Nama: Muthu vel A/L Muthulinggam Muhamad Shahruni Bin Supaat No.ic : 950605-05-5207 No.

matric:06 DPS 1309-3676 Lecturer: Cik Arbai

HEART FAILURE

 When

the heart no longer has the ability to adequately eject blood out of ventricle, it is considered to be failing. The heart failure may be a result of a heart attack that affected a large portion of muscle Because, when the heart muscle dies, it no longer contributes to the pumping function of the heart.

Heart failure may also be caused by:

a valve disorder hypertension Pulmonary embolism cardiac rhythm disturbances certain drugs

Heart failure can be categorized as left ventricular failure and right ventricular failure. The consequences of left or right ventricular failure can be understood by recalling the function of two sides of the heart. Left ventricular failure occurs when the left ventricle cannot pump blood out of the left ventricle effectively This reduces blood flow to the arteries and the perfusion of blood to the cells throughout the body.

When the right side of the heart fails, the blood backs up into the venous system. The right side of the heart may fail due to failure of the left ventricle. Chronic obstruction pulmonary disease (COPD) may increase the pressure in the pulmonary vessels in the lung. It cause the right ventricle to work much harder. Over time, may cause the right ventricle to fail.

Another problem than can occur with left and right heart failure is a condition known as cardiogenic shock. This is a clinical state in which the left or right ventricle fails to pump out enough blood to meet the demands of the body. The most common cause for this is myocardial damage that occurs secondary to a heart attack. Cardiogenic shock can be from the pumping inadequacy of either the left or right ventricle.

 When

the left ventricle fails, the cardiac output drops and there is a diminishment in perfusion pressure to the rest of the bodys organs. The right ventricle can also fail for any of the same reasons as the left, but has slightly different presentation.

 Congestive

heart failure (CHF) is a medical diagnosis that refer to the condition in which there is a buildup of fluid in the body resulting from the pump failure of the heart. It represent the condition where the left, the right, or both ventricles are failing to meet the bodys needs. Congestive heart failure commonly leads to pulmonary edema and edema in other areas of the body.

The fluid may also accumulate in the liver, causing it the enlarge, and also in the abdomen. When fluid collects in the abdomen, the abdomen may become distended and feel like a sponge.

Marked or severe dyspnea (shortness of breath) Tachycardia Difficulty breathing when supine (orthopnea) Sunddenly waking at night with dyspnea Fatigue on any type of exertion Anxiety Tachypnea Diaphoresis

Cool, clammy, pale skin Chest discomfort Cyanosis Edema to the hands, ankles, and feet Decreased SpO2 reading Blood pressure may be normal, elevated or low Distended and soft spongy abdomen

 Mild

to severe confusion Cyanosis Tachypnea May cough up pink sputnum Low, normal, or high blood pressure Rapid heart rate A desire to sit upright

 Anxiety Distended Crackles Shortness

neck veins

of breath(dyspnea) Pale ,cool,clammy skin Abdominal distention Pedal and lower extremity edema

The treatment for the patient with heart failure is basically the same as for the patient with an acute myocardial inforction. Provide positive pressure ventilation with supplemental oxygen connected to the device if the breathing is inadequate. The heart failure patient with pulmonary edema will benefit significantly from positive pressure ventilation. It will increase the effectiveness of gas exchange by forcing the oxygen to cross over the alveoli and the space between the alveoli and the capillary. If the patient will tolerate positive pressure ventilation and medical direction allows its , attempt to provide ventilation early. If the patient has an adequate respiratory rate and tidal volume, apply a non rebreather mask at 15lpm.

Any venous direction will cause less blood to return to the heart and reduce the workload of the ventricles. Never force for the patient to lie flat since this will commonly worsen the dyspnea.

Cardiogenic shock is caused by ineffective pump function of the heart. The patient has an adequate blood volume and vessel tone. Hipoperfusion result from inability of the heart to contract effectively. The heart muscle that is lost no longer contributes to the force of contraction. The result is the reduction in stroke volume, cardiac output and systolice blood pressure, leading to poor tissue perfusion.

Cardiogenic shock is both a category and a type of shock. The depressed pump function reduce the force of the left ventricular contraction, stroke volume, cardiac output, systolice blood pressure and perfusion. Emergency care focus on management of the airway, ventilation and oxygenation. The patient may benefit from intervention and medication administrate by an advance left support unit.

During the primary and secondary assessment, assess for physical sign of shock and obtain vital sign. Must specifically assess sign of perfusion has will has vital sign. The signs of perfusion, independent of the vital sign, will provided evidence of a shock state.

The following are sign of poor perfusion : Altered mental status Pale, cool, clammy skin Delayed capilary refill Decreased urine output Wake or absent peripheral pulses

In distributive shock, the skin is warm and flushed from the vasodilation. Vital sign assessment must include the following : Blood pressure Heart rate Pulse character Respiratory rate and tidal volume Skin colour, temperature and condition Pulse oximeter reading

The vital sign may vary, depending on the type of shock. Cardiogenic shock may present which an extremely slow heart rate or on irregular rhythm. These are only a few example of variation of vital sign that might be found in the differing shock state.

Management of shock is gered to improving oxygenation of the blood and delivery of oxygen and glucose to the cell. The general goals of shock management are : Secure and maintain a pattern airway Establish and maintain adequate ventilation Do not remove an impaled object. Keep the patient in a supine position. Rapidly transport the patient to the most appropriate medical facility.

THANK YAU