where inflammation from an infection accidentally activates immune cells that attack pancreatic β-cells.

Factors affecting HR (3)

• autonomic innervation
• hormones
• age

Factors affecting SV (4)

• heart size
• contractility (force, duration)
• preload (end diastolic volume)
• afterload (vascular resistance)

Why athletes generally have lower heart rate

what is Preload

(stretch, filling)

• volume of blood in ventricles at end of diastole (EDP)

what is Afterload

(vascular resistance)

• Left ventricle must overcome resistance to circulate blood

when does preload increase

- hypervolemia
- regurgitation of cardiac valves
- heart failure

when does after load increase?

↑afterload = ↑cardiac workload

• afterload increases in
  - hypertension
  - vasoconstriction

what are factors that affect Contractility

what factors affect Preload

what is Ejection fraction?

The fraction of blood ejected from ventricle in each heart beat (contraction)

• EF= SV/EDV = (~70 ml) / (~140 ml) = (~ 50%)

what does stroke volume depend on

1. preload

2. after load

3. Contractility

If preload increases and afterload decreases this will increase stroke volume. If contractility increases will increase stroke volume

• higher stroke volume means higher cardiac output

what happens to the heart in congestive heart failure (CHF)

• fails to pump the blood efficiently
• not able to maintain normal blood flow to organs
• unable to provide adequate perfusion to meet
metabolic needs of peripheral tissues

what are two major types of heart failure?

1. systolic failure

2. Diastolic failure

what is systolic failure?

The heart loses its ability to contract or pump blood
into the circulation

• It cannot eject enough blood during systole.

• More blood remains in the ventricle after each contraction.

what is Diastolic failure

The heart loses its ability to relax because it becomes
stiff and cannot fill properly between each beat.

• Less blood can enter the ventricle at normal filling pressures.

• Ejection fraction may remain normal despite impaired filling.

CHF is divided into 2 categories based on changes in what?

Ejection fraction

• - heart failure with preserved EF (≥50%)
  - heart failure with reduced EF (≤40%

Common causes of Congenital heart failure (7)

• heart attack (myocardial infarction)
• coronary heart disease
• hypertension
• congenital heart defects
• heart valve defects (mitral, aortic)
• cardiac myopathy (heart muscle disease)
• lung disease

Four major compensatory mechanisms in CHF to help maintian bp

1. Elevated heart rate (activation of SNS

2. Elevated preload

3. Ventricular hypertrophy (enlarged heart

4. Vasoconstriction (endothelin, RAAS, SNS

what are pros and cons of Elevated heart rate (activation of SNS

- Pros: helps maintain cardiac output
- Cons:↓filling time, ↑O 2 demand, ↑risk of arrhythmia

pros and cons of Elevated preload

- Pros: ↑stroke volume; ↑cardiac output
- Cons: pulmonary/peripheral edema, ↑O2 demand

whats the method used to elevate preload?

↑renin/angiotensin/aldosterone system → Na+ and water
retention

pros and cons of Ventricular hypertrophy

- Pros: helps to maintain cardiac output
- Cons: ↑risk of ischemia, arrhythmias, fibrosis

pros and cons of Vasoconstriction (endothelin, RAAS, SNS)

- Pros: maintains BP, recruit blood to heart and brain
- Cons: ↑afterload (resistance) → ↓stroke volume

functions of NE, RAAS, ALdosterone, Anti diuretic hormone, Natriuretic peptides

Signs and symptoms of CHF

Symptoms depends on the type of heart failure (left-sided
or right-sided) as a side note

• Fluid retention and edema (peripheral/pulmonary

• Shortness of breath (dyspnea, orthopnea, cough)

• Fatigue (especially with activity)

• Cyanosis (insufficient oxygen in blood)

• Confusion (if blood flow to brain is reduced

what does fluid retention and edema cause (4)

– weight gain (mainly due to edema)
– pitting edema (squishy feet/ankles)
– elevated JVP (jugular venous pressure)
– crackling sounds in lungs (on auscultation)

what are two types of heart failure and why they happen

1. left sided heart failure - left side of heart (mainly left ventricle) fails; blood back up in lungs

2. Right sided heart failure - - also called “Cor Pulmonale”
   - right side of heart fails; blood back up in abdominal organs and peripheral tissues

Symptoms of left-sided CHF

Symptom	Simple explanation
Exertional dyspnea	Shortness of breath during exercise
Orthopnea	Difficulty breathing when lying flat
Paroxysmal nocturnal dyspnea (PND)	Suddenly waking up at night struggling to breathe
Crackles	Abnormal lung sounds caused by fluid in the lungs
Tachypnea	Increased breathing rate
Tachycardia	Increased heart rate
Fatigue	Reduced blood delivery to tissues
Cyanosis	Bluish discoloration due to inadequate blood oxygenation

how do diagnose CHF by looking at Physical assessment?

