Heart Failure

Seminari 1 – Fallida Cardíaca

• A 70-year-old man is hospitalized with respiratory failure, severe fatigue, abdominal distention, and ankle swelling.
• The patient is also experiencing angina and progressive respiratory insufficiency.
• The physical examination reveals cyanosis, distended neck veins, rapid breathing (20/min), crackling sounds in the lungs, mild tachycardia (110 beats/min), and a diastolic gallop rhythm.
• Measurement shows an enlarged liver, excess fluid in the abdomen, and edema in the ankles and shins.
• The patient's blood pressure is 115/80 (normal is 120/80).
• A chest X-ray shows an enlarged heart and diffuse density at the base of the lungs, indicating fluid.
• The ECG shows a normal sinus rhythm, Q waves, and left axis deviation
• Treatment includes bed rest, digitalis administration, and a diuretic.
• Distended neck veins and liver enlargement indicate increased venous return.
• The mechanism involves venous blood from the liver not being able to exit due to a blockage of the vessel, thus returning to the liver and causing it to swell.
• This increases pressure in the portal vein, leading to the dilation of esophageal veins to decrease pressure.
• This problem can result in heart failure, with residual volume exceeding systolic volume, indicating an inability to expel blood effectively.
• Because the anomaly affects the liver, the problem locates in the heart.
• The efficiency of the heart is impaired due to the dilation caused by blood accumulation (residual volume), which results in the heart being unable to pump all the blood, and ejecction will be less than normal.
• The slight tachycardia shows the effort the heart is doing, a secondary compensation.
• Efficiency decreases because venous return accumulates.
• Cannot confirm if efficiency decreases causes alteration of the heart frequency.
• There is a decrease in ejection fraction and an increase in residual volume due to heart failure.
• Length of fibres increases and the heart is dilated.
• Due to a smaller ejection fraction, kidneys interpret a lack of blood volume, triggering renin release, activating angiotensin and aldosterone which promotes water accumulation to compensate and increase blood volume.

Noradrenaline and Phlebotomy

• Norepinephrine could be useful as it causes excitability, contraction, and increased heart rate (sympathetic nervous system activation).
• However, it would increase peripheral resistance due to vasoconstriction.
• Norepinephrine constricts vascular smooth muscle, closing arteries and making it harder for the heart to pump.
• Phlebotomy would decrease hematocrit while relieving venous return (volemia).
• Reducing venous return would not solve the patient's problem because contraction issues would not get solved with a blood transfusion.

Gallop Rythm and Cardiac Contractility

• Diastolic gallop rhythm is characterized by hearing R3 and R4, generally accompanied by tachycardia and heart failure
• Galop is due to the heart being dilated by excess residual blood, which causes turbulence and reflux as blood enters the ventricle, producing an extra sound
• Usual heart sounds are due to the closure of the heart valves
• The patient's condition causes a distended heart
• Cardiac muscle fibers increase in length beyond optimal, reducing cardiac contractilit
• More residual volume results in less contractility

Dilation vs Hypertrophy

• Dilation is the accumulation of blood, distension of the fibers.
• Hypertrophy is the overexertion of the muscle.
• Hypertrophy requires more metabolic energy.
• Coronary arteries cannot meet the demand.
• Causes unrelated to exercise include arterial hypertension (more narrow arteries to pump to), stenosis (narrower vents).

Peripheral Resistance

• Blood pressure determines cardiac output and peripheral resistance.
• The patient maintained normal blood pressure and the heart rate was diminished, so peripheral resistance increases.
• The body has baroreceptors that detect low blood flow and compensate by decreasing the diameter of the vessels.
• Blood pressure can be increased in a physiologically through exercise.
• Pressure equals cardiac output multiplied by peripheral resistance.

Heart Rhythm

• The heart rhythm gets discretely high due to the need of more beats per minute to compensate the diminishes cardiac output.
• This is determines by baroreceptors.

Blood Volume

• Blood volume increase improves the patient has it decreases overload
• Distention is caused by the elevated blood volume.

Dilated Heart

• Increased heart rate is due to the amount of blood remaining after hear beat that it can't ejecct.

Respiratory Problems

• Problems are related to liquid acummulation at the lungs.
• As the heart can't pump effectively, blood accumulates, increasing the pressure.
• Blood vessels push air (alveoli) out, increasing stress and lower interchanging gas to the lungs.

Edema

• Swelling is caused by a alteration fo ther venus return
• Hydostatic (increased volume) pressure increases agains the walls

Water Displacement

• Water Displacement depends on osmotic pressure.
• This is caused because the hydostatic pressure tends to get ride of liquids.

