Student%20Lecture%2025%20%28Congestive%20Heart%20Failure%29

Student Lecture - Lecture 25 Heart Failure Heart Thursday 4­15­10 Announcements Outline Outline – Proof of completion of online course

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Unformatted text preview: Lecture 25 Heart Failure Heart Thursday 4­15­10 Announcements Outline Outline – Proof of completion of online course evaluation. Due 5­7­10. – Proof of attending a Purdue Sporting event (ticket stub and picture) plus ½ page summary of applying concept learned in HK368 to what you observed. Due 5­7­10. – Ultrasound practice subject. Contact: [email protected] Monday and Friday – 8:30am to 12:30pm Tuesday and Thursday – 9:30am Wednesday – 8:30am to 11:30am Lecture – Seminar – April 14th, 3:30pm, Armstrong 1109 – Heart Failure What is heart failure? What Definition of Heart Failure Definition Heart failure: __________________________________ __________________________________ ___________________ Progressive in nature. No cure. Heart Failure Statistics Heart ___million individuals currently diagnosed with HF in United States ________ new cases are diagnosed each year ________ individuals die each year in the United States. Over __million hospitalizations a year at a cost of _____ billion. Age Specific Prevalence of Hospitalizations per 1000 Population 0­44 years 0­44 years – – – – 1979 (____) 2004 (____) 1979 (____) 2004 (____) 45­64 years 65­84 years 85+ years – 1979 (_____) – 2004 (_____) – 1979 (_____) – 2004 (_____) CDC.gov Causes of Heart Failure Causes _______________ – limits myocardial blood supply. _______________ – associated with death of myocardium. _______________ _______________ – allows blood to move in wrong direction (regurgitation) or decreases ability of valve to open (stenosis). _______________­ disease which cause death of myocardium ________________ Why is the prevalence of heart failure rising in the United States? ______________________________________ ______________________________________ ____________________ is the #1 reason why the prevalence of heart failure has increased so rapidly over the past two decades. _____ of men and _____ of women will develop heart failure within 6 years of having myocardial infarction. Compensated Heart Failure Compensated ____________________ ___: Asymptomatic decreases in cardiac function that are compensated for by multiple mechanisms in an attempt to maintain cardiac output. Adaptive Mechanisms – – – – _____________ _____________ _____________ _____________ Porth Adaptive Mechanisms: Adaptive Frank-Starling 1. 2. Decrease __________ leads to decreased ____________ blood flow. Decreased ____________ leads to increased salt and water retention in an attempt to compensate for decreased blood flow and pressure. _______________________ _________________ 3. 1. 2. Initially a good thing. Chronically increases in volume can lead to pulmonary congestion and decreases in wall thickness of ventricle. Porth Adaptive Mechanisms: Adaptive Sympathetic Nervous System 1. 2. Decrease cardiac output leads to reductions in blood pressure. Reduced blood pressure unloads baroreceptors which in turn increase sympathetic activity. _______________________ _________________ 3. 1. 2. Initially a good thing. Chronically increases in sympathetic nerve activity can lead to increased afterload (increases wall thickness of ventricle) and decreased perfusion of organ systems (except heart and brain). Porth Adaptive Mechanisms: Adaptive Renin-Angiotensin 1. 2. Decrease cardiac output leads to reductions in blood flow and pressure. Reduced blood flow and pressure in kidneys leads to an increase in renin release and conversion into angiotensin II. _______________________ _________________ Initially a good thing. Chronically increases angiotensin II can lead to increased afterload (increases wall thickness of ventricle) and increased aldosterone realease which promotes water retention in kidneys. 3. 1. 2. Porth Adaptive Mechanisms: Adaptive Renin-Angiotensin 1. 2. Decrease cardiac output leads to reductions in blood flow and pressure. Reduced blood flow and pressure in kidneys leads to an increase in renin release and conversion into angiotensin II. _______________________ ________________ Initially a good thing. Chronically increases angiotensin II can lead to increased afterload (increases wall thickness of ventricle) and increased aldosterone realease which promotes water retention in kidneys. 3. 1. 2. Porth Adaptive Mechanisms: Adaptive Hypertrophy 1. Myocardial hypertrophy is the long term mechanism by which the heart compensates for an increase in workloads that are produced by increases in __________________ Increased myocyte size through addition of sarcomeres is associated with _______________________ _______________________ __ and increase extracellular matrix proteins which make the heart fibrous and stiff. 2. Porth Type of Hypertrophy Type 1. __________________ – a proportional increase in muscle length and width. (athletes) 2. __________________ – increase in muscle width (hypertension) 3. __________________ – increase in muscle length (volume overload) 1 2 3 Porth Types of Heart Failure Types Right side – Failure of right ventricle to move blood into __________________. – Causes blood to pool in veins which increases venous pressure. – Increased venous pressure causes fluid to be force out of capillaries and into peripheral tissue. – __________ Peripheral Visceral Porth Types of Heart Failure Types Left side – Failure of left ventricle to move blood into __________________. – Causes blood to pool in pulmonary circulation. – Increased pressure in pulmonary circulation causes fluid to be force out of capillaries and into interstitium of the lungs. – Edema _____________ Porth Symptoms of Heart Failure Symptoms __________________ __________________ __________________ __________________ ______________ (bluish discoloration of skin do to desaturation of hemoglobin). _______________ (normal 65%) ___________ ____________________ Pharmacological Treatments for Heart Failure Heart Diuretics Digitalis – ___________________ – ________________________________ – Block the conversion of ANG I to ANG II which decreases blood pressure – Blocks NE from binding to α ­adrenergic receptors. Chronic α­adrenergic receptor stimulation causes myocardial death. ____________ ____________ Central mechanisms for decreased exercise tolerance with heart failure exercise _____________ _____________ – 50­65ml/beat – Mechanism Already have maximized preload at rest. Decreased contractility Increased afterload – <50% of normal – 10­15L/min ________________ – Resting HR is increased – Heart rate reserve is less Pina 2003 Peripheral mechanisms for decreased exercise tolerance with heart failure exercise Decreases in muscle blood flow associated with HF during exercise are also influenced by peripheral factors. – ______________________ – ______________________ – ______________________ Vascular Impairments Vascular Ability of arterioles to dilate during exercise is impaired with heart failure. Mechanism – __________________ – __________________ – __________________ – __________________. Skeletal Muscle Impairments Skeletal Skeletal muscles ability to utilize oxygen for energy production is impaired during exercise in individuals with heart failure. Mechanisms – ______________________ – _______________________ – _______________________ Cardiac Output Mismatching Cardiac Blood flow is not directed to the skeletal muscle during exercise to the same extent in individuals with heart failure. Normal ____ of CO to exercising muscle. Heart Failure _____ of CO to exercising muscle. Effects of Chronic Training on Heart Failure Heart Chronic exercise training increases peak VO2 by _________ Pina 2003 Effects of Chronic Training on Heart Failure Heart Mechanisms for increases in peak VO2 with chronic exercise training in HF patients are still unclear. Potential mechanisms – – – ___________________________________ ___________________________________ ___________________________________ Majority of studies suggest that ejection fraction is not affected by training. Quality of Life and Survival After Chronic Exercise Training Preliminary data suggests that individuals Preliminary data suggests that individuals with heart failure that exercise _________. However, more studies are needed. Quality of life has been shown to _________ in individuals with heart failure that participate in aerobic exercise programs. Is it safe? Is ______ Pina 2003 ...
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This note was uploaded on 02/17/2011 for the course HK 458 taught by Professor Newcomer during the Spring '10 term at Purdue University-West Lafayette.

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