Chronic HF (Newman) Flashcards
inability of the heart to deliver O2 to tissues
heart failure
HF is a syndrome of _______ dictated by _____
salt and water retention dictated by renin-aldo system (decreased renal perfusion**)
What type of hypertrophy can cause HF
both concentric and eccentric
Does ejection fraction predict the severity of HF?
no, it does not predict CO, RBF, RAAS activation, salt and H2O retention
Flow to the kidney is more important
What are the functions of ang II and aldo?
ang II: vasoconstriction and release aldo
aldo: retain Na and excrete K
if we reduce Na in diet, what happens to aldo levels?
increases (want to retain what we have)
If you are standing up renin (inc or dec).
Why?
increases
decreases perfusion to kidneys
What can help reduce renin level? (3)
- low Na
- lying down (with legs up) to maintain renal perfusion
- dec thermal stress (stay out of the heat)
prolonged bed rest can help reduce CHF by …
determined by one of Newman’s mentors
reduce signs and symptoms
inc response to digitalis
dec cardiomegaly
What is the difference between decompensated and compensated HF?
Symptoms:
- compensated can function relatively normally
- decompensated cannot, are in ER
Pathophys:
- compensated: renin is balanced by naturetic peptides
- decompensated: renin system have overwhelmed naturetic peptides
In CHF, Na and water retention initially increases ______ volume which physically manifests as _____
intravascular volume manifested with JVD (venous column is 2 cm above RT atrium)
*do valsava maneuver to find JVD
= 3L of extra fluid intravascularly
In CHF, progressive Na and water retention increases ______ volume which physically manifests as _____
extravascular volume manifested edema
–> pitting at ankle (3L) –> knee –> thigh (10-20L) –> anasarca –> (30L)
How much extra fluid is retained with ... JVD pitting at ankle knee and thigh anasarca
3 L intravasualrly
3L extracellualrly
10-20L
30L
What drug is on exam? and can lead to hyperkalemia with its use
ACEi
due to dec Aldo = dec K+ secretion
If we inhibit ACE in lungs what are we inhibiting?
ang II production –> aldo dec = less K+ secreted
