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Acute heart failure in ICU (Pathophysiology (natriuretic pepetides…
Acute heart failure in ICU
Pathophysiology
origines from three layers
I. cardiac pressure :arrow_up:
II. SV :arrow_down: HR :arrow_up: CO不變
III. CO :arrow_down:
natriuretic pepetides
排鈉
preload :arrow_down:
dialate vessels
afterload :arrow_down:
preload :arrow_down:
BNP
腎臟排泄
table 13.1
SV :arrow_down:
交感 :arrow_up:
RAA systems
type
HFrEF
HFpEF
Rt HF
CVP delayed rise
不易早期發現
left diastolic dysfunction
interventricular interdependence
management
high BP
vasodilators
preload :arrow_down:
venous congestion :arrow_down:
afterload :arrow_down:
BP :arrow_down:, CO :arrow_up:
nitroprusside
不建議用在肝腎病人身上
coronary steal disease
ischemic heart disesse
for short-term HTN crisis
NTG
safe
diuretics
vasodilator 無效 (PAWP > 20mmHg)或volume overload
normal BP
vasodilators
if 怕低血壓
inodilators(升壓+vasodilators)
Dobutamine
Milrinone
Levosimendan
diuretics (同右)
low BP
shock
dobutamine
dopamine
mechanical cardiac support
mechanical cardiac support
IABP
systole
afterload :arrow_down:
diastole
MAP :arrow_up:
coronary blood flow :arrow_up:
complications
fever
limb ischemia
distal pulse 不見
sensorimotor
remove it
positive pressure breathing
continuous positive airway pressure (CPAP)
CO :arrow_up:
table 13.2