Professional Documents
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Failure
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Heart Anatomy
Preload
Contractility
Afterload
CO
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Congestive Heart Failure
Definition
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Definition (Cont’d)
• Cardiac diseases:
long-standing hypertension
coronary artery disease (CAD)
• Characteristics:
ventricular dysfunction
↓ exercise tolerance
↓ quality of life
shortened life expectancy
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Definition (Cont’d)
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ETIOLOGY & RISK
FACTORS
– CAD
– Age
– Hypertension
– Obesity, high cholesterol level
– Smoking
– DM
– African American descent
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Manifestation of Ventricular
Failure
• low BP,
• low CO
• poor renal perfusion,
• poor exercise tolerance,
• ventricular arrhythmias
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PATHOPHYSIOLOGY
• CO depends on:
– Preload
– Afterload
– Myocardial contractility
– Heart rate
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Compensatory
Mechanisms
1. Ventricular dilatation
2. Ventricular hypertrophy- in
chronic CHF
3. Sympathetic nervous system
stimulation
4. Neurohormonal responses:
>Kidneys: angiotensin
aldosterone
>Brain: antidiuretic
hormone L Del Balso
(ADH)
Types of CHF
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Left Sided Failure
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Right Sided Failure
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Acute CHF
• Manifestation: Pulmonary edema.
• Cause: Lt ventricular failure secondary to CAD
• Symptoms:
-Pale or cyanotic, Cold, clammy skin-
secondary to vasoconstriction from
sympathetic nervous system response
-Agitation
-Severe dyspnea-use of accessory
muscles, orthopnea
-Tachypnea , wheezing, crackles,
coughing
-Nocturia
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CHRONIC CHF
• Fatigue.
• Dyspnea, orthopnea (key symptom)
-Paroxysmal nocturnal dyspnea
• Dry hacking cough.
• Tachycardia- (compensatory mechanism)
• Edema-pitting edema, dependant edema
(sacral edema).
• Sudden weight gain
• Nocturia (6-7 x/night)
• Skin changes
• Behavioral changes
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Complications of CHF
1. Pleural effusion: collection of
fluid in pleural space.
2. Arrhythmias: alteration normal
electrical pathway.
3. Left ventricular thrombus:
enlarged LV and decrease CO
can increase chance of clot.
4. Hepatomegaly (RV failure)
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CLASSIFICATION OF CHF
by the NY Heart Association
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CLASSIFICATION (cont’d)
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Diagnostic Studies
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Diagnostic studies (cont’d)
– Echocardiogram-measures ejection
fraction.
– Stress testing
– Cardiac catheterization
– Ejection fraction (EF)
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Collaborative Care
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Drug Therapy
Goal: improve symptoms, minimize side effects
of treatment, prevent morbidity and prolong
survival
• ACE inhibitors
• Diuretics
∀β-Adrenergic blockers
• Inotropics agents
• Vasodilators
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ACE Inhibitors
3 Types:
• Thiazide-Hydrochlorothiazide:
Inhibit Na/H2O resorption of distal
tubule
2. Loop Diuretics- Lasix
-Acts on ascending loop of Henle
-Na, CL, H2O excretion.
-SE: hypokalemia, ototoxicity,
severe hypotension.
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DIURETICS (cont’d)
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Beta Adrenergic
Carvedilol, Metoprolol, Bisoprolol
• Action:
-Blocks the sympathetic nervous system
(high HR)
-improve L ventricular ejection fraction,
increase exercise tolerance, slow progression
of CHF,
• Adverse effects: fluid retention from
worsening CHF, fatigue, hypotension,
bradycardia, MI
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INOTROPIC AGENTS
1.DIGOXIN(LANOXIN)
• cardiac glycoside, anti-arrthymic
(digitalis)
• used CHF & arrthymias
• functions in 2 ways:
– increases force of myocardial
contractility
– slows conduction from AV node
slows HR ventricular emptying
>inhibits K Intracellular levels uptake
>increase intracellular Na, Ca---
increase contractility
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Digoxin (cont’d)
• NRSG:
– take AP for full minute
– note rate & rhythm (if AP < 60, HOLD)
– monitor K+ levels
– educate client & family to assess
pulse for rhythm & rate
– educate & monitor for signs of digoxin
toxicity *(sign of toxicity??)*
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Digoxin (cont’d)
• SE:
-Therapeutic range: 1.54 +/- 0.5 mmol /L
-First sign is arrthymia
-anorexia, N & V, malaise (mild)
-vision disturbances: “yellow”
-changes in HR & rhythm through
palpation, auscultation or on ECG
-monitor K+ levels: hypokalemia may
predispose to toxicity
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INOTROPIC AGENTS
2.sympathomimetics:
• Dopamine
• Dobutamine
• Hydralazine (APRESOLINE)
Increases CO and renal blood flow.
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INOTROPIC AGENTS (cont’d)
3.Phosphodiesterase inhibitor
• Inamarinone lactate(INOCOR):
-increases contractility (increasing ca
entry)
-Vasodilator, increases CO and
decreases afterload (lower BP)
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Vasodilators
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POTENTIAL COMPLICATIONS
• Electrolyte imbalances due to use of
diuretics & digoxin
• Hypokalemia: (low K+)
– weakens cardiac contractions
– leads to digoxin toxicity
– Signs of hypokalemia: weak pulse,
hypotension, muscle flabbiness, generalized
weakness & diminished deep tendon reflexes
• K supplements(K-Dur) if not on ACE
inhibitor or K sparing diuretics. Give with
meals.
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POTENTIAL COMPLICATIONS
(cont’d)
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Nutritional Therapy for CHF
• Fluid restrictions not commonly prescribed
only for severe CHF
• Na restriction in order to decrease
circulating volume and decrease workload
of heart
– 2 g sodium diet for mild CHF
– 500-1000mg for severe CHF
• Daily weights
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Nursing and Collaborative
Management
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Nursing and Collaborative
Management (Cont’d)
Action demands:
– Improving cardiac function
– Reducing anxiety
– Promote skin integrity
– Promote activity tolerance
– Provide client & family education:
self care at home
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