Re: heart failure

[Frederic Martini <martini@xxxxxxxx>]

Title: Re: heart failure

Chronic stress and acute stress have different effects on the heart.  The crisis phase of the stress response increases the CO and cardiac workload, and if there's CAD this can result in angina.  Acute stress can also lead to arrhythmias by creating multiple ectopic pacemakers in the ventricles.  If there's coronary ischemia due to CAD, this can also lead to an MI.   An MI, which damages the myocardium, can lead to CHF. 

At the end of the resistance phase of the stress response, there are lots of other metabolic things happening - ketoacidosis, for example - compounded by depletion of myocardial energy reserves and breakdown of myofibrils.  The acidosis can lead to more excitable membranes, and elevated K levels don't help any. 

You might set up a series of nested flow charts, starting with one for acute stress and one for chronic stress, and then linking the two. 

Good luck and best wishes,

Ric

> Hi Ric,
>
>         Thanks a lot for the fig. 
> I do have the Appl. manual.  I think they (yours and others) are
> really useful but find that I don't have time to devote to exploring
> them and then exploiting them;  my problem, nothing the author
> could do differently!  I am looking for something different, but
> perhaps that indicates an error in my thinking.  What I started
> to sketch on my own included other conditions - ischemia, angina
> pectoris, and ventricular fibrillation, and more focused on what leads
> to each problem (e.g. starvation ---> V-fib).  Your fig. would
> be a good part 2 to that.  What began my thought process is a
> student asking me about people having "heart attacks" from
> being very stressed;  not sure if she really meant MI, or
> palpitations, or angina, or what.  So I wanted to find or make
> something showing starvation, stress, kidney failure, as well as
> cardiovascular disease, all funneling down to V-fib or MI or CHF, but
> also something showing the relationship between those last few
> events.  i.e., V-fib is not MI, MI is not CHF, but they are
> related.  I'll still be looking for awhile, I guess!  Or if
> someone with clinical experience can straighten me out, maybe I'd see
> that such a flow chart would be incorrect or misleading. 
> Sometimes, it's tough being a non-clinical type teaching this
> class.
>
>
> At 03:12 PM 1/23/2003 -1000, you wrote:
> > Hi Alice,
> > I'm not replying to the list for fear of being accused of advertising,
> > but please check out Figure A-40, attached, which is from p.106 of the
> > Applications Manual for the 6th edition of Fundamentals of A&P. 
> > It gives a basic overview that you can spin in several directions as
> > needed.
> > Let tell me if this is what you wanted.  It's a lot of work
> > putting it together, but I don't think many people even know the
> > Applications Manual exists, let alone that it can have useful stuff in
> > it.
> > Fond regards,
> > Ric
> Dr. Alice Mills
> Dept. of Biological Sciences
> University of Tennessee at Martin
> Martin, TN  38238
> (731) 587-7175
> (731) 587-7187 (fax)