Chapter 22 Cardiac Failure

Acute Pulmonary Edema Increased Venous Return Insufficient Pumping Buildup of Blood in Lungs Increased Capillary Pressure Buildup of Fluid in Lungs Diminished O 2 Transport Peripheral Vasodilation

Treatment for Pulmonary Edema Tourniquets on arms and legs Tourniquets on arms and legs Bleeding the Patient Bleeding the Patient Diuretic (e.g. furosemide) Diuretic (e.g. furosemide) Pure O 2 to breathe Pure O 2 to breathe Cardiotonic drug (e.g. ouabain) to strengthen the heart Cardiotonic drug (e.g. ouabain) to strengthen the heart

Cardiac Reserve Maximum amount that the CO can increase. Maximum amount that the CO can increase. Generally %. Generally %. Can be % in athletes. Can be % in athletes. Can be zero for diseased heart. Can be zero for diseased heart.

Exercise Test Put on a treadmill Put on a treadmill Look for Look for Shortness of breath Shortness of breath Muscle fatigue Muscle fatigue Increased heart rate. Increased heart rate.

Graphical Analysis of Cardiac Output AV Fistula Normal Normal Venous Return

Heart Defects Patent Ductus Arteriosis (PDA) Patent Ductus Arteriosis (PDA) Tetralogy of Fallot Tetralogy of Fallot (Left to Right Shunt) (Left to Right Shunt) Blue Baby Blue Baby 4 abnormalities 4 abnormalities Aorta (partially) originates from RV Aorta (partially) originates from RV Stenosed Pulmonary artery Stenosed Pulmonary artery Blood from the RV passes through a septal hole Blood from the RV passes through a septal hole Right Ventricular Hypertrophy Right Ventricular Hypertrophy German Measels is a common cause of heart defects. German Measels is a common cause of heart defects.

Extracorporeal Circulation Methods: Methods: Bubbling O 2 through blood Bubbling O 2 through blood Dripping blood over a large surface Dripping blood over a large surface Passing blood over rotating discs Passing blood over rotating discs Passing blood through thin membranes or porous tubes Passing blood through thin membranes or porous tubes Problems: Hemolysis, Clotting, Bubbles, Emboli of antifoam agent, need for large quantities of blood, need for heparin (inteference with hemostasis). Problems: Hemolysis, Clotting, Bubbles, Emboli of antifoam agent, need for large quantities of blood, need for heparin (inteference with hemostasis).

Cardiac Hypertrophy Caused by Congenital and Valve Diseases Generally occurs with all defects Generally occurs with all defects Part of heart affected depends on type of defect Part of heart affected depends on type of defect Extreme hypertrophy can cause heart failure Extreme hypertrophy can cause heart failure Coronary vasculature does not increase Coronary vasculature does not increase Fibrosis often develops (especially subendocardial) Fibrosis often develops (especially subendocardial) Ischemia can cause anginal pain. Ischemia can cause anginal pain.