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Common Congenital Heart Lesions - page 87 / 126

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  • Over time, ventricular function declines, causing chamber to dilate out of proportion with wall thickness. Increased wall stressÆ decompensationÆ downward spiralÆ heart failure

  • Decrease in ventricular function seen in heart failure is caused by myocyte loss and dysfunction. Loss of mycocytes results from to necrosis and apoptosis secondary to catecholamines, AII, cytokines, and mechanical strain. Myocyte dysfunction causes decreased Ca homeostasis and ATP utilization

Factors that cause compensated heart failure to decompensate: (Table 9.3)

A. B. C. D. E. F .

Increased metabolic demand: fever, hyperthyroid, tachycardia, pregnancy Increased Volume: injesting lots of salt and water, renal failure Increased Afterload: HTN, pulm embolism Decreased CTY: negative inotrophic meds, MI, Ethanol Slow heart rate Failure to take heart failure meds

Clinical Manifestations of Heart Disease

Left heart failure

Pathophysiology: impaired CO and elevated venous pressure due to failure of left ventricle. work of the breathing and can cause transudation of fluid into lungs.

Clinical Presentation:

  • 1.

    dyspnea (can occur even if congestion is absent)

  • 2.

    nocturia

  • 3.

    dulled mental status

  • 4.

    fatigue

  • 5.

    orthopnea (labored breathing while lying down that is relieved by sitting upright, measured by number of pillows person sleeps on at night)

  • 6.

    paroxysmal noctural dyspnea (severe breathlessness that awakens patients from sleep 2-3 hours after going to bed)

  • 7.

    noctural cough

  • 8.

    hemoptysis

Physical Findings: General:

  • 1.

    cachexia (frail, wasted appearance from appetite and metabolic demand)

  • 2.

    dusky appearance (CO)

  • 3.

    diaphoresis (Sympathetic drive)

  • 4.

    Cool extremities (vasoconstriction)

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