LSHF: Left Sided Heart Failure

Normal Circulation

• Deoxygenated blood goes to the heart via the inferior and superior vena cava
• Venous blood returns to the right atrium (RA)
• Blood continues towards the tricuspid valve and right ventricle (RV)
• From the RV, it goes into the lungs and becomes warm, oxygenated and red
• Then, from the lungs, it goes to the pulmonary vein > left atrium (LA) > bicuspid valve > left ventricle (LV)
• From the LV, it goes through the aorta to the rest of the body

Left Sided Heart Failure - LSHF

• If RSHF is going to be the subject, it must be specified, otherwise it is LSHF or Complete Heart Failure (CHF)
• The left atrium (LA) and left ventricle (LV) have failed
• Warm, red, oxygenated blood cannot go out to the body

Signs and Symptoms of LSHF Without Warm Red Oxygenated Blood

• Extremities become cold and clammy
• Pallor
• Decreased oxygen
• Low blood pressure
• Lowered perfusion to the kidneys, resulting in low urine output
• Pulmonary edema occurs as fluid enters the lungs.
• Pink, frothy sputum, Crackles (rales), SOB (dyspnea), Orthopnea

Are You Feeling Okay? - FOA with LSHF

• Fluid in their lungs and are having trouble breathing, then it becomes an AIRWAY problem

Right Side of Heart Failure Action

• In LSHF, the right side is still working and has to work harder because fluid is coming back

Transitioning to Complete Heart Failure CHF

• Over time the right side of the heart is working hard and now the whole heart has failed

Remembering LSHF

• LSHF can eventually lead to RSHF, then development of CHF

Congestive Heart Failure Info

• CHF Heart Failure.
• Congestive Heart Failure is Complete Heart Failure.
• LSHF will specifically say left-sided

Complete Heart Failure (CHF)

• Both sides of the heart have failed
• The Right Atrium (RA) and Right Ventricle (RV) filled up.
• The fluid starts to back up the Superior Vena Cava (SVC).

Signs and Symptoms of Left and Right Sides Failing

• Jugular Vein Distention JVD
• Puffy face/ Swollen cheeks
• Increased abdominal girth
• Peripheral edema
• Pitting edema
• Swollen Chest Vein - JVD
• Swollen Face - Puffy face/ Puffy cheeks
• Cold and clammy (due to poor circulation)
• Pale/Pallor
• Low O2
• Low UOP
• Low BP
• Ascites
• Hepatosplenomegaly

Brain natriuretic peptide (BNP) Testing

• Clinically identify HF by looking at S/S
• But need labs to confirm
• As the ventricles expand, the the body releases a peptide: Brain Natriuretic Peptide (BNP).
• BNP more than 100 indicates HF
• Normal BNP = <.100

Priority Questions for LSHF With Congestion

• Pt will be SOB and "drowning" in their own fluids

Treatment for Heart Problems

• Goal is to get fluid off
• Diuretics
• Types: Loop, Thiazide, and Potassium sparing

Loop Diuretics

• Suffix: -ide
• Types: Furosemide, Torsemide, and Bumetanide
• OOHH DANG!
  • Orthostatic hypotension:
    • Low Blood Pressure
    • Change position gradually, because too much fluid is coming off. That B/P goes up against gravity, so get up slowly.
  • Ototoxicity:
    • Occurs with too fast infusion, thus, SLOW the infusion rate.
    • Key identifiers: Tinnitus, Fullness of the ear, balance issue, ringing in the ears, vertigo
  • Hypokalemia:
    • Dehydrating
    • Pt might be in bed watching tv and they start to develop leg cramps. IDENTIFY by checking their K levels with muscle cramps.
  • Hypomagnesemia:
    • Tremors (note - not the highest yield symptom)
  • Hypotension :
    • Too much fluid is coming off.
    • Change position slowly, b/c too much fluid is coming off.
    • That Blood Pressure goes up against gravity, thus, let them get up slowly.
  • Dehydration:
    • If done too long.
    • Check kidney lab values!
    • Dehydration signs: Tachycardia, Oliguria, Decreased mucous membranes

