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CHF and Super Heroes John Jameson, Pharm.D.

CHF and Super Heroes John Jameson, Pharm.D. Circulation Review. Afterload Pressure the heart has to pump against. Preload Pressure filling the left ventricle. High pressure. Low pressure. Heart Failure The heart cannot pump enough blood to meet the need.

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CHF and Super Heroes John Jameson, Pharm.D.

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  1. CHF and Super Heroes John Jameson, Pharm.D.

  2. Circulation Review

  3. Afterload Pressure the heart has to pump against Preload Pressure filling the left ventricle High pressure Low pressure

  4. Heart Failure • The heart cannot pump enough blood to meet the need. • This is not the same as a heart attack • This is not the same as coronary artery disease • Those things are just one of many causes of heart failure

  5. Systolic vs Diastolic Heart Failure Systole: When the heart is pumping Corresponds to Systolic blood pressure 160ml 140 / 90 Systolic Heart Failure is failure of the heart to Pump Pump

  6. Systolic vs Diastolic Heart Failure Diastole: When the heart is relaxing / filling Corresponds to Diastolic blood pressure 160ml 140 / 90 Diastolic Heart Failure is failure of the heart to Relax Relax

  7. Systolic vs. Diastolic Dysfunction (round 2)

  8. NormalHeart Normal MuscleThickness Normal Amount of blood at the end of diastole

  9. Ejection Fraction 55 -65% EF 70/120 Normal Heart Normal amount ejected Normal Cardiac Output (around 5 L/min)

  10. Systolic Dysfunction Thin Heart Muscle Much larger amount at the end of diastole in Systolic Dysfunction Normal Amount of blood at the end of diastole

  11. Big, floppy heart , more than 50% of the chest cavity

  12. Systolic Dysfunction

  13. Ejection Fraction 25 % EF 70/120 58 % SystolicDysfunction Small amount ejected Reduced Cardiac Output

  14. DiastolicDysfunction Thickened (hypertrophied)Heart Muscle Normal Amount of blood at the end of diastole Smaller amount at the end of diastole in Diastolic Dysfunction

  15. DiastolicDysfunction Normal CardiacSilhoutte

  16. DiastolicDysfunction

  17. EF 70% EF 70/120 58 % DiastolicDysfunction Small amount ejected Similar Cardiac Output to Systolic Dysfunction

  18. OUTLINE DIPIRO USE DIPIRO SLIDES Other Neuroendocrine mediators • Arginine Vasopressin (ADH) • Stimulated by extreme low kidney perfusion, just like Aldosterone. Causes free water retention and hyponatremia

  19. Tolvaptan, (V2 antagonist), Conivaptan (V1a and V2 antagonist)

  20. Other Neuroendocrine mediators • EndothelinOne of the absolute most potent vasoconstrictors. Endothelin antagonists in the works • Atrial and B-type Natriuretic peptideStimulated by stretch of the atria and the ventricles and cause sodium and water excretion. Sort like a counter-regulatory hormone to aldosterone

  21. CHF: Compensation Cardiac Output Cardiac Output (Compensated) Kidney Perfusion SNS Preload Renin Angiotensin Aldosterone Na+ & H2O retention

  22. CHF: Compensation Cardiac Output

  23. CHF: Compensation Cardiac Output Kidney Perfusion

  24. CHF: Compensation Cardiac Output Kidney Perfusion Renin Angiotensin Aldosterone

  25. Na+andH2O retention CHF: Compensation Cardiac Output Kidney Perfusion Renin Angiotensin Aldosterone

  26. Na+andH2O retention CHF: Compensation Cardiac Output Kidney Perfusion Preload Renin Angiotensin Aldosterone

  27. Na+andH2O retention CHF: Compensation Cardiac Output Cardiac Output (Compensated) Kidney Perfusion Preload Renin Angiotensin Aldosterone

  28. CHF: Compensation Cardiac Output Cardiac Output (Compensated) Kidney Perfusion Preload Renin Angiotensin Aldosterone Na+and H2O retention

  29. CHF: Compensation Cardiac Output Cardiac Output (Compensated) Kidney Perfusion SNS Preload Renin Angiotensin Aldosterone Na+ andH2O retention

  30. WHY? CHF: Cardiac Output

  31. WHY? CHF: Cardiac Output Systolic Dilated Cardiomyopathy CAD HTN

  32. WHY? CHF Cardiac Output Systolic Dilated Cardiomyopathy CAD HTN Diastolic Hypertension CAD Hypertrophic Cardiomyopathy

  33. CHF: The Viscious Cycle Cardiac Output Kidney Perfusion Renin Angiotensin Aldosterone

  34. CHF: The Viscious Cycle Cardiac Output Kidney Perfusion Vasoconstriction SNS Renin Angiotensin Aldosterone

  35. CHF: The Viscious Cycle CardiacOutput Afterload Kidney Perfusion Vasoconstriction SNS Renin Angiotensin Aldosterone

  36. CHF: The Viscious Cycle Cardiac Output Kidney Perfusion Renin Angiotensin Aldosterone

  37. Na+andH2O retention CHF: The Vicious Cycle Cardiac Output Kidney Perfusion Renin Angiotensin Aldosterone

  38. Na+andH2O retention CHF: Vicious Cycle Cardiac Output Kidney Perfusion Preloadand Pulmonary Edema Renin Angiotensin Aldosterone

  39. Na+andH2O retention CHF: Vicious Cycle Cardiac Output Strain Kidney Perfusion However Preloadand Pulmonary Edema Improved Renin Angiotensin Aldosterone

  40. Na+andH2O retention CHF: Symptoms Cardiac Output Strain Low Perfusion Fluid Overload Kidney Perfusion Preloadand Pulmonary Edema Renin Angiotensin Aldosterone

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