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Cardiac Failure – failure of the heart to pump enough blood to satisfy the needs of
the body
(2) Varying degrees of recovery of the heart itself over a period of weeks to months
PHYSIOLOGY2
Failure of the cardiac output (and arterial pressure) to rise to the critical level
required for normal renal function results in (1) progressive retention of more and
more fluid, which causes (2) progressive elevation of the mean systemic filling
pressure, and (3) progressive elevation of the right atrial pressure until finally the
heart is so overstretched or so edematous that it cannot pump even moderate
quantities of blood and, therefore, fails completely. Clinically, one detects this
serious condition of decompensation principally by the progressing edema,
especially edema of the lungs, which leads to bubbling rales in the lungs and to
dyspnea (air hunger). Lack of appropriate therapy when this state of events occurs
leads to rapid death.
Treatment:
Decompensation process can be stopped by:
1. Strengthening the heart (administration of cardiotonic drug such as digitalis –
strengthen the cardiac contraction by increasing the quantity of calcium ions
in muscle fibers)
In the failing heart muscle, the sarcoplasmic reticulum fails to
accumulate normal quantities of calcium and, therefore, cannot release
enough calcium ions into the free-fluid compartment of the muscle fibers to
cause full contraction of the muscle. One effect of digitalis is to depress the
calcium pump of the cell membrane of the cardiac muscle fibers. This pump
normally pumps calcium ions out of the muscle.
Three known causes of the reduced renal output of urine during cardiac
failure:
1. Decreased glomerular filtration
2. Activation of the renin-angiotensin system and increased reabsorption of
water and salt by the renal tubules.
3. Increased aldosterone secretion
Atrial natriueritc factor - is a hormone released by the atrial walls of the heart
when they become stretched
- help prevent extreme congestive symptoms during cardiac
failure
PHYSIOLOGY4
Thus, a vicious circle has been established. Once this vicious circle has
proceeded beyond a certain critical point, it will continue until death of the patient
unless heroic therapeutic measures are used within minutes.
Cardiac reserve - maximum percentage that the cardiac output can increase
above normal
Any factor that prevents the heart from pumping blood satisfactorily will decrease
the cardiac reserve. This can result from ischemic heart disease, primary myocardial
disease, vitamin deficiency that affects cardiac muscle, physical damage to the
myocardium, valvular heart disease, and many other factors.
Diagnosis of low cardiac reserve can be easily made by requiring the person to
exercise either on a treadmill or by walking up and down steps, either of which
requires greatly increased cardiac output. The increased load on the heart rapidly
uses up the small amount of reserve that is available and the cardiac output soon
fails to rise high enough to sustain the body’s new level of activity.