What is CHF?
- Cardiac output is inadequate and the heart in not able to pump an adequate amount of oxygenated blood to meet the demand of the demands of the body.
- blood volume accumulates in the pulmonary and/or venous system
- pulmonary congestion causes retention of sodium and water and elevated pressure in LV
what are some things that cause CHF?
- Rheumatic heart disease
- Endocarditis or myocarditis
- Noncardiovascular causes include Acidosis
- pulmonary disease
- various metabolic diseases
What are the grades of CHF?
- i: No symptoms even with activity
- II: Start to have symptoms with min/normal activity
- III: Very little activity = symptoms
- IV: Symptoms even at rest
What are some compensatory mechanisms that occur with CHF?
- Stroke Volume increases and cardiomegaly develops
- tachycardia occurs in effort to maintain adequate stroke volume
- Catecholamines are released by sympathetic nervous system which increased vascular resistance and venous tone and decreased cutaneous, splanchnic and renal blood flow
- Glomerular filtration decreases and tubular reabsorption increases, causing diminished urinary output and sodium retention
Complications of CHF include....
- Respiratory infections
- Pulmonary Edema
- Intractable CHF
- Myocardial Failure
- **Dig toxicity due to decreased renal perfusion and potassium depletion**
- Cardiac arrhythmias
- Pulmonary Infarction
- Pulmonary Embolus
General S/S of CHF
- Dyspnea and tachypnea
- Peripheral Edema
- Anorexia, Pallor,
- Hypertrophy that displaces PMI
- Restlessness, Easy Fatigability
- Non-Productive, irritative Cough
- Weight Gain, Diaphoresis
- Neck Vein Distention, Hepatomegaly
Left Sided Heart Failure
Congestion mainly occurs in the lungs because the blood backing up in the pulmonary vein and capillaries
S/S of Left Sided Heart Failure
- SOB and Dyspnea at rest or exertion
- Anginal Pain
- Restlessness and anxiety
- persistent hacking cough
- changes in mental status
- adventitious lung sounds
- irregular heart rhythm (presence of S3 and/or S4)
- Elevated PAWP
why do Left sided Heart failure pts have SOB and Dyspnea
SOB and Dyspnea at rest or on exertion as well as paroxysmal nocturnal dyspnea is caused from the blood backing up in the pulmonary veins and capillaries, the excess blood and fluid increases the pressure in the chest and makes it hard to breath
what causes the fatigability in Left sided heart failure patients?
decreased cardiac output, nocturia (up and down to bathroom all night), insomnia, SOB (hard to breath so can't rest good), catabolic effect
Why do Left Sided Heart Failure pts have angina pain?
decreased cardiac output
what causes the hacking cough, and restlessness in left sided heart failure pts
- Cough is caused by pulmonary edema
- change in mental status can include insomnia, depression (can't do things want to do or used to do) fatigue (decreased cardiac output), memory loss
- Restlessness and anxiety is caused by resp distress
what caused S3 in left sided Heart Failure patients
S3 is due to pulmonary congestion
What causes Left Sided Heart Failure patients to have S4
S4 due to decreased ventricular compliance
CHF patient should ____ every day
- weight themselves every day around the same time every day with the same amount of clothing.
- Pt must call physician is they gain 3 pounds in 1 week
What are S/S of Right sided Heart failure
- Abnormal fluid in body cavities
- Anorexia or nausea
- Weakness or fatigue
- Anginal Pain
- Increased Anxiety
Right sided failure
Increased anxiety is related to...
resp distress and depression
Anginal Pain in right sided heart failure patients is related to...
decreased cardiac output
weakness and fatigue in right sided heart failure patients is related to....
- decreased cardiac output
- decreased tissue perfusion and oxygen levels
Right Sided Heart Failure
demonstrates S/S of elevated pressures and congestion in systemic veins and capillaries
Peripheral edema is only evident after...
- peripheral edema of extremities especially in the ankles, or unexplained weight gain and pitting edema is obvious only after a 4.5kg (10pound) fluid retention
- some weight daily!!
why do right sided heart failure patients have hepatomegaly?
- hepatomegaly or ascites result from liver engorgement.
- the intravascular fluid and pressure may also cause abdominal pain
JVD is seen in which heart failure
- right sided because the fluid is all going systemic
- Increased venous pressure causes increased blood pressure, JVD, hepatomegaly