-Diastolic Failure– impaired ability of ventricles to fill during diastoleoCommonly caused by HTN
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A&E EXAM 2oInability to fill & relax LV is issueoUsually result of LV hypertrophyoPulmonary congestionoNormal ejection fraction-Mixed Systolic and Diastolic FailureoSeen in dilated cardiomyopathy (poor systolic function + dilated ventricular walls that are unable to relax cardiomyopathy; LV enlarged & weakened HF b/c can’t pump blood efficiently) oBiventricular failureoPts have extremely poor ejection fractionsoCompensatory mechanismVentricular dilationInitial adaptive mechanism to ↑ CO then becomes inadequate → can no longer contractVentricular hypertrophy (remodeling)
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