Friday, July 31, 2020
How Long Is An Essay? Guidelines For Different Types Of Essay
How Long Is An Essay? Guidelines For Different Types Of Essay Make sure you know their arguments reasonably well and have armed yourself with flexible quotes from their work. If you can, familiarise yourself with the people who think theyâre wrong and awful. Figure out if there are arguments which are unresolved and see if you can make a contribution towards resolving them. Next, think about what you need to prove in order to make that claim. What might be the immediate negative reaction of someone reading your central claim? This is the stuff that actually makes up your argument. If you perform poorly at this, you might as well pack up and go home. They might ask you to compare and contrast two different ideas, or say which of two theories is the more accurate. You donât want to get penalised because you didnât reference your readings properly after youâve put in all that effort to make sure that your arguments are founded in the literature. Select the most appropriate author for the paper. EssayPro is easy-to-use - with access to customer support who are here to answer any questions or concerns you may have. If youâre in any doubt, keep in mind that our service is legal and legitimate. We have learned to provide the ultimate consumer experience to students from the USA, Canada, Australia, the UK, and the UAE. EssayPro has a qualified writing team, providing consumers with ultimate experiences. As a result, customer satisfaction is at 93.66%, according to reviews. They might ask you to âcritically assessâ some claim or concept, or ask you a simple question which youâll have to answer in a complex way. Theyâll make a statement and tell you to discuss it. If Iâm reading it, I want to know within literally five seconds what youâre trying to convince me of. Ninety nine percent of the structure of your essay is exactly the same as you learned in secondary school. You might think youâre too good for Point, Evidence, Explain. How are you going to relate your argument to the existing literature? How can you defend yourself against that response? Ideally you want to be able to split your burdens of proof into a few different points. Start your intro with the central claim of your essay. This goes by price, rating, success rate, and more importantly, specialty. The ability to write any assignment type in any field. Our website is super convenient and easy to use! We work to make sure the experience of our clients is always positive. Think about the strongest possible response to the claim youâve put forward, then beat that. If youâre making a claim, you need to tell me why that claim is correct. Think of a potential response to your argument, perhaps from an author youâre arguing against. Write out that response, then tell me why it doesnât defeat your argument, or at least why it only mitigates it. You will save yourself literally days over the course of your university career. They allow you to reference as you write, and you can create and reformat your bibliography and citations at the touch of a button. Finally, make sure you formulate every claim in the strongest possible terms. Donât make your opponent look like they have no arguments, or take the weakest version of their argument.
Tuesday, June 2, 2020
Domination - The Power Shift from Women to Men Through Ancient Literature - Literature Essay Samples
Through history, civilizations and cities have typically put men in positions of authority, showing their dominance in society and giving them all the power. Ancient Sumeria was a refreshing sight in contrast to this. Evidence from literature and myths of the ancient Sumerians heavily support the idea that Sumeria was a matriarchal society. Women, instead of men, were the ruling sex. Ancient hymns praise Inannaââ¬âa goddess who ruled over all the humans, animals, and other gods in Sumeria. She can easily be seen as the ultimate god in Sumeria, the one who all look up to. Indeed, she may have helped the matriarchy in Sumeria, as women were revered as being higher than men, and were given more rights than they were. Much as the Ramayana serves as a prime example of what a relationship should be like for couples in India, Inanna could have served as a role model for women in Sumeria. However, as androcratic ideas began to blend into Sumerian society, the matriarchy was slowly overth rown, and ancient Sumeria became as patriarchic as the rest of the worldââ¬â¢s history. The fall of Inanna in literature showed the drastic shift from a female-dominated society to an androcratic one. The tale of Gilgamesh rose to popularity and remains more well-known than the hymns of Inanna. A great empire ruled by a great goddess, overthrown by influential powers. Sumeria, much like the rest of the world, had its power falling into the hands of men. Inanna was hailed and worshipped under many titles. She was the ââ¬Å"Queen of the Earth Gods, Supreme among the Heaven Godsâ⬠, the ââ¬Å"First Daughter of the Moonâ⬠, and many other titles (Wolkstein and Kramer, 1983). The hymns portray her in such a