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  • 1. CARDIAC FAILURE 03/17/11

2. Group members:

  • Karjome Lama
  • Alok Chandra Thakur
  • Namita Gyawali
  • Nanayakkara Sattambi R.D.Thanuga Dilhani

03/17/11 3. NORMAL HEART HEART FAILURE 03/17/11 4. INTRODUCTION

  • One of the most common ailments treated by the physicians.
  • In simple words, cardiac failure means failure of the heart to pump the blood to satisfy the bodily needs but it doesnt mean that the heart has completely stopped like incardiac arrest .
  • Itis not considered as a disease. Rather, it is the result from any heart condition that reduces the ability of the heart to pump the blood due to decreased contractility of myocardium.

03/17/11 5.

  • Heart failure may occur suddenly, or it may develop gradually. When heart function deteriorates over years, one or more conditions may exist. The strength of muscle contractions may be reduced, and the ability of the heart chambers to fill with blood may be limited by mechanical problems, resulting in less blood to pump out to tissues in the body. Conversely, the pumping chambers may enlarge and fill with too much blood when the heart muscle is not strong enough to pump out all the blood it receives.
  • In addition, as the architecture of the heart changes as it enlarges, regurgitation of the mitral valve may develop, making the heart failure even worse.

03/17/11 6. Cardiac Physiology (remember this?)

  • CO = SV x HR
  • HR: parasympathetic and sympathetic tone
  • SV: preload, afterload, contractility

Preload Contractility Afterload Stroke Volume Heart Rate Cardiac Output 03/17/11 7. Preload

  • Def:Passive stretch of muscle prior to contraction
  • Measurement: Swan-Ganz
    • LVEDP(Left Ventricular End-Diastolic Volume)
  • Really a function of LVEDV
  • Affected bycompliance
    • Low compliance = higher LVEDP @ lower LVEDV
    • False high estimate of preload

03/17/11 8. Afterload

  • Def:Force opposing/stretching muscleaftercontraction begins
  • Measurement: SVR(Systemic Vascular Resistance)
  • Really a function of:
    • SVR
    • Chamber radius (dilated cardiomyopathies)
    • Wall thickness (hypertrophy)

03/17/11 9. Contractility

  • Def:Normal ability of the muscle to contract at a given force for a given stretch,independentof preload or afterload forces
  • In other words:
    • How healthy is your heart muscle?
  • Ischemia, Hypertrophy, Muscle loss

03/17/11 10.

  • What Causes Heart Failure?
    • Health conditions that either damage the heart or make it work too hard
      • Coronary artery disease
      • Heart attack
      • High blood pressure & Hypertension
      • Abnormal heart valves
      • Heart muscle diseases (cardiomyopathy)
      • Heart inflammation (myocarditis & pericarditis)

03/17/11 11. ENDOCARDITIS PERICARDITIS 03/17/11 12. NORMAL HEART HYPERTROPHIED HEART 03/17/11 13.

  • What Causes Heart Failure?
      • Congenital heart defects
      • Severe lung disease
      • Diabetes
      • Severe anemia
      • Overactive thyroid gland (hyperthyroidism)
      • Abnormal heart rhythms(Arrhythmias)

03/17/11 14.

  • What Causes Heart Failure?
    • Coronary artery disease
      • Cholesterol and fatty deposits build up in the hearts arteries
      • Less blood and oxygen reach the heart muscle
      • This causes the heart to work harder and occasionally damages the heart muscle

03/17/11 15.

  • What Causes Heart Failure?
    • Heart attack
      • An artery supplying blood to the heart becomes blocked
      • Loss of oxygen and nutrients damages heart muscle tissue causing it to die
      • Remaining healthy heart muscle must pump harder to keep up

03/17/11 16.

  • What Causes Heart Failure?
    • High blood pressure & Hypertension
      • Uncontrolled high blood pressure and hypertension doubles a persons risk of developing heart failure
      • Heart must pump harder to keep blood circulating
      • Over time, chamber first thickens, then gets larger and weaker

03/17/11 17.

  • What Causes Heart Failure?
    • Abnormal heart valves
    • Heart muscle disease
      • Damage to heart muscle due to drugs, alcohol or infections
    • Congenital heart disease
    • Severe lung disease
      • Cor pulmonaleis the term given to heart failure due to lung disease, such as chronic obstructive airways disease.

03/17/11 18.

  • What Causes Heart Failure?
    • Diabetes
      • Tend to have other conditions that make the heart work harder
      • Obesity
      • Hypertension
      • High cholesterol

03/17/11 19.

  • What Causes Heart Failure?
    • Severe anemia
      • Not enough red blood cells to carry oxygen
      • Heart beats faster and can become overtaxed with the effort
    • Hyperthyroidism
      • Body metabolism is increased and overworks the heart
    • Abnormal Heart Rhythm
      • If the heart beats too fast, too slow or irregular it may not be able to pump enough blood to the body

03/17/11 20. TYPES OF HEART FAILURE

  • Anatomically
    • Left versus Right
  • Physiologically
    • Systolic versus Diastolic
  • Functionally
    • How symptomatic is your patient?

03/17/11 21. Left versus Right Failure

  • Left Heart Failure
    • Dyspnea
    • Decrease exercise tolerance
    • Cough
      • Orthopnea
      • Pink, frothy sputum
  • Right Heart Failure
    • Decrease exercise tolerance
    • Edema
    • Hepatomegaly
    • Ascites

03/17/11 22. Bilateral pulmonary effusion in right heart failure Pitting edema of the ankle. 03/17/11 23. The reninangiotensinaldosterone system

  • Reduction of renal blood flow and glomerular filtration rate.
  • The reninangiotensinaldosterone system is activated.
  • Increase in peripheral vascular resistance.
  • Increase in sodium and water retention.

03/17/11 24. THE RENIN ANGIOTENSIN ALDOSTERONE SYSTEM ACE ACE INHIBITORS JGA RENIN ADRENAL ALDOSTERONE ANGIOTENSINOGENANGIOTENSIN 1 ANGIOTENSIN 2 VASOCONSTRICTS Na RETENTION INCREASED BP 03/17/11 25. Systolic versus Diastolic

  • Systolic cant pump
    • Aortic Stenosis
    • HTN
    • Aortic Insufficiency
    • Mitral Regurgitation
    • Muscle Loss
      • Ischemia
      • Fibrosis
      • Infiltration
  • Diastolic- cant fill
    • Mitral Stenosis
    • Tamponade
    • Hypertrophy

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