Increase in Electrical Charge

Accomplished through cellular ion exchange

Generates cardiac contraction

preload

afterload

contractility

volume of blood flowin through either the systemic or pulmonary circuit per minutes (L/min)

normal: 5L/min

"stretch"

Volume and associated pressure with end diastole in the ventricles (the blood remaining in the ventricle after atrial contraction)

"squeeze"

Left ventricular afterload is the resistance or impedance of the ejection of blood from the LV

Top number

cardiac work phase

Bottom number

Cardiac Rest phase

defined as the amount of pressure change to create teh feeling of a pulse

Difference between systolic and diastolic numbers

inner layer of the blood vessels

Smooth lining of the blood vessel

inadequate pumping or failure of the cardiact muscle to pump sufficient bloo to meet the body's metabolic needs.

decreased CO, increased Preload, increased Afterload

activation of the SNS

activation of the RAAS

ventricular hypertrophy (restructuring)

cardiac output falls

blood backs up to the pulmonary circulation

Causes:

• LV infarction
• HTN
• aortic and mitral valve stenosis

Manifestations

• pulmonary congestion
• dyspnea
• activity intolerance

blood backs up to the systemic circulation

causes:

• COPD
• left-sided HF
• pulmonic and tricuspid valve stenosis

manifestations:

• edema
• weight gain

• history and physical
• chest x-ray
• ABG's
• Echocardiogram
• Electrocardiogram
• BNP

• identify and manage underlying cause
• lifestyle modification
• ACE inhibitors
• Diuretics
• Beta-Adrenergic Blockers
• Calcium channel blockers
• Biventricular pacemakers
• intraaortic balloon pump
• heart transplant

fluid that accumulates in the pericardial cavity.

Can progress into life-threatening cardaic tamponade

chronic inflammation of the pericardium

the pericardium becomes thick and fibrous from the chronic inflammation and adheres to the heart

The pericardium becomes like a restrictive rubber band that has lost its elasticity

loss of elasticity

restricts cardiac filling --> decreasing CO and causing systemic congestion

• Pericardial Friction rub (grating sound heard when breath is held)
• Sharp, sudden, severe chest pain that increases with deep inspiration and decreases when sitting up and leaning forward
• Dyspnea
• Tachycardia
• Edema
• Fever/flulike symptoms

• CBC
• C-reactive protein
• EKG (Shows fluid)
• Chest X-ray (shows large volume)
• Echocardiogram
• MRI/CT
• Cardiac Catheterization

• Antibiotics
• NSAIDS
• Gluccocorticoid agents
• Analgesics
• Pericardiocentesis
• Pericardectomy (Chronic)

acute cardiac compression caused by excessive fluid accumulation in the pericardium. Complication of pericarditis

affects the pressure gradient of the heart

Life-threatening (may lead to heart failure/shock/death)

Paradoxical Pulse (Increase in systolic pressure. abnormal arterial pressure)

muffled heart sounds

narrowing pulse pressure (result of decrease SV and CO)

Labs

EKG

chest x-ray

echo

MRI/CT

catheterization

pericardiocentesis

pericardectomy

inflammatory process involving endothelial layer of the heart (includes valves and septal defects)

Commonly caused by Streptococcus and Staphylococcus infections

• IV drug use
• Valvular disorders
• Prosthetic Heart Valves
• rheumatic heart disease
• coarctation of the aorta
• congenital heart defects
• Marfan syndrome

• Fever/chills/Palor
• s/sx of HF
• emboli-systemic
• heart murmur
• petechiae
• splinter hemorrhages under the nails, osler's nodes (bumps on palms, tender) & janeway's lesions (Bumps, non tender)

• Blood cultures (definitive-- 4-6 sets with 2 positive cultures)
• Labs: CBC, UA, serum rheumatoid factor, ESR
• Electrocardiogram-- sees vegetative areas of the heart
• Echocardiogram and TEE (will show vegetations/abscesses)

• IV antibiotics
• anticoagulants
• antiarrhymthmics, diuretics, vasodilators, as dictated by complications
• Surgery

Inflammation of the myocardium

an infiltration of myocardial cells by various forms of bacteria/viruses which cause damage and inflammation

organisms, blood cells, toxins, and immune substances invade and damage the muscle

rheumatic fever

mono

polio/mumps

typhoid

radiation

lead

medications

chronic use of cocaine

HF

cardiomyopathy

dysrhythmias

thrombus formation

Flulike symptoms

dyspnea

dysrhythmias

palpitations

tachycardia

heart murmurs

chest discomfort

cardiac enlargement

Antipyretics

Anticoagulants

Antidysrhythmics

Immuno suppressive agents

narrowing (obstructed flow)

less blood can flow through the valve

causes decreased cardiac output, increased cardiac workload and hyptertrophy

insufficient closure

blood flows in both directions through the valve

causes decreased cardiac output, increased cardiac workload, hypertrophy, and dilation

conditions that weaken and enlarge the myocardium

Dilated, Hypertrophic, and Restrictive Cardiomyopathy

• Characterized by gross dilation of all 4 chambers of the heart, interference with systolic function (impaired systolic function) and damage to myofibrils
• Risk is higher with aging and African American Men
• most common type
• Cardiomegaly and ventricular dilation damages myocardium muscle fibers, resulting in decreased cardiac output and blood stagnation

• chemotherapy
• alcoholism
• cocaine abuse
• pregnancy
• infections
• thryotoxicosis
• DM
• neuromuscular diseases
• HTN
• CAD
• hypersensitivity to medications
• ischemia

S/Sx of HF

dyspnea & fatigue

nonproductive cough

orthopnea and PND

dysrhythmias/angina

tachycardia/murmurs

cool, pale extremities/poor cap refill

ascites, hepatomegaly & jugular vein distension

• angiotensin converting enzyme inhibitor & diuretics
• digoxin & beta adrenergic blockers
• antidysrhythmics
• implantable cardiac defibrillator cardioversion
• pacemaker/valvular repair & heart transplant

beta-adrenergic blockers

calcium channel blockers

surgical removal of excess myocardium

Considerations: Strenuous activity is prohibited

Abnormal diastolic filling occurs as a result of infiltration of the endocardium or myocardium with fibro-elastic tissue

common in South and Central America, India, Asia, and Africa

Amyloidosis

hemochromatosis

radiation exposure to the chest

connective tissue diseases

myocardial infarction

sarcoidosis

cardiac neoplasms

many cases are asymptomatic

when present, symptoms include:

fatigue/dyspnea/orthopnea

weakness/activity intolerance

angina/murmurs

hepatomegaly/jugular vein distention/ascites

peripheral cyanosis & pallor