bright light that showcases how much they worshipped her. ââ¬Å"The people of Sumer parade[d] before the holy Inannaâ⬠and ââ¬Å"purif[ied] the Earth for herâ⬠(Wolkstein and Kramer, 1983). It is hard to identify, based on the hymns, if she was human or not, as the texts make many references to both ideas. Ultimately, Inanna was a savior of all people, someone that all the Sumerians could look up to. To love someone so much and hold them as a symbol of power, loveââ¬âwhether they were human or notââ¬âshows how Inanna may have been a model to, not just women in Sumerian society, but all other people as well, as ââ¬Å"the male prostitutes comb their hair beforeâ⬠her (Wolkstein and Kramer, 1983). By c ontrast, ancient India was a strong androcracy, in which males were treated better than their female counterparts. The Ramayana serves as an example, in which Sita, the devoted wife to Rama, speaks multiple times of her place beside her husband, as her duty lies with him. Rama and Sita are hailed as models for couples in India. If the couple is comprised of a male and female, the male takes after Rama, and the female after Sita. It is clear that Sumeria was unique in itself in this right. Inanna was the one major god that everyone could look to for almost anything. Being one of the few matriarchies in the world, however, the female ruled society soon began to assimilate to match the rest of the world. Sumeria began to advance and allow more foreigners into their land. The influence of foreign populations began to change ancient Sumeria. Either willingly or by force, Sumeria was pushed to shift into a patriarchy. Akkadians and Assyrians from the neighboring territories began to ease into Sumer. Both were strong cultures that had spoken Semitic languages and both were very involved with warfare (Wilson, 2013). Sumeria began to develop its own army, as they moved out of their land to find materials they did not have themselves, and the influences of more warlike nations on their territories encouraged the behavior. Militaristic ideas and the leaders of the army slowly became permanent, and democratic ways of governing fell, as the rise of the monarchies led by kings emerged (Wise, 2013). Inanna was pushed back, no longer the goddess that all Sumerians looked up to and worshipped. The goddess Ninlil did not take Inannaââ¬â¢s place, but her myths and legends may have contributed to the harsher treatment of women in Sumeria. Ninlil was raped four times by Enlil, once when he was not under a guise, and three times when he had disguised himself as someone else (Black, 1998). The legend may have served as an excuse for men who saw fit to rape women and ultimately hold power over the Sumerian women. The fall of Inanna spelled disaster for the female population of Sumeria, as men began to decrease the value that women held in society and traded them off as slaves and wives for money (Wise, 2013). They were seen as expendable members of society with no other purpose aside from childbearing, cooking, and standing beneath men, much like the rest of the world had come to see women in their societies. From a position of power to one of ridicule, Inannaââ¬â¢s popularity decreased amongst the ancient Sumerians, as even Gilgamesh himself looked down upon her and who she was. long gone was the highly respected, all powerful god of Sumeria. Gilgamesh, in which she is known as Ishtar, portrays her as a liar who wants nothing more than to seduce him, then throw him away like she had to all her previous lovers (Mitchell, 2004). She comes off as a spoiled brat and a manipulator, as she convinces her father to give her the Bull of Heaven, then proceeds to use it to kill three hundred innocentsââ¬âthere is no trace of the once highly renowned and loved goddess that used to be known as the Great Lady of Heaven in ancient Sumeria. Gilgamesh is the strongest literary example of how Sumeria had morphed from a matriarchy into a patriarchy. Inanna, who was once seen as the greatest being in all of Sumeria, had been replaced by Gilgamesh, a cruel king who did as he pleased as long as it was for his own benefit. He took sons from their fathers and daughters from their mothers and broke them. He was the sole ruler of Sumeria; there was no queen to rule by his side. There is a stronger sense of monarchy now than there was when Inanna was revered with power. The city now looked up to Gilgamesh, and even after seeing his abuse of power, they did not remove him from where he stood in the social hierarchy. Instead, they saw fit to placate him with another man, Enkidu, who would change Gilgamesh into a better ruler of the people. And so Inanna fell and Gilgamesh rose to power, symbolizing the overthrowing of the matriarchy and introduction of the androcracy. One can use ancient Sumerian literature to trace the power shift between men and women in the civilization. Early ancient Sumeria hailed Inanna, either a goddess or an ordinary human, as their queen, the strongest power in Sumeria whom all could look up to for guidance in many things. Hymns would praise her beauty, strength, and abilities, and she had