Dcm dysfunc dcm decreased cardiac output decreased

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Unformatted text preview: LV dilatation and hypertrophy) Increased preload hypertrophy Activation of SNS- tachycardia Activation SNS tachycardia Activation of RAAS- salt and water retention Activation RAAS retention Frank- Starling’s Law Frank Both systolic and diastolic dysfunction result Both systolic diastolic dysfunction in elevated LV End Diastolic pressures elevated LV press Compensatory mechanism for Frank-Starling’s Law Law Pathophysiology Pathophysiology LV remodelling remodelling Immediate response to decreased output is increased preload (Starling’s law) increased LV dilatation leads to chronic LV enlargement and LV dilatation chronic change in geometric structure change geometric struc Necrosis, apoptosis and later fibrosis leads to apoptosis fibrosis distortion of LV structure (neurohumoral) distortion struc Initial adaptation but later less efficiency adaptation later Neurohumoral Activation Neurohumoral Activation of RAAS with decreased GFR Activation RAAS decreased Increased aldosterone, angiotesin II and Increased aldosterone angiotesin II vasopressin vasopressin Salt and water retention which initially water initially maintains Cardiac Output maintains ardiac Increased afterload Increased afterload Activation Of SNS-tachycardia Activation SNS-tachycardia Eventually leads to peripheral oedema and Eventually peripheral oedema pulmonary oedema pulm oedema Heart Failure Heart Results when cardiac and systemic responses Results cardiac systemic overcompensate leading to a cycle of fluid overcompensate cycle retention, pulmonary oedema and worsening retention pulmonary oedema worsening pump dysfunction- decompensated heart pump dysfunction- decompensated heart failure failure Cardiovascular alterations with alterations compensated heart failure compensated heart Major causes of Cardiac Dysfunction Major causes Cardiac Dysfunc Coronary Artery Disease (60-70%) oronary rtery Idiopathic (20%)(often DCM) )(often DCM Valvular HTN Alcohol Direct toxin to myocyte Other Causes Other Causes Others Adriamycin – breast cancer Toxic (adriamycin, radiation, uremia, catecholamines) radiation, Infectious (Chagas, Coxsackie, HIV) Chagas - trypanosomiasis Coxsackie, Endocrine (hyperthyroidism , DM, acromegaly) Infiltrative (sarcoidosis, amyloidosis, hemochromatosis) Genetic (HCM) Metabolic (thiamine and selenium deficiency) selenium Peripartum pregnant Precipitants Precipitants HTN Endocarditis Anemia RHD Thyrotoxicosis Noncompliance To medication Arrhythmia Infection Lun...
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