Page 583 - Cardiac Nursing

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C HAPTER 24 / Heart Failure and Cardiogenic Shock 559
Pressure load Volume load y ty Others
olume load
V
Myocardial dysfunction
(Compensatory mechanisms)
Myocardial failure
(Compensatory mechanisms)
Heart, pump failure
Diastolic dysfunction, Downregulation Systolic dysfunction, ↓CO reserve Fatigue, renal dysfunction,
failure of beta receptors failure confusion, anorexia
↑Peripheral ↑Peripheral ↑Vascular
vasoconstriction ↓Effective arterial resistance stiffness
blood volume
Increased ventricular
diastolic pressure ↑Sympathetic activity ↑Renin, angiotensin
↑Arginine vasopressin
↑Aldosterone
↑Peripheral ↑Pulmonary
capillary pressure capillary pressure
Renal vasoconstriction; ↑Atrial ↑b-type
redistribution of flow; Na , H O retention natriuretic natriuretic
+
↑filtration fraction 2 peptide peptide
Congestion
↑Plasma volume
Peripheral Pulmonary Atrial
distention
Ventricular
distention
Edema Dyspnea
■ Figure 24-2 Sequence of events in heart failure. An increased load or myocardial abnormality leads to
myocardial failure and eventually heart failure, resulting in increased sympathetic activity, increased activ-
ity of the renin–angiotensin–aldosterone system, pulmonary and peripheral congestion and edema, and de-
creased cardiac output reserve. Both the atrial natriuretic and b-type natriuretic plural–peptides are also re-
leased in response to increased plasma volume. (From Francis, G. S., Gassler, J. P., & Sonneblick, E. H.
[2001]. Pathophysiology and diagnosis of heart failure. In J. W. Hurst [Ed.], The heart [10th ed.]. New
York: McGraw-Hill.)
Evolution of Heart Failure
■ Figure 24-3 The evolution of HF along Risk Factors Cellular Venticular Venticular
AHA/ACC guidelines for the diagnosis and manage- Pathophysiology Remodeling Dysfunction
ment of HF clinical stages. (From Schocken, D. D.,
Benjamin, E. J., Fonarow, G. C. , et al. [2008]. Pre- Aging
vention of heart failure. A scientific statement from Hypertension Hypertrophy
the American Heart Association Councils on Epi- Smoking Infarction LVH Systolic
demiology and Prevention, Clinical Cardiology, Car- Dyslipidemia Accelerated Dilatation Diastolic
diovascular Nursing, and High Blood Pressure Diabetes apoptosis Both Both
Research; Quality of Care and Outcomes Research Obesity Fibrosis
Interdisciplinary Working Group; and Functional Toxins Symptomatic
Genomics and Translational Biology Interdisciplinary Genes Structural Heart Disease without Symptoms Heart Failure
Working Group. Circulation, CIRCULATIONAHA.
107.188965.)
Stage A Stage B Stages
AHA/ACC Stages of Heart Failure C and D