quickly become someone that all the citizens of Sumeria would have liked to look up to. As time passed, however, invading powers began to shift Sumerian ideals, bringing with them their patriarchal claims and beliefs that would forever change Sumeria. Inanna lost popularity amongst her worshippers and men rose to power then. King Gilgamesh, now seen as the strongest being in Sumeria, stole Inannaââ¬â¢s thunder and used his own privilege to put her down and cast a dark light on her. From there, the power never did shift back, and along with the rest of the world, Sumeria moved through history, a society dominated by men, their great p riestess discarded and forgotten. References Black, J.A., Cunningham, G., Fluckiger-Hawker, E, Robson, E., and Zà ³lyomi, G., The ElectronicText Corpus of Sumerian Literature (http://www-etcsl.orient.ox.ac.uk/), Oxford 1998Brisch, N. (n.d.). Ninlil (Mulliltu, Mullissu, Mylitta) (goddess). Retrieved November 4, 2015,from http://oracc.museum.upenn.edu/amgg/listofdeities/ninlil/ Mitchell, Stephen. Gilgamesh: A New English version. New York: Free, 2004 Wilson, E. (2013, October 8). Development of Patriarchy in Sumer. Retrieved November 4,2015, from https://heartwellproductions.wordpress.com/2013/10/08/development-of-patriarchy-in-sumer/ Wise, J. (2013, July 26). Part V: Punishing Eve: Tracing the Shift to Patriarchy in Sumer. Retrieved November 3, 2015, from http://www.dailykos.com/story/2013/07/26/1226749/-Part-V-Punishing-Eve-Tracing-the-Shift-to-Patriarchy-in-Sumer# Wolkstein, Diane, and Samuel Noah Kramer. Inanna, Queen of Heaven and Earth: Her Stories and Hymns from Sumer. New York, Harper and Row, 1983
Saturday, May 16, 2020
Correcting Run-On Sentences Proofreading Practice
This exercise will give you practice in identifying and correcting run-on sentences. Before attempting the exercise, you may find it helpful to review how toà correct a run-on sentence with a period or semicolonà andà correcting run-ons through coordination and subordination. The following paragraph contains three run-on sentences (fused sentences and/or comma splices). Read the paragraph aloud and mark any run-on sentences that you find. Then correct each run-on according to the method you think is most effective. When you have completed the exercise, compare your corrections with the following paragraph below it. Run-On Sentence Exercise Why I Had to Get Rid of the Monster Although I am a dog-lover by nature, I recently had to give away my three-month-old retriever, Plato. I had several good reasons for doing so. A few months ago I picked up the dog at the Humane Society as a Christmas gift for my girlfriend. Alas, she dumped me on Christmas Eve I was left to console myself by caring for the dog. Thats when my true misery began. For one thing, Plato was not housebroken. Throughout the apartment he left little mementos, staining rugs and furniture and fouling the air, he would burrow under any newspapers I laid down for him. To make matters worse, his untamed potty habits were supported by an insatiable appetite. Not content with a sack of Kibbles n Bits every day, he would also gnaw at the couch and shred clothes, sheets, and blankets, one night he chewed up a friends new pair of clogs. Finally, Plato simply wasnt happy being cooped up by himself in a small apartment. Whenever I left, he would begin whimpering, and that soon turned into furious barking . As a result, my neighbors were threatening to murder both me and the monster, as they took to calling him. So, after six weeks of life with Plato, I gave him away to my uncle in Baxley. Fortunately, Uncle Jerry is quite accustomed to animal feed, waste, noise, and destruction. Corrected Version of Run-On Sentence Paragraph Below is the corrected version of the paragraph used in the exercise above. Why I Had to Get Rid of the Monster Although I am a dog-lover by nature, I recently had to give away my three-month-old retriever, Plato. I had several good reasons for doing so. A few months ago I picked up the dog at the Humane Society as a Christmas gift for my girlfriend.à Alas, when she dumped me on Christmas Eve, I was left to console myself by caring for the dog.à Thats when my true misery began. For one thing, Plato was not housebroken.à Throughout the apartment he left little mementos, staining rugs and furniture and fouling the air. He would burrow under any newspapers I laid down for him.à To make matters worse, his untamed potty habits were supported by an insatiable appetite.à Not content with a sack of Kibbles n Bits every day, he would also gnaw at the couch and shred clothes, sheets, and blankets. One night he chewed up a friends new pair of clogs.à Finally, Plato simply wasnt happy being cooped up by himself in a small apartment. Whenever I left, he would begin whimpering, and that soon tur ned into furious barking. As a result, my neighbors were threatening to murder both me and the monster, as they took to calling him. So, after six weeks of life with Plato, I gave him away to my uncle in Baxley. Fortunately, Uncle Jerry is quite accustomed to animal feed, waste, noise, and destruction.
