-
What is heart failure?
(formerly “CHF”)
- Characteristics:
- Impaired ventricular pumping
- Reduced exercise tolerance. May present like COPD because both result in v O2 sat.
- Diminished QOL
- Shortened life expectancy
-
Systolic failure
- Left Ventricular pump failure
- Impaired contractility due to weakened heart muscle.
 - Decreased EF (ejection force)
- Increased afterload
- Cardiomyopathy
- Mechanical problems
- More common than diastolic failure
-
Diastolic Failure
- Impaired ventricular filling
-
- High filling pressures
- Venous engorgement
- Pulmonary congestion
- Pulmonary HTN
- Normal EF
-
Compensatory Mechanisms
- SNS Activation
- --increased HR, contractility, vasoconstriction
- Dilation of muscle tissue, not vasodilation.
- --Muscle fibers stretch to increase contractility
- Hypertrophy (cardiac remodling)
- --Overwork causes increased muscle mass of ventricular walls
- --Can be stopped and to some degree reversed with ACE inhibitors if diagnosed early.
- Neurohormonal Response
- --Kidneys respond with renin + angiotensin-->angiotensin 1 system.
-
Right vs. Left sided failures of the heart.
-
SnSs of of Acute HF
Pulmonary Edema (swelling of lungs)
- Agitated
- Pale
- Cyanotic?
- Cool & clammy
- Tachypnea/Dyspnea
- Adventitious BS
- ^HR & BP changes
- Pink and Frothy discharge
-
SnSs of Chronic Heart Failure
- Fatigue
- Dyspnea
- Tachycardia
- Edema
- Nocturia
- Skin changes
- Behavioral Changes
- Chest Pain
- Weight Changes (good indicator of fluid retension or fluid loss)
-
Complications of HG
- Pleural effusion
- Hepatomegaly (blood pooling in liver-->enlarged liver)
- Renal failure
- Arrhythmia (afibrillation most common)
- Left Ventricular thrombosis
-
Diagnostis for HG
- H & P
- Lab studies (BNP)
- CXR
- Hemodynamic monitoring
- ECG (electrocardogram. Not to be confused with echocardiogram).
- Echocardiogram
- Stress testing
- Cardiac Catheterization
Goal is to determine root cause.
-
Nursing intervensions for pt w/HF
- Tx underlying cause
- Position (High Fowler)
- O2
- Cardiac monitor & oximetry (VS)
- Daily weights
- Rest
- Sodium-restricted diet
- Medications:
- ACE inhibitors, to prevent remodeling
- Inotropics, to improve "squeeze.
- Diuretics, to clear excess fluid buildup.
- Vasodilators
- Antiarrhythmics
- Beta-blockers, for high HR
- Human B-type natriuretic peptide (BNP)
- Anxiolytics
- et al...
-
Cardiomyopathy
A group of heart muscle diseases that affect the structural or functional ability of myocardium
- Know how it might present in various forms of HF.
- Can be...
- dilated: chambers are too large.
- hypertrophic: heart wall is abnormally thick, overdeeloped.
- restrictive: Heart wall is "stiff."
|
|
