Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

36  Chapter 2 • Cardiovascular Care

Understanding Congestive Heart Failure

PICTURING PATHO

ANP is released by the atria in response to acute increased fluid volume and pressure.

Vascular resistance (afterload)

Frank–Starling mechanism

Cardiac contractility Heart rate

ANP

ANP

ANP

Cardiac output

Sympathetic reflexes

ANP

The atria and ventricles become enlarged in response to increased fluid volume.

ANP

Myocardial hypertrophy and remodeling

Renal blood flow

Vascular tone

Venous return (preload)

Renin– angiotensin- aldosterone mechanism

BNP

BNP

Angiotensin II

BNP

BNP

Aldosterone

BNP

BNP

Adrenal gland

BNP

Vascular volume

Sodium and water retention

BNP is released by the ventricles in response to prolonged fluid volume overload or elevated pressure .

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

Left ventricular failure

Congestion of peripheral tissues

Pulmonary congestion

Decreased cardiac output

Dependent edema and ascites

Activity intolerance and signs of decreased tissue perfusion

Liver congestion

Pulmonary edema

Impaired gas exchange

Signs related to impaired liver function

GI tract congestion

Orthopnea

Cyanosis and signs of hypoxia

Anorexia, GI distress, weight loss

Paroxysmal nocturnal dyspnea

Cough with frothy sputum

Manifestations of right and left ventricular failure. (Reprinted with permission from Porth C. Essentials of Pathophysiology . 4th ed. Philadelphia: Wolters Kluwer; 2015.)