Wednesday, May 6, 2020
Employee Job Satisfaction Has A Large Impact On Their...
Employee job satisfaction has a large impact on their organization. Employees being dissatisfied can lead to high turnover, higher absenteeism, affect their overall job performance, and impact customer satisfaction (Robbins Judge, 2009 pp 87-89). This post will discuss the impact job satisfaction has in regards to organizational citizenship behavior and employee engagement. Causes of Job Satisfaction There are several factors that influence an employeeââ¬â¢s satisfaction in their job. Some of the factors that impact an employeeââ¬â¢s satisfaction are pay, advancement opportunities, co-workers, the work itself, and enjoying the work (Robbins Judge, 2009 pg. 84). Many people would consider pay as the factor that might contribute the most to job satisfaction. In the United States, pay is more important to employees making less than $40,000 annually and greatly decreases in employees making over $40,000 (Robbins Judge, 2009 pg. 85). Where I work, a large number of the staff is paid considerably less than the $40,000 annual salary, and it is a constant source of discontentment with the staff members. My department alone has had a 25% turnover already this summer which is consistent with the turnover from the previous summer. Our department also struggles with absenteeism and low productivity. The issues are not adequately addressed when author ity figures make the statement that they have no need to adjust the salaries due to an ââ¬Å"endless pool of applicantsâ⬠.Show MoreRelatedEmployee Attitude and Satisfaction in a Prison1318 Words à |à 5 PagesEmployee Attitude and Satisfaction in a Prison Name Course Professors Name Date of Submission Employee Attitude and Satisfaction in a Prison: As a new warden at a large prison in America, I have noticed that the prison is plagued with several physical quarrels and gang loyalties that are divided along racial lines. In addition, the prison staff has had several problems that are related to racial identity as evident in staff arrangement based on racial groups during a turnout before shift-changeRead MoreOrganizational Socialization and Job Satisfaction1519 Words à |à 7 PagesOrganizational Socialization and Job Satisfaction (intoduction) Job satisfaction Job satisfaction is the way a person feels about his or her job (Jex amp; Britt, 2008). Job satisfaction is also the attitude a person possesses towards his or her job. A person may feel like his or her job is demanding, interesting, rewarding, or outright stressful, and demeaning. A person who is happy with his or her job demonstrates a positive attitude about the job. Several factors play a key role in how a personRead MoreJob Satisfaction And Organizational Commitment1502 Words à |à 7 PagesEmployees have their attitudes and different kind of ideas and concerns about their jobs, careers and organizations. Research proves that the most employees have attitude is job satisfaction. ââ¬Å"Job satisfaction is the most widely researched job attitude and most extensively researched subjects in organization Psychology (Judge Church, 2000)â⬠. Most of the employees evaluate their work experience and show their satisfaction and dissatisfaction. Similarly, an attitude is refer to opinions, beliefs and givesRead MoreAnalysis Of Quicken Loans, The Third Largest Retail Mortgage Of The United States1472 Words à |à 6 Pagesgoals and values have on job satisfaction and motivation, there are key components from both Job Characteristics Model and the Employee Satisfaction Model that could be applied their business model. There are similarities with both models, regarding goal setting to motivate and incentivize, task identity and significance, focus on job performance, job satisfaction, productivity, and customer satisfaction. Quicken loans business model can be adopted by many organizations. Larger corporations mayRead MoreThe Various Influences on Job Performance Essay examples1747 Words à |à 7 PagesJob Performance is the most important factor for the every organization because it is the factor which gives the maximum productivity to the organizations. The job performance always gives the good impact on the organizations. Every organization must keen to m otivate the employees for the benefit of the organizations. Job performance is influencing by many other factors which directly related to job performance. Performance is always perceptions and attitudes. There appear to be so many variablesRead MoreEmployee Benefit Plan Development : Employee