Download - CHF and Super Heroes John Jameson, Pharm.D
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Circulation Review
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PreloadPreloadPressure filling the left ventriclePressure filling the left ventricle
AfterloadAfterloadPressure the heart has to pump againstPressure the heart has to pump against
Low Low pressurepressure
High High pressurepressure
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Heart Failure
•The heart cannot pump enough blood to meet the need.
•This is not the same as a heart attack
•This is not the same as coronary artery disease
•Those things are just one of many causes of heart failure
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Systolic vs Diastolic Heart Failure Systole: When the heart is pumpingCorresponds to Systolic blood pressure
160 ml140 / 90
Systolic Heart Failure is failure of the heart to Pump
Pump
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Systolic vs Diastolic Heart Failure Diastole: When the heart is relaxing / filling
Corresponds to Diastolic blood pressure
160 ml140 / 90
Diastolic Heart Failure is failure of the heart to Relax
Relax
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Systolic vs. Diastolic Dysfunction (round 2)
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Normal Amount of
blood at the end of diastole
Normal HeartNormal MuscleThickness
Normal MuscleThickness
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Normal amount ejected
EF 70/120
Ejection Fraction
55 -65%
Normal Cardiac Output (around 5 L/min)Normal Cardiac Output (around 5 L/min)
Normal Heart
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Systolic Dysfunction
Thin Heart Muscle
Thin Heart Muscle
Normal Amount of
blood at the end of diastole
Much larger amount at the end of diastole
in Systolic Dysfunction
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Big, floppy heart , more than
50% of the chest cavity
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Systolic Dysfunction
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Systolic DysfunctionEF 70/120
58 %Ejection Fraction
25 %
Small amount ejected
Reduced Cardiac OutputReduced Cardiac Output
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Diastolic
DysfunctionThickened (hypertrophi
ed)Heart Muscle
Thickened (hypertrophi
ed)Heart Muscle
Normal Amount of
blood at the end of diastole
Smaller amount at the end of diastole
in Diastolic Dysfunction
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Diastolic
Dysfunction
Normal CardiacSilhoutte
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Diastolic
Dysfunction
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Diastolic DysfunctionEF 70/120
58 %EF
70%
Similar Cardiac Output to Systolic DysfunctionSimilar Cardiac Output to Systolic Dysfunction
Small amount ejected
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OUTLINE DIPIRO USE DIPIRO SLIDES Other Neuroendocrine mediators
Arginine Vasopressin (ADH)
Stimulated by extreme low kidney perfusion, just like Aldosterone. Causes free water retention and hyponatremia
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Receptor Site Effect
V1a Vascular smooth musclePlateletsCardiac muscle
VasoconstrictionPlatelet aggregationPositive intropism
V1b Anterior pituitary Release of ACTH and Beta endorphins
V2 Renal collecting dugs
Increased water absorption
Tolvaptan, (V2 antagonist), Conivaptan (V1a and V2 antagonist)
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Other Neuroendocrine mediators
Endothelin
One of the absolute most potent vasoconstrictors. Endothelin antagonists in the works
Atrial and B-type Natriuretic peptide
Stimulated by stretch of the atria and the ventricles and cause sodium and water excretion. Sort like a counter-regulatory hormone to aldosterone
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CHF: CompensationCardiac Output
Kidney Perfusion
ReninAngiotensinAldosterone
Na+ & H2O
retention
Preload
SNS
Cardiac Output
((Compensated)
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CHF: CompensationCardiac Output
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CHF: Compensation
Kidney Kidney PerfusionPerfusion
Cardiac Output
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CHF: Compensation
Kidney Perfusion
ReninReninAngiotensinAngiotensinAldosteroneAldosterone
Cardiac Output
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CHF: Compensation
Kidney Perfusion
ReninAngiotensinAldosteroneAldosterone
Na+Na+ andand H2OH2O
retentionretention
Cardiac Output
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CHF: Compensation
Kidney Perfusion
ReninAngiotensinAldosteroneAldosterone
PreloadPreload
Cardiac Output
Na+Na+ andand H2OH2O
retentionretention
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CHF: Compensation
Kidney Perfusion
ReninAngiotensinAldosteroneAldosterone
PreloadPreload
CardiacCardiacOutputOutput
(CompensatedCompensated))
Cardiac Output
Na+Na+ andand H2OH2O
retentionretention
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CHF: Compensation
Kidney Kidney PerfusionPerfusion
ReninAngiotensinAldosterone
Na+ and H2O
retention
Preload
Cardiac Output CardiacCardiacOutputOutput
(Compensated)Compensated)
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CHF: Compensation
Kidney Perfusion
ReninAngiotensinAngiotensinAldosterone
Na+ and H2O
retention
SNSSNS
Cardiac Output CardiacCardiacOutputOutput
(CompensatedCompensated))
Preload
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CHF:Cardiac Output
WHY?
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CHF:Cardiac Output
WHY?
SystolicSystolic DilatedDilated CardiomyopathyCardiomyopathy CADCAD HTNHTN
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CHFCardiac Output
WHY?
SystolicSystolic DilatedDilated CardiomyopathyCardiomyopathy CADCAD HTNHTN
Diastolic
Hypertension
CAD
Hypertrophic Cardiomyopathy
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CHF: The Viscious CycleThe Viscious Cycle
Kidney Perfusion
ReninAngiotensinAldosterone
Cardiac Output
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CHF: The Viscious Cycle
Kidney Perfusion
ReninAngiotensinAngiotensinAldosterone
VasoconstrictionVasoconstriction
SNS
Cardiac Output
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CHF: The Viscious CycleCardiacCardiac OutputOutput
Kidney Perfusion
ReninAngiotensinAngiotensinAldosterone
VasoconstrictionVasoconstriction
SNS
AfterloadAfterload
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CHF: The Viscious Cycle
Kidney Perfusion
ReninAngiotensinAldosteroneAldosterone
Cardiac Output
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CHF: The Vicious Cycle
Kidney Perfusion
ReninAngiotensinAldosteroneAldosterone
Na+Na+ andand H2OH2O
retentionretention
Cardiac Output
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CHF: Vicious Cycle
Kidney Perfusion
ReninAngiotensinAldosteroneAldosterone
PreloadPreload and and Pulmonary EdemaPulmonary Edema
Cardiac Output
Na+Na+ andand H2OH2O
retentionretention
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CHF: Vicious Cycle
Kidney Perfusion
ReninAngiotensinAldosteroneAldosterone
PreloadPreload and and Pulmonary EdemaPulmonary Edema
Cardiac Output
Na+Na+ andand H2OH2O
retentionretention
StrainStrain
Improve
d
However
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CHF: Symptoms
Kidney Perfusion
ReninAngiotensinAldosteroneAldosterone
PreloadPreload and and Pulmonary EdemaPulmonary Edema
Cardiac Output
Na+Na+ andand H2OH2O
retentionretention
StrainStrainLow PerfusionLow PerfusionLow PerfusionLow Perfusion
Fluid OverloadFluid OverloadFluid OverloadFluid Overload