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Aurigemma g p et al circulation 2006113296 304

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Unformatted text preview: creased collagen •  Normal systolic (contracDle) funcDon Systolic •  Strength of contracDon inadequate to maintain stroke volume; commonly caused by ischemic disease •  Increased EDV & ESV; eccentric myopathy, decreased sDffness •  Decreased parameters of LF performance •  Increased EDP HF and PV RelaDonship Schematic LV pressure-volume relationship through 1 cardiac cycle in systolic heart failure (left), a normal control (center), and diastolic heart failure (right). Aurigemma G P et al. Circulation 2006;113:296-304 Copyright © American Heart Association 4 4/9/13 Compensatory Mechanisms Counteract the Effect of Lowered Cardiac Output in HF 1.  FrankStarling mechanism: –  output increases at expense of rise in LVEDP; this causes a rightward shi\ on the curve and can restore cardiac output –  Stretch increases contracDle energy because of maximizing thin/thick filament overlap, and increased responsiveness to intracellular Ca2+ N = Normal A = Uncompensated HF B = Compensated HF 2. Neurohumoral effects –  Increased AnD ­diureDc hormone –  Increased renin ­ angiotensin system –  increased sympatheDc nervous sDmulaDon 3. Chronic Structural CompensaDon •  Le\ ventricular hypertrophy –  Eccentric, in response to volume overload as in mitral or aorDc valve regurgitaDon – ...
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