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36
Chapter 2
•
Cardiovascular Care
PICTURING
PATHO
Vascular resistance
(afterload)
Cardiac contractility
Heart rate
Sympathetic
reflexes
Vascular
tone
Frank–Starling
mechanism
Myocardial
hypertrophy and
remodeling
Renal blood flow
Vascular volume
Sodium and
water retention
Angiotensin II
Renin–
angiotensin-
aldosterone
mechanism
Adrenal
gland
Venous return
(preload)
Aldosterone
Cardiac
output
Compensatory mechanisms in heart failure. The Frank–Starling
mechanism, sympathetic reflexes, renin-angiotensin-aldosterone
mechanism, and myocardial hypertrophy function in maintaining cardiac
output for the failing heart. (Reprinted with permission from Porth C.
Essentials of Pathophysiology
. 4th ed. Philadelphia: Wolters Kluwer; 2015.)
Right ventricular failure
Congestion of peripheral tissues
Liver congestion
Dependent
edema
and ascites
Signs related
to impaired liver
function
Anorexia, GI distress,
weight loss
Left ventricular failure
Pulmonary congestion
Decreased cardiac output
Activity
intolerance
and signs of
decreased
tissue
perfusion
Pulmonary
edema
Impaired gas
exchange
Cough with
frothy sputum
Orthopnea
Paroxysmal
nocturnal dyspnea
Cyanosis
and signs of
hypoxia
GI tract
congestion
Manifestations of right and left ventricular failure. (Reprinted with permission from Porth C.
Essentials of Pathophysiology
. 4th ed. Philadelphia: Wolters Kluwer; 2015.)
Understanding Congestive Heart Failure
ANP
ANP
ANP
ANP
ANP
BNP
BNP
BNP
BNP
BNP
BNP
BNP
ANP is released by the
atria in response to
acute increased fluid
volume and pressure.
BNP is released
by the ventricles
in response to
prolonged fluid
volume overload or
elevated pressure
.
The atria and
ventricles
become
enlarged in
response to
increased
fluid volume.