insufficiency
(in‵sŭ-fish'ĕn-sē 
)
[ L. insufficientia, insufficiency]
Inadequacy for a specific purpose.
accommodative i.The inability of the eye to sustain accommodation over time. It is usually due to repeated or sustained visual effort or underlying stress or illness. SYN: accommodative fatigue; ill-sustained accommodation.
active i.Loss of the ability to generate muscle tension because of muscle shortening.
SEE: Active Insufficiency
acute adrenocortical i.Sudden deficiency of adrenocortical hormone brought on by sepsis, surgery, or Waterhouse-Friderichsen syndrome. A frequent cause is sudden withdrawal of adrenal corticosteroids from patients with adrenal atrophy secondary to chronic steroid administration. SYN: addisonian crisis; adrenal crisis.
adrenal i.Abnormally low production of adrenal hormones, esp. cortisol. Primary adrenal insufficiency results from inadequate cortisol production by the adrenal gland s, as in Addison's disease. Secondary adrenal insufficiency results from a decrease in the production of adrenocorticotropic hormone or its release from the pituitary gland .
ABBR: AI
An imperfect closure of the aortic semilunar valve at the junction of the left ventricle and the aorta, due to distortion of the valve leaflets or dilation of the aortic annulus. This causes blood that has been ejected into the aorta to fall back into the left ventricle. It may produce volume overload of the ventricle, leading to left ventricular dilation and hypertrophy, and congestive heart failure. Stroke volume and ejection fraction (EF) fall. SYN: aortic incompetence; aortic regurgitation; aortic valve insufficiency.Chronic aortic insufficiency produces a gradual volume overload of the heart and eventual congestive heart failure. It may occur in patients with poorly controlled hypertension, tertiary syphilis, Marfan disease, or other disorders that affect aortic valve competence. Management often includes antihypertensive vasodilators such as nifedipine. If congestive heart failure becomes severe enough, valve replacement may be recommended for patients who are good operative cand idates. Surgery usually is recommended to be done before EF falls below 55%.
Chronic AI may be asymptomatic until heart failure (HF) occurs. With HF, patients often report difficulty breathing (such as during exercise or sleep), and lower extremity swelling. Patients may occasionally report palpitations or a subjective awareness of their heart beating.
The murmur of AI occurs in diastole, is high-pitched (best heard using the diaphragm of the stethoscope), and is usually described as “blowing” and “decrescendo.” It is best heard at the left second to fourth intercostal spaces, radiating to the apex and sometimes the right sternal border, after the patient exhales and sits leaning forward, holding his or her breath. Patients with AI often have a widened pulse pressure with a water-hammer pulse and may have head bobbing, bobbing of the uvula, or visible movement of blood under the nails when the tips of the nails are gently compressed (Quincke pulse). The patient may experience dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and fatigue.
A history of related cardiac illnesses and symptoms is obtained. Fever and other signs of infection are noted. Vital signs, weight, and fluid intake and output are monitored for indications of fluid overload. Activity tolerance and degree of fatigue are assessed regularly, and the patient is taught to intersperse periods of activity with rest.
Desired outcomes include adequate cardiopulmonary tissue perfusion and cardiac output, reduced fatigue with exertion, and ability to manage the treatment regimen.
aortic valve i.Aortic insufficiency.
cervical i.Cervical incompetence.
chronotropic i.Chronotropic incompetence.
coronary i.Obstruction to the flow of blood through the coronary arteries, resulting in an inadequate supply of blood relative to the metabolic demand s of the heart muscle.
SEE: angina pectoris; coronary artery disease.
gastric i.Inability of the stomach to empty itself.
hepatic i.Inability of the liver to produce albumin, bile, or proteins, or to detoxify xenobiotics that are taken up by the gastrointestinal tract.
ileocecal i.Ileocecal incompetence.
mitral i.Mitral regurgitation.
muscular i.A condition in which a muscle is unable to exert its normal force and bring about normal movement of the part to which it is attached.
myocardial i.Inability of the heart to eject blood and distribute it effectively to other organs.
passive i.A restriction in the range of motion of multijoint muscles such as the extrinsic finger flexors and extensors, the hamstrings, and the quadriceps caused by inadequate extensibility of antagonist muscles, muscle groups or fascia. This limitation is a normal property of multijoint muscles and helps optimize the relation between muscle length and tension.
SEE: Passive Insufficiency
primary adrenal i.Addison's disease.
pulmonary valvular i.Imperfect closure of the pulmonary semilunar valve at the junction of the right ventricle and the pulmonary artery. The clinical consequences may include right ventricular failure.
renal i.Chronic kidney disease.
respiratory i.Inadequate oxygen intake or carbon dioxide removal associated with abnormal breathing and signs and symptoms of distress.
secondary adrenal i.Insufficient stimulation of the adrenal gland s caused by failure of the pituitary gland to secrete adrenocorticotropic hormone. In this disorder, cortisol levels are reduced, but aldosterone secretion, which is governed by the renin-angiotensin-aldosterone system, is preserved. This differs from primary adrenal insufficiency or Addison's disease in which the adrenal gland s secrete neither cortisol nor aldosterone.
tertiary adrenal i.Inadequate stimulation of the adrenal gland s that results from a failure of the hypothalamus to secrete corticotropic-releasing hormone.
uteroplacental i.Inadequate blood flow through the placental intervillous spaces to enable sufficient transmission of nutrients, oxygen, and fetal wastes. It may be caused by diminished maternal cardiac output due to anemia, heart disease, regional anesthesia, or supine hypotension; vasoconstriction due to chronic or pregnancy-related hypertension or uterine overstimulation; vasospasm due to pregnancy-induced hypertension; vascular sclerosis due to maternal diabetes or collagen disease; or intrauterine infection. It increases the risk for intrauterine growth retardation.
valvular i.Backward flow of blood through a valve, e.g., a cardiac valve during the stage of the cardiac cycle when the valve leaflets should be closed.
velopharyngeal i.Failure of the palatal sphincter to close, with inadequate separation of the nasopharynx from the oropharynx. This may result in snoring, nasal speech, or inhalation of food into the nasal passages. SYN: velopharygeal incompetence.
SEE: cleft palate.
venous i.A failure of the valves of the veins to function, which interferes with venous return to the heart, and may produce edema. SYN: primary valvular incompetence.