Myocardial Dysfunction Cardiomyopathies (Acute MI, HPN, degenerative condition of the heart) Volume overload (Renal Failure) Excessive

ive work demands (hypermetabolic states; hyperthyroidism) Alcohol, cocaine abuse, Stress S/S: Decrease blood supply to the tissues and general hypoxia; fatigue and weakness

Dec. blood volume ejected from ventricles/Dec. Cardiac output Activation of the RASS

Body cannot respond to Inc. supply demands

Dec. Systemic BP Activation of receptors in aortic and carotid bodies Stimulation of vasomotor regulatory center in the medulla of the brain Vasoconstriction

S/S: Fatigue

Dec. activity tolerance

SNS Activation Inc. Catecholamine (epinephrine and norepinephrine) Inc. HR and Contractility S/S: tachycardia, palpitations, weak pulse

Inc. Aldostrerone

Na+ and H2O retention

Cytokines (TNF)

Inc. Fluid volume

Inc preload and Afterload

Inc Stress to ventricular wall

RV cannot effectively pump out blood from ventricle to aorta

Decrease contractility of myocardial fibers

Inc. RV end-diastolic volume and pressure Inc. Congestion in peripheral tissues Inc. Venous pressure

Inc. end-diastolic blood volume

Stretching of myocardial fibers

Ventricular dilation

Increase Hydrostatic pressure throughout venous system

Further stress on ventricular walls Further increased workload of heart

S/S: edema on lower extremities ( dependent edema), hepatomegaly, ascites, weight gain, anorexic and nausea,

Resistance to ventricular filling Inc. Ventricular filling pressure despite normal or reduced blood volume

Ventricular hypertrophy (Inc. thickness of heart muscle Ventricular remodeling (abnormal proliferation of myocardial cells

Inc Workload of the heart

Dec. LV: cannot effectively pump oit blood from ventricle to aorta

Over distended cardiac chambers

Release of ANP and BNP Inc. end-diastolic volume and pressure Inc pulmonary venous blood volume and pressure Force fluids from pulmonary capillaries into pulmonary tissues and alveoli Vasodilation and diuretics (not strong enough to overcome other neg. mechanisms

Pulmonary Edema

Impaired Gas exchange Dec. O2 inhaled

S/S: Dyspnea,cough, crackles, dec O2 sat, orthopnea, PND, fatigue,

Dec O2 in blood

Dec. ventricular blood volume

Large myocardial cells are dysfunctional and die early

Dec. tissue perfusion to tissues and organs

Dec Renal perfusion

Dec. GI Perfusion

Dec. Brain perfusion

Dec. blood perfusion pressure

Altered Digestion

S/S: dizziness, light headedness, confusion, restlessness, anxiety