Atlas of Pathos Chapter 6

• Radionuclide ventriculography reveals an ejection fraction less than 40%; in diastolic dysfunction, the ejection fraction may be normal. Treatment • Treatment of the underlying cause, if known • Angiotensin-converting enzyme inhibitors or ARBs (for patients with left ventricular dysfunction), specific beta-adrenergic blockers (for patients with left ventricular dysfunc- tion), diuretics, digoxin, nitrates, morphine, or oxygen • Dobutamine, milrinone, and nesiritide (for refractory HF) • Lifestyle modifications to reduce risk factors • Coronary artery bypass surgery (if caused by CAD), angio- plasty, or heart transplantation • Placement of prophylactic ICD (with or without Bivent pacing) for patients with low EF

C a r d i o v a s c u l a r D i s o r d e r s

TYPES OF HEART FAILURE

Right-sided heart failure Ineffective right ventricular contractility

Left-sided heart failure Ineffective left ventricular contractility

Failure of right ventricular pumping ability

Failure of left ventricular pumping ability

Decreased cardiac output to lungs

Decreased cardiac output to body

Blood backup into right atrium and peripheral circulation

Blood backup into left atrium and lungs

Weight gain, peripheral edema, engorgement of liver and other organs

Pulmonary congestion, dyspnea, activity intolerance

Pulmonary edema and right-sided heart failure

NORMAL CARDIAC CIRCULATION

Superior vena cava

Pulmonary arteries

Pulmonary arteries

Pulmonary veins

Pulmonary veins

Left atrium

Right atrium

Left ventricle

Right ventricle

Inferior vena cava

Chapter 6 • Cardiovascular Disorders  67