Fhysiological Condition

• Fetus taking up lot a space to an edema
• Water pressure goes out.

Presions

• Hydostatic it the water pressure that is the liquid
• Osmotic detemrines how much osmolites and water inside.

Diuretics and Dieting

• Block sodium channels to eliminat fluid.
• The help to resolve cardiac problems.

Diúretics

• It is a the act of doing phelebotomi
• Ión transport sistems.

Dietary Restrictions

• Redicin sodium for less liquids
• Eating a lot will not recharge the liver to much.

Conclusion

• Inssuficeince caused by previous hearth problems
• Angina is the temporary stop
• Miocites die

SEMINARI 2

Arteriosclerosis Case

• FC, pumping, cardiac expenditure, and resistance are equal.
• The difference is arterial distensibility
• Father = 0.3; Son = 3
• Father arterial distensibility is lower than the son's
• Decrease on arterial distensibility is related to the volume in minutes/ resistence perifical function.
• Arterial minute refers to the pressure that travels towards the peripheral.

Differences

• It depeds on the peripheral resistence
• What happens in the aorta.
• No depend what happens in the aorta

Solu

• Pa=Q2Rt=4.820=92

Concepts

• Sistolic and distolic persion relation relation.
• Low father.
• The arterior pressure high
• The pressio low
• Because it does not have almost pressure.
• With the normal flexibility

Fhater

• Incompatible if the heart valves close so hard, they'll have an impact.
• The arteries will start disntesining
• Not have constant the flux of blood

Heart Failure

• Pressure in which blood exits the arterior.

Aortas

• Aortas that had dilation.

Elasticity

• Arteris loose distentiblily
• The impact affects the atora.
• To de resistance more work

Systolic

• Dilation of the artial makes this more difficult

Presion artial mital PAM

• The aterile proptionals to the voliment
• Resitence of ateriles

Volume and Sistemic

Volume and sistemic affects arterial pression

HIPERENSION

• High is high
• Low lowers for more easy

Volume

• Aumeting can mean vasodilatrion
• Desminicution by constrictiong

Pression

• High pressure
• Muscle problems
• The most part have hugh pression becaus of arterials

CAS 2

Aerial Persions

• Perical is already too elevated

Ventroicle

• Ventroicle is contracted
• Hemodilaic is low

Pression

• Equal pd ps and pas are the resposible for the hemodialicos.
• Hih is gic rt
• Provoking increse in the arterial
• Pression for perfusion and is constance.

Vessel

• Vasocotsrictrion elavted diameter
• Pressio have augment.
• Aumentar is the result of augment and ps pd.

VScricty

• Less of the blood have.
• More to go.

Normal Dilation

• How to expalgin why pulsio arterial is different.
• Pressio de polaridad y su relación con esta presión.

Pulse

• The polaridy is amplitud

Ventricle

• Ventriele presuare has great pressure

Arterial

• Arterial modified some.

Friction

• Frication of blod to walls of vessels blood

PULSAIT

• pulait the pressio goes out transmeseted

SEMINARIO 3

COPD

• Patient with chronic obstructive pneumopathy
• Has always dismea feeling
• when the patient is expiring is as he breaths better

Tests for the Patient

• FEV 65% ref
• VEMS 42%ref
• FVC 64 ref
• TLC 6 %
• RV 150%

Questions

• FEV1/FVC indicates of that has the patione.
• the normal is 7, and it the number is smallet meand is obstructing but to get to.
• This obstruction of vias means probelms gettinf water.
• Hipeer instificaiton means the TLC water, the patione have a 106 that is ok

Atrapamiento

• atrapamiento
• He hase atrapamiento
• The diafragma

Musculos

• Musculos contraring
• This means lungs more space muscles are flat.

Air Flujo

• Pir pems stait
• Suport dinan

Trans diafragma

• Relaja la presion
• Genera dial diafragma

Presion

• Cajas son grandes
• Difia complentar pacion

Resitence

• Mas por resistnt
• Es con bronquios grsndes.

Estantica Complaci

• Volumer en pulmón
• Parnequin

Resisntence

• Menos que la de un lifudo normal

Enerfy

• The positing for tenerife

Morir el Pations

• Pressing the end is mas alto.

###Seminaro Cuatrp

Enfermedas

• Epopf Fuerte re friado
• En sangre se pueden observar pas y pas.

Oigenacion

• En sangre emporas y auno se ahiga

Pasivos

• En sangre hipotesima
• Es más de 6 emos insful
• Pero es que se es más de el co

Desacrilizar

• El riñon esta y puede llegar.