Benefits Essay1508 Words à |à 7 PagesEmployee Benefit Plan Development ââ¬Å"Understanding your employeeââ¬â¢s perspective can go a long way towards increasing productivity and happinessâ⬠ââ¬â Kathryn Minshew, founder of The Muse. In todayââ¬â¢s highly competitive and robust job market, benefit programs have become an integral aspect of an employerââ¬â¢s total compensation package. In fact, an employerââ¬â¢s total benefit package plays just an important role in attracting and retaining talent for organizations as monetary compensation, according to a recentRead MoreOrganizational Downsizing : The Organization And Strategies Managers1510 Words à |à 7 Pagesthrough businesses all over the world. Organizations downsize for various reasons which are not always understood by the people that make up that organization. Not only does downsizing completely change the structure of the organization, it has many effects on the people within that organization. Employee morale, proficiency, motivation, commitment, and attitude can all be effected by downsizing. The way such a change is implemented in an organization is imperative to the way the employees handleRead MoreTeaching New Skills And Methods Essay1356 Words à |à 6 Pagesmanagers and trainers spend significant time with trainee to teach a set of skills that have been specified in advance. On the ââ¬âjob ââ¬âtraining includes mentoring and coaching, learning by doing, shadowing and job rotation, e-learning, and apprenticeship. Mentoring and coaching: mentoring is when an experienced employee takes charge of the training and development of a new employee. The mentor acts as an adviser and protector to the trainee. Coaching in another hand is when a manager takes an active roleRead MoreBenefits Of Telecommuting At The Industrial Revolution Essay1716 Words à |à 7 Pagesthe employee/individual, the employer/organization, and society. Benefits of Telecommuting towards the Employee/Individual Telecommuting should be the new normal because of the benefits such as autonomy, increased productivity, and savings in time and expenses it affords the employee/individual. A major aspect of telecommuting is that it provides individuals with autonomy or independence over their craft. The absence of a person of authority directly monitoring an employee gives the employee theRead MoreHuman Resource Practices And Job Satisfaction Essay1560 Words à |à 7 Pagesand job satisfaction that is varies with demographic factors. HRM practices are tools in helping achieve departmental objectives and enhance productivity. Whereas demographic factors are age, race, gender, economic status, level of education, income level and employment. This study discuss about the influence of demographic factors in strategic human resource management practice in the different level of HR planning, recruitment selection and workplace motivation and employee satisfaction. Discussion
Tuesday, May 5, 2020
Delinquent Behavior free essay sample
Can delinquent behavior be deterred by threats of punishment? If not, how can it be controlled? The thought that punishment would be able to deter crime is absolutely ludicrous. If the threat of punishment actually worked, the prisons would be empty. It is clear punishment failed as a deterrent, so why does society insist on punishing criminals? I believe society just likes to punish. We like to get even with those who offended us/ or our social norms. Another reason juveniles are not deterred by crime is because they do not fully understand the punishment. Looking back at some of the choices I made when I was younger I can hardly believe I am the same person. For lot of young kids growing up without proper adult supervision and nothing else to do, crimes seems appealing. In the book they talk about routine theory of delinquency, ââ¬Å"Routine activities theory holds that delinquency is caused by the lack of capable guardians, the availability of suitable targets, and the presences of motivated offenders (such as unemployed teenagers)â⬠. We will write a custom essay sample on Delinquent Behavior or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Jail does nothing to reform juvenile offenders, it just integrates them into a culture of adult offenders. I think the key to curbing delinquent behavior in kids starts with the family. We dont have the reigns as tight on our kids as our parents had on us, and it shows. Kids need curfews, jobs, and a sense of respect in general, and no amount of threats will instill on that. I think families and communities have to take more responsibility for teaching children to distinguish right from wrong. For example we need more juvenile outreach programs and studies show that after school programs have been proven to deter crime among juveniles. Last, but not least I think the nation must expand preventive programs that help families and steer children away from crime. The problem is not a lack of adequate punishment, but the deterioration of the family
