Patho 233

Front 1

Collateral circulation

Back 1

Provides some back flow, develops w/age and exceersize

Front 2

Atrial Kick

Back 2

Helps C/O, atrium provide 10% of C/O, Sterlings law, Increased Stretch increases contractility. A-fib decreases Atrial kick which reduces BP

Front 3

CO=

Back 3

HR X Stroke Vol.
4-6l/min @ 60-70 BPM, 70ml/beat

Front 4

Increased HR does what?

Back 4

Decreases Diastole which decreases fill time, decreased stretched, therefor decreased contractility, (CO) decreased Coronary atr. fill time.

Front 5

Coronary arteries fill when?

Back 5

During Diastole, shorten this phase>>>>Ischemia of Myocardium

Front 6

Preload...

Back 6

Volume in heart precontraction

Front 7

Afterload...

Back 7

How much resistanct to pushing during contraction, increased afterload or preload increases work load, or increased O2 need.

Front 8

Sterlings Law....

Back 8

"Clap Law" "Stretch law"
Increased stretch increases contractlity.

Front 9

Sympathetic innervation of heart

Back 9

Fast-flight or fight

Front 10

Parasympathetic innervation of heart

Back 10

Slow

Front 11

Heart muscle characteristics

Back 11

-Auto
-excite
-conductivity
-contractility

Front 12

Pulsis paradoxus

Back 12

- is an exaggeration of the normal variation in the pulse during the inspiratory phase of respiration, in which the pulse becomes weaker as one inhales and stronger as one exhales

Front 13

Pulsus Alternans..

Back 13

-Pressure Alternans is a sign of a failing ventricle. It can be seen in Left Ventricular pressure tracing or arterial waveform (shown above) where it represents severe left ventricular dysfunction. In severe Right ventricular dysfunction, Pulsus or Pressure Alternans can be seen in the Right ventricular pressure tracing recored from a Swan-Ganz catheter

Front 14

Heart Failure Define..

Back 14

-CHF
-Continula emerging symptoms and deterioration
-Caused by Ischemic heart diseas, HPT, Cardiomyopathy, Hyperthyroidism
-Not able to pump enough blood
-Mostly chronic progressive, (MI is rapid change)
-Impaired myocard. contractil., LV empting problem
-Pulmonary congestion may be there, rails not often noted (20% have them)

Front 15

Only cardiac condition that is continuing to grow

Back 15

Heart Failure
-affects 4.7 mill. americans

Front 16

Systolic Dysfunction...

Back 16

Impaired ejection of blood during systole
-Decr. contractility and EF
-Volume overload
-Pressure overload
Increased EDV, ventricular dilation, formation of scar tissue and fibrosis

Front 17

Heart Failure defined...

Back 17

LV systolic dysfunction
-ischemia to heart musclw
-CAD
-Hypertension
-DM

Front 18

Types of Heart failure

Back 18

-Systolic f.
-right sided f.(Rght becomes high pressure, unable to pump blood to left)
-left sided failure (ventical not functioning)

Front 19

diastolic failure

Back 19

Decreased EF due to decreased diastolic filling and stiffening of the LV
-40 % of cases
Ventircular hypertrophy, wall thickening with reduced chamber size, and ventricular stiffening
-Mitral stemosis, hypertrophic cardiomyopathy, aging, ischemic heart disease

Front 20

Stage A Heart failure..

Back 20

-Comorbid conditions that are strongly associated with HF.
-No signs or symptoms of HF and have never manifested s&s of HF.
-No structural or functional abnormalities of valves or ventricles.
-Examples: pts with systemic hypertension, CAD, or diabetes mellitus

Front 21

Stage B...

Back 21

-structural heart disease is developed, ass. w/HF w/os/sof HF and have never had them
-ex. LVH, enlarged dilated ventricles, previous MI

Front 22

Stage C...

Back 22

-current and prior symptoms of HF ass. w/ structural heart disease.

Front 23

Class D...

Back 23

-Marked symptoms of HF at rest despite max. medical therapy and who require specialized interventions.
Examples: Pts who cannot be safely discharged from hospital, are recurrently hospitalized, are in the hospital waiting a heart transplant, are in a hospice setting, are home receiving continuous intravenous support for symptom relief or are being supported with mechanical circulator assist devices.

Front 24

Class 1 NYHA Classification..

Back 24

Cardiac disease w/o S/s with activity, no objective evidence of disease

Front 25

Class II NYHA Classification..

Back 25

-Card Disease with minimal limit w/Physical act. Comfortable at rest.

Front 26

Systolic Heart Failure (S3 gallop

Back 26

Most common 2/3 of cases
Heart is unable to contract effectively
Decrease in CO and ejection fraction
LV is the main problem
Hemodynamic profile
Low CO and decreased ejection fx (< 40%)
Elevated LV pressures (preload)
Elevated systemic vascular resistance (afterload)
Vasodilators, arterial dilators, diuretics, inotropic

Front 27

LV Failure

Back 27

Decreased CO
Increased pressure in LV, LA, and pulmonary vasculature.
Increased hydrostatic press = accumulation of intracellular fluid in pulmonary capillary bed = pulmonary edema.
Congestion in the pulmonary veins, capillaries
Dyspnea and fatigue

Front 28

RV Failure

Back 28

Typically follows LV failure
Pressure increases in right side of heart
Hydrostatic pressures force more blood into systemic venous circulation
Neck vein distention
Peripheral edema (weight gain)
Engorgement of hepatic and gastric vessels.

Front 29

Diastolic heart failure (S4 gallop)

Back 29

-Ventricles cannot fill properly
-LV hypertrophy
-Systemic hypertension
-Both ventricles become stiff & noncompliant
-Contractility may or may not be effected EJ > 40%.
-Ventricles are unable to relax to fill
-More common in women

Front 30

The Cycle, TRIGGERS to Myocardial dysfuction..

Back 30

-Valve disease, infection, alcohol and drugs
-Heart Fails
-The body tries to compensate for impaired circulation
Sympathetic nervous system stimulation leading to increase in circulating neurohormones.
Activation of the renin-angiotensin-aldosterone system
Ventricular remodeling
Initially preserves CO & B/P but if untreated !

Front 31

Valve Disease types..(2)

Back 31

-Stenosis, valve tightens down
annulus (ring hardens with Ca+)-increases pressure build back pressure.
-Growth on the valves themselves, (Bacterial from parental, dental introduction, systemic infection)
-causes sloppy valve closure.
-leaky valves (incompetant) due to hardening, causing regurge.
-papillary.cord. tendonea can be disrupted

Front 32

Stenotic sounds are

Back 32

Systolic murmurs

Front 33

Incompetant valves are..

Back 33

Diastolic murmurs

Front 34

SA Node fires at

Back 34

60-100 pulses /min

Front 35

AV node fires @

Back 35

30? pulses/min

Front 36

Bundle branches, pukingi fibers fire @

Back 36

pulses/min