Pulmón enfermedad Hipotesmia

• Excesive a la alboler

Dispersiones

• La infucion es de 70

Relaciones

• Infecciones
• El empujante con bajase afectan

Cuando da alboler

• Capilares zona al contraió se da en restos

Hiposix

• Hipotesi para para la intercamsin alboleros y lugares lejanos

Suce de En pulmones

• Aumentan a causa vasos
• No esta en el circuito normal no elevara.

Presion Pulomares

• Producirá menor circuito.

Catere para auricular

• Pulmonares bien en auricular.

Oxigenacion

• Malo y tiene difusión es lenta.

Hematies

• Lo mismo es velocidad.

Saturaccino de Homoglobnina

• Sano2 saturaciones moleculas

Causado Curva Cambio

• El aumento de la tensión desciende desciende a al sangre.
• Otro facut menos impotant de la sangre B PG
• A sacas esto es 20 de 10.

Seminario 5

Ulcera

Gastrica

• un caso de un agogato de 30 años que se le puso mala y tovo que inegrir con carbon calcius, estrategias de estrese.

Al sitema repiratorio provuco anemia

• Que produca una reancios de tabaquio.

El medico noto algo extrabajido

• Un impulso al pasiente de a la corazon

Si cambia de color sigunifical la hemoglobina

• El es mas negro

Si la vemos es la lectura procsisa

• vegetals rabajidos

El homatacriti pasante

• El hematoto desinte de lo normal En si tenesemos una v de tot

Pero de por ezo tan poquitos bajo

• Pero si es con un baja ezo en homologia.

Para poner

• Para hacer u diagnostico con valor corporal.
• Volument celulat celulat.

Hacemos la pruebs

• Deducimos un anemia
• La prueba de de una anormalidad de una enfermedad.
• Como se a comentado anteritmente

Los eritici

• Tienen una forma que libera el otigino muy fucul.

Este mecanismo

• El el objetivo para la la distrbuicion de la sangre a a todos.

Anemia

• Una gastrostomia un confirmo.
• Las cusa desangre en e tracto de digestion superior.
• Causa las hemoratias.
• Es contriaria bacteias de eizacion pepitca.
• Acausia la inficion.

Como debamos tratar

• Los tibicos deben combateir a la bacertias.
• Lo administar con hierro.

Hierros

• Debe simtiteizsar homaglonias.

Puerde sr en forsas

• Averiqua con erodox

El fersso es poco soluble

• Oxida que tiene un PH poco acido

Perio disfilcultad par hacer

Se ingeire en zumdo

• Inpide que peros.

Sinen en ometraposaol

• Existeb un aung de anemia megalobastic

Averiqua

• Que el acido acilidrico es su valor celular.
• las celulat oxiaticas produmen y el factor de absorción de bitamin 12.

Si no functiionan

• La capacids de transporter es bataj.

La celuica oiticast

• El omenosazpol inibie la bomba a los actirios

Seminario 6

Caso 1

Tras 5 de años

• De parralida el hombrw a padicido por terrible color un podologo recomendo beber más agua y recita antiulicosurilco

La hipericemia es un ecc de los aciso de la a las sangre

• Para mantener las sangre en lo escretado.

ADN y RNA

• al metalisaron acisd unicos y con la sangre no l pueden eliminar el adicido muy fuertre

Ademes y la reabsoricon

• Diate con ecceso con un poco de todo lo mismo
• Probleams funcions

Alcol

Produce el excreto acito en tu tubulin

Antiinflamatorio

• Antiinflamatorios ayudan a calmar el dolor y ayudar al paciente

Teraptica uricosico

• En al a exrexcion del al urinano

###Porque beber

• Al alumenta r la medicio se forma urico se fomara nefritis

Y en el tuulo distal

• Pero a el

PICO

• Causa produccion o aumento

A cido rico

• Prmatas y huamno

Antioxidante

• Actura en el alaramiento de la irtes y presion.

Semianrio 2

Edad de 35 años

• Con adenoma supreas y una hiper secreción es razonar.

En las glalndulas suprae a hipersecrecion se frena u aumenta lo el agua

• En el tuulo distrito y colector

Crecimiendo bombo pasito

• Sodisio canisles . y todo ele sodio
• A aumenta la osmilaridades

Aumwnto las prestioenes atrile.

• Bajar la prestiona desmuinuir la dietero

De la sangre

• Aumt a la absorcion lo colector mas absorver mas.
• Aumenio circulante se alfectra* ###Filtrcion
• Aumenta la prestiona glondunrld

Todos tenen el obhetivo de sacar agua de la sangre

SEMINARIO 7

ACRM

• Varons de 48 con impotencia