Exam 5.docx - Heart Failure Heart Failure The heart isn’t meeting cardiac output requirements It is either not filling enough not ejecting enough or

Exam 5.docx - Heart Failure Heart Failure The heart isn’t...

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Heart Failure 11/09/2017 ° ° Heart Failure! The heart isn’t meeting cardiac output requirements It is either not filling enough, not ejecting enough, or both Basically, it’s failing as a pump and the tissues suffer ° ° What is Heart Failure? Heart failure isn’t really a disease so much as it is a collection of symptoms (syndrome) Characterized by: o Ventricular dysfunction o Reduced exercise & activity tolerance Activity level tolerance will continue to decrease as the heart failure progresses o Diminished quality of life o Shortened life expectancy High rates of morbidity and mortality HF is the most common reason for people to be hospitalized who are over the age of 65 ° ° Risk Factors For CHF Primary Risk Factors o Advancing age o CAD If the coronary arteries are bad, the heart itself doesn’t get enough oxygen and the myocardium isn’t working optimally Contributory Risk Factors
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o HTN – The major contributing factor The worse the hypertension, the greater the risk for HF o Diabetes o Tobacco use o Obesity o Elevated lipids (high cholesterol) ° ° So what causes it? Anything that interferes with the normal mechanisms that regulate CO. o Anything that decreases cardiac output can contribute to a heart failure o Beta-blockers CO depends on: o Preload o Afterload o Myocardial fibers (contractility) o Heart rate Major Causes of HF Primary Causes o CAD o MI (CAD that’s gotten too bad) Causes irrevocable damage/death to the myocardium o HTN o Pulmonary HTN
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A lot of pressure in the lungs causes a lot of pressure in the right side of the heart The right side of the heart can work too hard and become gimpy o Cardiomyopathy o Problems with the heart valves (such as mitral stenosis) Precipitating Causes – don’t have to memorize these o Anemia o Infection o Dysrhythmias o Lung disease o Pulmonary emboli ° ° Quick Review of Terms Systole: The actual moment the ventricles are contracting o When the ventricles contract to the lungs or the body Diastole: The moment where the ventricles are open and filling o When the atria are contracting to fill the ventricles Preload: Amount of volume being pushed into the ventricles o The bigger the preload, the greater the stretch, the greater the contraction (Frank Starling’s law) Afterload: The resistance that the heart has to pump out against o Affected by: Stroke Volume: Amount that the ventricle ejects with each contraction CO = SV x HR ° ° Classes of Heart Failure – These are all types of left-sided heart failure
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Systolic Failure (HFrEF/Heart failure with reduced ejection fraction) – when the ventricles don’t pump blood out to the body well enough o We measure systolic failure by measuring ejection fraction (the percentage of blood that is ejected) Decreased ejection fraction is a hallmark finding in systolic failure Normal is 55%-60%, but these patients will have less than 45% o
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