1. Assessment of JVP

2. Presence of ascites

3. Peripheral edema (pitting edema

what is Jugular venous pressure (JVP)

JVP is an estimate of pressure in the right atrium, assessed using the jugular veins in the neck.

• Normal: Generally no more than about 3–4 cm above the sternal angle, depending on measurement technique.

• Elevated JVP: Suggests increased right atrial pressure and possible systemic congestion.

In simple terms, if pressure is backing up into the veins, the jugular veins may become more distended.

what are Ascites

Ascites = Abnormal fluid accumulation in the peritoneal cavity (abdomen).

In right-sided heart failure, systemic venous pressure increases, promoting fluid accumulation in the abdomen.

what is peripheral edema

Peripheral edema = Fluid accumulation in peripheral tissues, especially the legs, ankles, and feet.

Your slide mentions pitting edema.

This means that when pressure is applied to the swollen skin, a temporary indentation remains.

LS CHF symp vs RS CHF symp

what imaging techniques can you use to diagnose CHF

1. Chest X-ray (CXR)

2. Echocardiogram (ECHO)

what do you evaluate in Chest X-ray (CXR)

• Heart size: Determine whether the heart is enlarged (cardiomegaly).

• Pulmonary edema: Detect fluid accumulation in the lungs due to heart failure.

cardio-thoracic ratio >50% indicates enlarged hea r

what is Echocardiogram (ECHO):

• ultrasound waves used to image heart
• detect heart structural & functional abnormalities
• assess left ventricular EF (normal = 55-70% ; HF = <40%)

Strategies used to improve CHF

1. control diet - less sodium and restrict fluids to 2L/day

2. Modify lifestyle - stop smoking, lose weight if obese, exercise only after symptoms are controlled

what is Thrombosis

Formation of blood clot comprised of
platelets, fibrin, & entrapped RBCs in
the vascular system which is attached
to vascular endothelium

what is Embolism

A small portion of the clot breaks off, travels, and becomes trapped in a small vessel, causing occlusion leading to ischemia and infarction

what is the Virchow’s Triad?

Three factors that promote venous thrombosis

1. Venous Stasis - abnormality of blood flow

2. Hypercoagulability - abnormality in clotting
   component

3. Endothelial Injury

what is Thrombosis in heart called

Thrombus on the wall of a heart chamber (ventricle or atria) is called mural thrombus

Thrombosis of Arterial system. Common locations include?

• cerebral
• coronary
• mesenteric
• renal arteries

thrombosis Venous system. Common locations include

• large deep veins of pelvis & lower extremities
• is referred to as deep venous thrombosis (DVT)
• may result in pulmonary embolism

how does Arterial thrombosis happen

It usually results from endothelial injury & platelet activation
(main cause: atherosclerosis)

Complications of arterial thrombosis

- vessel occlusion
- ischemic injury
- organ infarction (myocardial infarction,
cerebrovascular accident

how does Pulmonary embolism occur

1. Blood clot (or fat, air, tumor) forms in a vein and breaks free from vessel wall

2. Embolus travels through the bloodstream to the hear

3. Embolus travels through the heart & blocks blood vessels in the lung

Clinical features of Deep vein thrombosis

• pain
• edema
• diaphoresis
• erythema

clinical symptoms of Pulmonary embolism

• shortness of breath
• chest pain
• cough
• syncope
• hemoptysis

what is used to Diagnosis of deep vein thrombosis?

1. Ultrasonography

2. Duplex ultrasonography

what is used to Diagnos of pulmonary embolism

1. Ventilation-Perfusion Scan
   A) Ventilation scan: inhalation of radioactive compound
   B) Perfusion scan: injection of radioactive compound

Treatment of pulmonary embolism (5)

• anticoagulants
• vena cava filters
• thrombolysis
• embolectomy
• prevention strategies for high-risk patients

Consequences of impaired LV function