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Question 9

Question 9 . Differentiate: 1. High and Low Output failure right and left sided heart failure systolic from diastolic dysfunction. Output Failure. Low Output Failure . High Output Failure. Due to low systemic vascular resistance Metabolic disorders

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Question 9

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  1. Question 9 Differentiate:1. High and Low Output failureright and left sided heart failuresystolic from diastolic dysfunction

  2. Output Failure Low Output Failure High Output Failure Due to low systemic vascular resistance Metabolic disorders Thyrotoxicosis, Nutritional Disorders (Beri-beri) Excessive blood-flow requirements Anemia, Pregnancy, AV fistula • Due to high systemic vascular resistance • Coronary artery disease • MI, Ischemia • Chronic pressure overload • HPN, Obstructive Valvular Disease • Chronic volume overload • RegurgitantValvular Disease, L-R shunt, Extracardiac shunting • Non-ischemic dilated cardiomyopathy • Viral disease • Disorders of rate and rhythm • brady/ tachyarrhythmia Patient has Low Output Failure

  3. Symptoms based on Sided of Failure Right-Sided Left-Sided Aortic regurgitation (ventricle hemodynamically overloaded) Dyspnea, orthopnea, PND, (pulmonary congestion) • Edema (Feet and sacral area) • Nocturia • Ascites • Hepatomegaly • Jaundice, coagulopathy • Systemic venous distention

  4. Signs based on Side of Failure Right-Sided Left-Sided Tachypnea or increase WOB Rales or crackles Pulmonary edema Cyanosis Laterally displaced apex beat Gallop rhythm Heart murmurs (AS or MR) • Pitting edema • Ascites • Hepatomegaly • Increased JVP • Parasternal heave

  5. Dysfunction Systolic Diastolic Impaired relaxation (EF >50%) Elevated filling pressure/ volume overload: elevated JVP Increase in pulmonary capillary pressure : Dyspnea • Impaired contraction • Inadequate cardiac output: weakness, fatigue, reduced exercise tolerance

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