pathophysiology chf simpson
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powerpoinTRANSCRIPT
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Pathophysiology of CHF
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CHFWhat is CHF?
Fix the underlying problem
Heart is a 2 sided pump
Both sides can fail independent of each other.
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CHFWhat different types of pathophysiology cause it?Systolic Dysfunction
Diastolic Dysfunction
High Output States
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CHFSystolic Dysfunction What is it? Is it only related to events that occur in Systole?-1. Decreased Contractility- a. Loss of Myocytes
- b. Over-stretched Heart
-2. Increased Afterload- a. Increased BP- b. Stenotic Valve- Pulmonic Valve and carcinoid syndrome 5HIAA
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CHFDiastolic Dysfunction What is it? 1. Impaired Relaxation
2. Obstruction to filling
Can systolic and diastolic functions coexist?
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CHFPressure volume loops are used to distinguish between systolic vs. diastolic dysfunction
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CHFHigh Output States What is it?Pagets Disease
Anemia
Thiamine Deficiency
Hyperthyroidism
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CHFThe failing heart and how it compensatesWhat does a failing heart mean, and what is decompensation? What does a failing heart look like?
Compensations made by a failing heartFrank Starling ForcesNeuro-Hormonal ChangesVentricular Remodeling
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CHFWhat is looks like:
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CHF CompensationsFrank StarlingLength Tension Mechanism
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CHF CompensationsL sided failure and FrankBlood is not going to go forward
Blood is going to back up into L atrium and pulmonary venous circulationL Atrium, what happens when it distends?
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CHF CompensationsHoarseness:
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CHF CompensationsL sided Failure and FrankBlood eventually backs up into the pulmonary circulationWhat happens there?
Whats the deal with Frank Starling Forces?
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CHF CompensationL sided failure and the lungs continuedPulmonary congestion
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CHF CompensationL sided failure and lungs continuedPulmonary HypertensionDoes pulmonary hypertension happen immediately?
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L sided CompensationL sided failure and CXRCephalization
Indistinct vessels, Kerly B-Lines
Whited Out lungs fields
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CHF CompensationsL sided failure symptoms related to congestionBlood not going forward: Muscle fatigue ConfusionBlood going backwards:Atrial DistensionArrhythmiasThrombus formationHoarseness Mitral RegurgitationS3
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CHF CompensationsL sided failure symptoms continued Blood going backwards continuedPulmonary congestionPulmonary edemaPulmonary hypertension R sided failureDyspnea, Dyspnea at nightNocturnal enuresisOrthopneaCardiac AsthmaHypoxia, cyanosis
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CHF CompensationsR sided failure and Frank:Most Common Cause is?Cor pulmonale?Blood is going to eventually back up into the R atrium and systemic and portal venous circulation.
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CHF CompensationsWhat happens when this blood backs up?Liver Congestion
Gastrointestinal Tract Nutmeg Liver
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CHF CompensationsWhat happens when this blood backs up continuedPitting Edema Frank Starling Forces
Stasis Dermatitis
P02?
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CHF CompensationsJVD jugular venous pressure chart
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CHF CompensationsAcute R sided failureCauses?Would you expect to see any change to the R ventricle?
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CHF CompensationsR sided failure symptoms from the backing up of blood:Pitting EdemaJVDGI discomfortLiver congestionRUQ painHepatojugular ReflexAscites Puddle sign
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CHF complicationsWould you expect someone with R sided failure only, that is, no L sided failure, to have pulmonary hypertension or pulmonary edema?
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CHF CompensationsNeurohormonal changes:Renin-Angiotensin System
Adrenergic System
ADH
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CHF CompensationsRenin-Angiotensin System raise EABV, and lower plasma oncotic p.
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CHF CompensationsDoes the Renin-Angiotensin System restore EABV back to normal?
Why is this harmful in the end?
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CHF CompensationsAdrenergic System:Increased Sympathetic outflowIncreased effects of epinephrine on adrenergic receptors throughout your bodyWhat pathological process could keep the adrenergic system on even if the EABV is restored?
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CHF CompensationsDoes the adrenergic system restore the EABV?
Why is this harmful in the end?
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CHF CompensationsADH secretion
Why do its effects become blunted in long run?
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CHF CompensationsVentricular Remodeling