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74 Y.O. F with CAD - Coggle Diagram
74 Y.O. F with CAD
HF
Inability of the heart to pump sufficiently
Cardiac output does not meet demands
Reduced ejection fracture
decreased stroke volume
Pathophysiological involvement
Impaired ventricular relaxation (HF with preserved ejection fraction)
Impaired ventricular contraction (HF with reduced ejection fraction)
Determined by
Heart Rate
Too low or too high can cause pump failures
Contractility
Rate of contraction
Afterload
Excessive afterload (significant hypertension)
Preload (end-diastolic volume)
Excessive preload (valvular regurgitation)
HF generally progresses from compensatory mechanisms
Increased myocardial contractions to deliver more blood
Increased arterial pressures
Activation of sympathetic nervous system
Activation of RAAS (Renin-angiotensin-aldosterone system)
Most common cause
Depression of myocardial contractility
Loss of functional muscle
Processes that impact the myocardium (cardiomyopathy)
Right sided HF
right ventricle loses ability to pump
backup of blood in peripheral circulation
Cyanosis
Causing the patient to become cold and clammy
Jugular vein distension
Edema in the ankles and calf
Fatigue
Causing SOB in patients
commonly caused by Left sided HF
Left sided HF
back up of fluid in the lungs
SOB/ dyspnea on exertion
fluid retention
Causing crackles in her middle and lower lung
pulmonary vasculature congestion d/t build up of blood
pulmonary edema
usually systolic HF
diminished ability of the heart to pump efficiently
LVEF <45%
common cause of MI vs. right sided HF
pt LVEF was 25% 6 months ago
MI
The death of part of the heart muscle due to
inadequate blood supply
Causes of MI
The most common cause of MI is coronary artery disease
Can result from severely low BP
Can result from a prolonged spasm of a coronary artery (vasospasm)
MI is the most common cause of HF
4- This scarring affect may affect preload and contractility in that way as well, decreasing cardiac output and possibly leading to congestive heart failure.
If the MI continues it results in permanent cell death which can lead to HF
Lack of oxygen to the myocardium
Decreased pumping action of the heart
3- The dead portion of the heart will result in a scar which is non contractile
2- Stroke volume is decreased due to lack on heart contraction
1- Early on the heart muscle does not contract well due to not receiving enough O2
Severity, location, and size of MI
Determined by evaluation of 12 lead EKG
Symptoms of MI
Angina
Nausea/ vomiting
SOB
Rapid/ irregular heart beat
Pain shooting down arm