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Left Systolic Ventricular Heart Failure (Risk Factors for peripartum…
Left Systolic Ventricular Heart Failure
Risk Factors for peripartum cardiomyopathy
Smoking
Medical Conditions
H/o cardiac disorders
Myocarditis
Mitral stenosis
Thyrotoxicosis
HTN
Preclampsia
Alcholism
Obesity
Use of certain medications
Pregnant
Multiple pregnancies/ twin gestation
Maternal age
African-American descent
Poor nurishment
low selenium
NYHA Classification
Class III
Marked limitation in physical activity
Class IV
Unable to carry on any physical activity without discomfort; symptoms of heart failure at rest; if any physical activity is undertaken, discomfort increases
Class II
Slight limitation in physical activity
Class I
No limitations in physical activity
Medical Management
ACE Inhibitor
Decreases workload of the heart
Diuretic
Beta-Blockers
Vasodilators
Milrinone Infusion
Decrease cardiac loading conditions
Signs & Symptoms
Shortness of breath from fluid in the lungs
Orthopnea - difficulty breathing when lying flat
Paroxysmal nocturnal dyspnea - sudden onset of SOB at night
Auscultation of lungs
S3 heart sound
CXR: pulmonary vascular congestion
Vessels engorged with blood
Rapid weight gain from fluid retention in the tissues
Determined by
Increaed Afterload
Heart is unable to pump sufficient cardiac output to meet the body's metabolic demands
Decreased Contractility
Increased Preload
Increased Heart rate
Pathophysiology of LHF
Stroke volume decreases
End-diastolic volume & pressure increase
Ventricular dilation
Elevation of diastolic pressures transmitted to atria & pulmonary & systemic circulation
Pulmonary or systemic edema
Decreased cardiac output
Increased sympathetic NS activity
Stimulates myocardial contractility, HR, vasoconstriction
Increased preload
Blood pools
Blood unable to reach all areas of the heart
Ischemia
Increased peripheral vascular resistance secondary to vasoconstriction
Increased afterload
Heart needs to overcome more pressure to pump blood over body
decreased coronary artery perfusion
Cycle continues
Reduction of renal blood flow & glomerular filtration rate
Sodium & fluid retention
Pathophysiology of PPCM
Viral antigen exposure
Antibodies against sarcomeric myosin and troponin I
increased oxidation of the left ventricle
Natural presence of prolactin of
Increase blood volume, decrease blood pressure, decrease antiogesin response
Dilation of Left Ventrile
Blood cumulated in the heart chambers
Decreased blood flow to body
Sympathetic nervous system tries to make heart pump more blood over body
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