Saturday, April 18, 2020
What Can I Do to Fight Racism an Example of the Topic Personal Essays by
What Can I Do to Fight Racism? Racism has existed throughout human history. It entails the abhorrence of one person by another due to the belief that that other person is less than human being because of his or her language, customs, especially his or her skin color or any other factor that exposes the essential nature of that person ("Racism"). For me, the belief with regards racism still depends on one's upbringing. Family is the basic foundation of one's beliefs and points of view of an individual, and as such, one's family background and upbringing either helps or avoid the development of a racist attitude. It should start in the parents' advices and lessons with their children. As a daughter and sister, I will treat all my relatives, whether they are of different races, equally. I will love them just like how I love my parents and siblings. Being a student, my viewpoints regarding racism has been altered when my eyes has been opened into different perspectives. I learned that all humans, whatever race they be long, are equal, especially in God's eyes. Therefore, I, as an individual and as a human, must treat all human beings with respect, without discrimination and prejudice. I need not be an ethnocentric who believes that the basic standard and principles of life and everything around me is anchored to the culture where I belong and to the country where I live in. Need essay sample on "What Can I Do to Fight Racism?" topic? We will write a custom essay sample specifically for you Proceed As a neighbor: I will respect all my neighbors, whether he or she is from the same race that I came from or not. If someone talks to me who has a different color of skin, I will speak to him or her in such a way that he or she will not be intimidated or will not feel different with me. I will establish a good rapport with my neighbors who belong in a different race, especially those of my same age so that they can also feel that they belong in our community. If there are new neighbors of different color or language, I will introduce myself to them and address them with their names. I will let them tell stories about the place they come from so that I can have their background; in return, I will listen to them and tell some personal anecdotes too. As a student: I will talk to my classmates of different color, tradition or language, courteously and treat them just like everyone else. I am aware that they are sensitive with regards to race treatment, so I will watch out for my words and action and make sure I will not hurt them.If a professor has given reading assignments written by authors of the different nationality and ethnicity, I will read them and pay attention to what they want to say. I will pull out from my thinking the notion that non-American or non-European authors are inferior to those Americans and Europeans.I will or I can join organizations advocating the equality of races and eliminating discriminations. If I have professors of diverse colors and language, I will respect them just like how I respect the professors of my same race. I will listen to their lectures, as a sign of respect and value, do my assignments and perform well in class. I will talk to them politely because I have this conviction that all people are equal regardless of the place they came from, the color of their skin, the language that they speak and the traditions and customs that they live with and believe in. Work Cited "Racism." 2001. Anti-Defamation League. 16 January 2009
Saturday, March 14, 2020
Congestive Heart Failure Essays - Circulatory System, Cardiology
