lOMoARcPSD|549 013 89
TOPIC 2
COLLABORATIVE MANAGEMENT OF CLIENTS WITH
HEART DISORDERS:
HEART FAILURE + DYSRHYTHMIAS
HEART FAILURE
1. Review cardiac anatomy + physiology
2. Explain HF in terms of definition, etiology, pathophysiology, compensatory
mechanisms
Definition:
Heart too weak to pump efficiently, insufficient CO
An abnormal condition of impaired cardiac pumping or filling
The heart can’t produce enough cardiac output to adequately perfuse the body
Characteristics: ventricular dysfunction, reduced exercise tolerance, diminished quality of life,
shortened life expectancy
It is a syndrome, not a disease
Associated w/ HTN, CAD + MI
Primary Risk Factors:
1. CAD
2. HTN
Contributing/Precipitating Risk Factors:
Downloaded by Beavan Chomba ()
, lOMoARcPSD|549 013 89
1. Diabetes
2. Tobacco use
3. Obesity
4. High serum cholesterol
Causes:
F – faulty heart valves (stenosis/narrow, regurgitation/leaks, infection)
A – arrhythmias (a fib or tachycardia)
I – infarction
L – lineage (congenital, family hx)
U – uncontrolled HTN stiffens heart walls R –
recreational drug use (cocaine) + alcohol abuse E –
evaders (viruses or infections that attack heart muscle)
Classifications:
a. Systolic failure
b. Diastolic failure
Reduced Ejection Fraction HF *Systolic
HF* Causes:
Cardiomyopathy
Mechanical abnormalities
Virus
Preserved Ejection Fraction HF *Diastolic
HF*
Ventricles lack ability to relax and fill during diastole = decrease SV and CO
Diagnosis: HF symptoms + normal EF Causes:
, lOMoARcPSD|549 013 89
Left ventricular hypertrophy from chronic HTN
Aortic stenosis
Hypertrophic cardiomyopathy
Mixed Heart Failure
Seen in dilated cardiomyopathy (DCM)
Poor EF (<35%) = high RR for more o2
High pulmonary pressures
Biventricular failure (both ventricles are dilated, have poor filling/emptying capacity)
Compensatory Mechanisms
Goal: *try to maintain adequate CO*
Dilation: enlarged chambers o Occurs when
LV pressure is elevated
o Initially, a compensation but becomes inadequate and CO decreases
Hypertrophy: increased muscle mass and wall thickness d/t overwork + strain (chronic HF)
o Leads to poor contractility, higher o2 demand, poor coronary artery circulation o
Risk for ventricular dysrhythmias
SNS Activation: release epinephrine and norepinephrine
RAAS vasoconstriction, Na, H2O retention
ADH release: Na + H2o retention
Endothelin: arterial vasoconstriction + increases contractility + hypertrophy
Counterregulatory Processes Natriuretic
peptides:
1. Atrial Natriuretic Peptide (ANP)
2. B-type Natriuretic Peptide (BNP) o Released in response to an increase in atrial volume
and ventricular pressure o Biomarker is released when there is excessive pressure in
ventricle d/t HF o BNP: < 100 is normal, 100-300 present, >300 mild, >600 moderate,
Downloaded by Beavan Chomba ()
TOPIC 2
COLLABORATIVE MANAGEMENT OF CLIENTS WITH
HEART DISORDERS:
HEART FAILURE + DYSRHYTHMIAS
HEART FAILURE
1. Review cardiac anatomy + physiology
2. Explain HF in terms of definition, etiology, pathophysiology, compensatory
mechanisms
Definition:
Heart too weak to pump efficiently, insufficient CO
An abnormal condition of impaired cardiac pumping or filling
The heart can’t produce enough cardiac output to adequately perfuse the body
Characteristics: ventricular dysfunction, reduced exercise tolerance, diminished quality of life,
shortened life expectancy
It is a syndrome, not a disease
Associated w/ HTN, CAD + MI
Primary Risk Factors:
1. CAD
2. HTN
Contributing/Precipitating Risk Factors:
Downloaded by Beavan Chomba ()
, lOMoARcPSD|549 013 89
1. Diabetes
2. Tobacco use
3. Obesity
4. High serum cholesterol
Causes:
F – faulty heart valves (stenosis/narrow, regurgitation/leaks, infection)
A – arrhythmias (a fib or tachycardia)
I – infarction
L – lineage (congenital, family hx)
U – uncontrolled HTN stiffens heart walls R –
recreational drug use (cocaine) + alcohol abuse E –
evaders (viruses or infections that attack heart muscle)
Classifications:
a. Systolic failure
b. Diastolic failure
Reduced Ejection Fraction HF *Systolic
HF* Causes:
Cardiomyopathy
Mechanical abnormalities
Virus
Preserved Ejection Fraction HF *Diastolic
HF*
Ventricles lack ability to relax and fill during diastole = decrease SV and CO
Diagnosis: HF symptoms + normal EF Causes:
, lOMoARcPSD|549 013 89
Left ventricular hypertrophy from chronic HTN
Aortic stenosis
Hypertrophic cardiomyopathy
Mixed Heart Failure
Seen in dilated cardiomyopathy (DCM)
Poor EF (<35%) = high RR for more o2
High pulmonary pressures
Biventricular failure (both ventricles are dilated, have poor filling/emptying capacity)
Compensatory Mechanisms
Goal: *try to maintain adequate CO*
Dilation: enlarged chambers o Occurs when
LV pressure is elevated
o Initially, a compensation but becomes inadequate and CO decreases
Hypertrophy: increased muscle mass and wall thickness d/t overwork + strain (chronic HF)
o Leads to poor contractility, higher o2 demand, poor coronary artery circulation o
Risk for ventricular dysrhythmias
SNS Activation: release epinephrine and norepinephrine
RAAS vasoconstriction, Na, H2O retention
ADH release: Na + H2o retention
Endothelin: arterial vasoconstriction + increases contractility + hypertrophy
Counterregulatory Processes Natriuretic
peptides:
1. Atrial Natriuretic Peptide (ANP)
2. B-type Natriuretic Peptide (BNP) o Released in response to an increase in atrial volume
and ventricular pressure o Biomarker is released when there is excessive pressure in
ventricle d/t HF o BNP: < 100 is normal, 100-300 present, >300 mild, >600 moderate,
Downloaded by Beavan Chomba ()
