Predisposing Factors: Age: 42 years old Environment: Second-hand smoke 16%) Congenital disease: weak heart Hereditary: heart

disease- mother Stress Sex: Female

Precipitating Factors: - anemia ( hgb- 11% and hct- 33% - bacterial infection (lymphocytes-

Anemia and bacterial infection

WBC- 20,000 cumm Lymphocyte- 16%

Abnormally high oxygen demand by the body tissues

Myocardial dysfunction

Decrease cardiac output Decrease systemic blood pressure

Activation of baroreceptors in the aortic and carotid bodies

Stimulation of sympathetic nervous system

Release of catecholamines ( epinephrine and norepinephrine)

vasoconstriction and decrease tissue perfusion

O2 Sat94%

gastrointestinal tract

skin and muscle

genito-urinary tract

brain

-epigastric pain and loss of appetiteverbalized by the patient -Back pain with the scale of 7 0ut 0f 10 -SGOT- 45.6 IU/l

body malaise and fatigue - pale extremities

release of rennin

altered glomerular filtration

restless lethargic drowsy

formation of angiotensin I

(+) protein in urine

increase preload and afterload

conversion of angiotensin I to angiotensin II by ACE bipedal edema

stimulates release of aldosterone and ADH, thus, increase sodium and fluid retention

fluid volume overload increase workload of the heart PR- 133 bpm, irregular

increase pulmonary pressure

impaired left ventricular relaxation increase diastolic pressure exceeding hydrostatic & oncotic pressure increased capillary pressure in the lungs fluid shifts from the circulating blood to the interstitium, bronchi, bronchioles & alveoli

overdistended heart chambers

stimulates release of atrial natriutic peptides(ANP) decrease contractility of myocardial muscle fibers and increase in end-diastolic blood volume increase size of ventricle and workload of the heart ventricular hypertrophy

CXR- 7-22-11: minimal to moderate bilateral pleural effusion

pulmonary congestion decrease lung expansion

Tachypnea (33cpm), dyspnea wheezing productive cough

ventricular remodeling
note: if not immediately treated

congestive heart failure