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A Failing Pump, activate calcium channels, Myosin head binds to ATP, in…
A Failing Pump
Heart failure
Impaired ability of heart to pump blood
Compensatory mechanisms
RAAS
Further stress on myocardium
Sympathetic N.S.
Diabetes
High cholesterol
High B.P.
Obesity
Left-sided
Most common
Ischemia, HTN, DCM, MI
Right-sided
Left-sided failure (mostly) or cor pulmonale
Lab & radiological investigation
Complete Blood Count (CBC) test
definition
It is a blood test that measures several components and features of your blood
it measures
RBC, WBC, Platelets, & hemoglobin
Serum Electrolyte Levels
It is a blood test that measures levels of the body's main electrolytes ( Sodium, Chloride, Potassium)
Blood Urea Nitrogen (BUN) and Creatinine Levels
Evaluate the function of the kidney
Lipid Profile
Assess risk of CVD
How?
A blood sample is obtained
check for
Total cholesterol
High-density lipoprotein cholesterol (HDL-C)
Low-density lipoprotein cholesterol (LDL-C
Triglycerides
ECG
Used to
Record the electrical activity of the heart to check for different heart conditions
The waves represent different changes
for example
P wave
atrial depolarization.
QRS complex
ventricular depolarization.
T wave
ventricular repolarization.
Echocardiogram
definition
A type of ultrasound scan that gives a moving image
of the internal structures of the heart.
It is used to:
assess the overall function of the heart.
Doppler echocardiography
Special type that shows direction and speed of blood flow in the heart.
X-ray
Detect any heart changes or abnormalities.
Cardiac output regulation
venous return
sympathetic activity
skeletal muscle activity and venous valves
venous capacity
respiratory activity
preload
volume of blood at end of diastole
hypervolemia
regurgitation of cardiac valves
afterload
resistance left ventricle must overcome to circulate blood
hypertension
vasoconstriction
heart can keep a constant cardiac output until it reach 160mmhg
as the afterload increase the cardiac output decrease
frank-starling law
as preload increases
stroke volume increase
cardiac output increase
length- tension relationship within the ventricles
preload inc --> ventricular fiber length inc. --> increased tensions and contraction
cardiac output (CO) = stroke volume (SV) X heart rate (HR)
Physical examination
hands
nicotine stain
heavy smoking
clubbing
low blood oxygen
osler's node
splinter hemorrhage
jenway lesions
peripheral cyanosis
low temperature
abnormalities of the peripheral circulation
blue fingers
jugular vein palpation
general inspection and vital signs
well or unwell
awake or drowsy
color
weight and muscle loss
heart rate
blood pressure
Psychosocial aspect
Breaking bad news
One of a physician's most difficult duties
Shorten in a mnemonic (ABCDE)
B: build therapeutic relationship/environment
C: communicate well
A: advance preparation
D: deal with patient and family reactions
E: encourage and validate emotions
Health belief model
6 aspects towards behaviour modification
Perceived Susceptibility
When individual understands their risk for a specific disease
Perceived Severity
When individual understands the consequences of a disease
Perceived Benefits
When individual realize there are benefits to prevent a disease
Perceived Barriers
Identity potential barriers towards the health behaviour change
A barrier could be lack of education
Cues to action
Reminder to prompt individual to take action towards health issues
Self-efficacy
Individual is confident to take action towards the Health issue
An individual focused model to help understand people's behaviour towards health
Epidimiology
HMC Heart clinic receives 1700 Patient with heart failure
Cardiovascular diseases are the leading cause of death in Qatar
Treatment of heart failure
Drug therapy
Vasodilators
ACE-Inhibitors
Blocking synthesis of angiotensin II
Lowering preload and afterload
Enalapril, Ramipril, Lisinopril
Adverse effects
Chronic cough
Hypotension
Angioedema
Renal failure
A2 antagonists
A competitive antagonist on angiotensin ll receptors
Decrease in preload and afterload
losartan, candesartan, Irbesartan
Diuretics
The glomerulus
Inhibition of NaCl absorption in the ascending loop of Henle
Decrease blood volume and preload
Furosemide
Adverse effects
Hypokalemia
Ototoxicity.
Severe dehydration
Reduced glucose tolerance
𝛽-Blockers
Negatively inotropic drugs
Reduction in cardiac contractility
Carvedilol, Bisoprolol, Metoprolol
Non-drug therapy
Implantable cardioverter defibrillator
Cardiac transplantation
Cardiac resynchronization therapy
Complications of heart failure
Left-sided heart failure
Pulmonary congestion
The accumulation of fluid in lungs
Paroxysmal nocturnal dyspnea
Shortness of breath while sleeping
Dyspnea
Shortness of breath while doing exertion
Orthopnea
Shortness of breath while lying down
Right-sided heart failure
Failure in venous return & increase pressure in veins
Push the fluid out into surrounding tissues
Hepatomegaly (nutmeg liver)
Distended central veins
Ascites
Abnormal build-up of fluid in the peritoneal cavity
Edema
Excess fluid in surrounding tissues
Heart functionality
Histology
Gap junctions
Electrical/ mechanical syncytium
intercalated discs
mechanism of contraction
SA node initiate the action potential
influx of calcium ions
Free actin binding site
Contraction
Calcium binds to troponin C
activate calcium channels
Myosin head binds to ATP
Actin filament pulled to sarcomere's centre
in 2017
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