1)  Preload

2) Starling's Law

3)  Afterload

4)  Decreased contractility

5)  Increased venous return

P=t/r

Phase 4:  polarized state; resting membrane potential

Phase 0: depolarization

Phase 1: early repolarization

Phase 2:  plateau

Phase  3:  repolarization

polarized state: hyperkalemia; inside of cell is more negative; stimulus causes depolarization

Na⁺/K⁺ pump

depolarization; Na⁺ rushes into cell;

efflux of K⁺

early repolarization; decreased Na⁺ influx;

Cl^- passive influx; efflux of K⁺ increases

Plateau;  efflux of K⁺ decreases;

Ca⁺⁺ influx (contraction)

1)  increased blood volume in lungs

2) retention of renal fluid causes increased blood volume; which leads to:

3) enlarged pulmonary vessels

4) increased pulmonary BP

5) Fluid in interstitial spaces and alveoli

6) PULMONARY EDEMA

1) Dyspnea

2)  Orthopena

3)  Paroxysmal dyspnea (cardiac asthema)

4) Productive cough

1) increase blood volume in systemic circulation

2) systemic vessel enlargement

3) Increased systemic BP

4) Fluid leaves systemic capillaries

1)  Distention of jugular and systemic veins

2)  hepatomegaly

3)  splenomegaly

4)   ascites (K-9)

5)  Sub-Q edema (K-9)

1) pre-surg work-up

2)  R/O arrhythima heard on ascultation

3) identify chamber enlargement

4) information about electrolyte disturbances

5) evaluation of trauma patients

6) monitor progression of cardiac DZ

7) monitor surgical patients under anesthesia

1)  increase HR

2)  increase contractility

3)  vasoconstriction

THIS IS ONLY A TEMPORARY FIX; AS INCREASED HR WILL RESULT IN DECREASED PRE-LOAD

NYS Heart Association classes of HF:

Class I

1)  No clinical signs, but soft Grade I-II murmur is present

2)  minimal enlargment on X-Ray

3)  no meds needed

4)  decrease Na⁺ intake

NYS Heart Association Classes of HF

Class II 

1)  presence of Grade II-III systolic murmur

2)  no clinical signs

3)  left atrial enlargment

4)  put patient of vasodialator

5)  low sodium senior diet

NYS Heart Association Classes of HF

Class III

1)  Grade III-IV murmur

2)  cough at night or after exercise

3)  enlargement on X-ray

4)  prescribe vasodialator and diuretic

5)  low sodium senior diet

NYS Heart Failure Classifications

Class IV

1)  Loud Grade IV-VI murmur

2)  signs of heart DZ all day

3)  increased HR

4) moderate to severe signs on X-ray

5) vasodialator; diuretic; glycoside

6)  restricted Na⁺ diet

1) soft, localized murmur

2)  detected only after several minutes of ascultation

soft murmur heart immedately

NOT localized

1) moderately intense murmur

2)  readily detectable

3)  present in MORE than one location

1)  moderately intense and/or loud

2)  detected in several areas

3)  usually on BOTH sides of the chest

 loud murmur w/ precordial thrill over PMI

1)  VERY loud murmur w/ precordial thrill

2)  murmur is detected when stethescope is pulled slightly off the chest wall

1) increased chamber volume

2)  increased muscle mass

3)  caused by increased PRE-LOAD

1) increased chamber mass

2)  volume stays the same

3)  caused by increased AFTERLOAD