Congestive Heart Failure Essays - Circulatory System, Cardiology Congestive Heart Failure Symptomatic myocardial dysfunction responsible for the inability of the heart to pump blood at a rate which is les than the requirement of metabolizing tissue or need a higher end diastolic volume to meet the demand o Systolic heart failure is due to impaired myocardial contractility resulting in reduction of stroke volume, inadequate ventricular emptying, dilatation of heart and elevated ventricular end-diastolic pressure Idiopathic dilated cardiomyopathy is the prototype of systolic heart failure o Diastolic heart failure is characterized by impaired relaxation and filling of ventricle resulting in increased ventricular diastolic pressure at any given diastolic volume- restrictive cardiomyopathies o Concentric hypertrophy of left ventricle in hypertension does cause impaired diastolic relaxation but does not cause failure Normal Ventricular function [pic] o Conditions simulating heart failure > Circulatory insufficiency without myocardial failure ( cardiac temponade or haemorrhagic shock > Circulatory congestion secondary to salt and water retention( renal disease > Sudden increase in myocardial load e.g. accelerated hypertension or rupture of valve cusps Prevalence: o In West, increases with age- 1% at 60 years to 10% after 80 years o In India, rheumatic heart disease is common in young age group and commonly presents with heart failure Etiology and pathogenesis of Heart Failure: [pic] Important causes of heart failure are o Valvular heart disease- common in India o Hypertensive heart disease o Coronary heart disease- responsible for 40-60% heart failure in US o Congenital heart disease o Myocarditis o Cardiomyopathies Pathophysiology of heart failure: o Backward Failure theory: Myocardial Dysfunction ( High End Diastolic Volume of Ventricles ( ( Pressure and volume of atrium and venous system ( ( transudation of fluid from capillaries ( Low circulatory volume ( Activation of Renin-Angiotensin-Aldosterone System ( Salt and Water Retention o Forward Failure Theory Myocardial Dysfunction ( Low Cardiac Output ( Low Renal Perfusion ( Activation of Renin-Angiotensin-Aldosterone System ( Salt and Water Retention o Adaptive mechanisms in heart failure > Frank-Starling mechanism- operated due to increase preload ( increased end-diastolic volume of ventricle ( longer length of myocardial fibers( increased force of contraction > Increased after load ( concentric hypertrophy( restoration of elevated stress on ventricular walls to normal > Redistribution of subnormal cardiac output- less blood flow to skin, muscles and kidney to maintain normal flow to heart and brain > Neuro-hormonal adjustments- increased catecholamines ( increased HR ( maintenance of cardiac output despite low stroke volume > There may be right shift of oxygen dissociation curve to release more oxygen for tissue at lower pO2 levels o Adaptive neuro-hormonal/ cytokine changes in heart failure: > Adrenergic Nervous System- . Increased levels of nor-adrenaline-important in acute heart failure . In chronic heart failure, it may increase after load by increasing peripheral resistance, induce cardiac arrhythmias and may damage myocytes further by causing Ca++ overload . Prognosis of heart failure correlates inversely with levels of nor- adrenaline > Renin -Angiotensin -Aldosterone (RAA) System . Gets activated when there is a fall in cardiac output . Increased angiotensin II causes vasoconstriction and Aldosterone increases retention of Na+ and water and perhaps cases cardiac fibrosis also > Endothelin . A potent vasoconstrictor . Concentration increased in heart failure . Experimental studies indicate benefit of blocking receptors in heart failure > Increased levels of TNF-(- in experiments has been shown to impair systolic function > Vasodilator peptides (Atrial Natriuretic Peptide and Brain Natriuretic Peptide . These hormones released due to stimulation of stretch receptors in atria (ANP & BNP) or ventricles (BNP) and stimulate sodium excretion and urine formation by kidneys . Higher levels correlate with poor prognosis Hypertrophy of ventricles o Pressure overload ( elevated systolic pressure ( parallel addition of myofibrils( concentric hypertrophy o Volume overload ( elevated diastolic pressure( addition of myofibrils in series( eccentric hypertrophy Precipitating Factors for Heart Failure o Infections > Pulmonary infections more likely to occur in the presence of pulmonary vascular congestion > Infections ( fever, tachycardia, ( metabolism and hypoxia ( cardiac overload o Anaemia > Increased oxygen demand of tissue met by increase in cardiac output ( increased cardiac workload o Thyrotoxicosis and pregnancy > Increased cardiac output states ( increased cardiac load o Arrhythmias > In compensated heart disease, arrhythmias are the most important cause of failure > The deleterious effects can be due to following
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