Thiazide Diuretics

• Suffix: -thiazide
• • Types: Hydrochlorothiazide (HCTZ) and Chlorthalidone
• Increases Na + H2O
• Decreases K+
• Causes Orthostatic hypotension
• Is Nephrotoxic
• Causes Dehydration
• Is Sulfa based

Potassium Sparing Diuretics

• Suffix: normally end in -one
• Types: Spironolactone, Aldactone, Eplerenone, Milrinone, and Amiloride.
• If pt has Sulfa allergy or hypokalemic, give a K sparing.

Watch For Signs of Hyperkalemia

• Gynecomastia as a Side Effect

Treatment for Hyperkalemia

• Aldosterone increases Na; controls Na, H2O follows it via the sodium potassium pump; If Knock out aldosterone, then Sodium goes down, Water follows, resulting in a potassium increase via Aldosterone ANTAGONIST.

Education points

• Check weight daily, either with no clothes on, or same clothes, in AM. A Heart Failure (HF) pt will gain 2-5lbs overnight
• Monitor intake and output: If you're drinking water, make sure it's going out
• Avoid Na because patients are gonna retain water.

Dietary notes

• AVOID, NOT DECREASE, Sodium: Packaged, Frozen, Processed, and Fast foods MUST avoid.
• CAN have a salt substitute, BUT check with patient, CANNOT advise.

More Helpful Facts

• Get patients in some sort of cardiac rehab
• Decrease / Do not consume alcohol
• Do not smoke!
• If your pt asks if a bag of chips is okay, SAY NO!
• Pts will retain too much water, will be puffy, and swollen, and should AVOID such items.

Dietary No-Nos

• Say the opposite!
• No Nutrition diet.
• Dont Exercise
• Dont consume Etoh
• Dont Smoke

Additional Actions

• Administer drugs in the morning after taking morning weight, or right as the wake.
• Fluid overload can interfere with breathing, so know when it's a priority

PEDIATRIC CARDIO - Tetralogy of Fallot

• Four simultaneous pathologies occur due to an anatomical defect that the patient is born with
• Pulmonic stenosis
• Right ventricular hypertrophy - RVH
• Overriding aorta
• Ventricular septal defect - VSD R
• Varied Pictures Of A Ranch

What To do for Tetrology

• Boards want to know HOW you are going to MANAGE this patient with signs and symptoms

In Tetrology, the Overriding Aorta Closes

• When there is no blood returning to the heart, the overriding aorta closes the ability to give oxygenated blood.
• blood returns to the heart must to push this overriding aorta open, to give oxygenated blood out, instead of Ventricular Septal Defect (VSD).
• What keeps it open is blood flow coming back and blood flow going forward.
• Crying, BM taking - STRESS closes off overriding aorta, making baby turn blue.

Tetrology: Important Info To Remember and Manage

Symptoms include instantaneous cyanosis, and turning blue the first time they cry. To prevent:

• Don't cry!
• Don't get stressed!
• Avoiding large meals which can prevent breathing!
• Small frequent meals
• Comfort them.
• Avoid large meals, b/c when not breathing well, it closes it off: cyanotic.
• Dont startle them.
• Comfort them.
• Give a pacifier. Knee-to-Chest Positing
• The Board loves this!
• Take baby, push feet towards chest, pushing blood from right to left, forcing open overriding aorta, thus getting oxygenated blood out!

Dont Stress the Child

• B.C. of becoming cyanotic, hypercyanotic, deoxygenated, and having blue-spells.

Knee-to-chest Intervention if Pt is older

They will learn to squat in order to relieve deoxygenation. They Squat b/c it'll relieve their Tet spells. Give small frequent meals so the patient doesn't want to cry. A large meal may prevent breathing properly.

Other Key Facts Regarding Tetrology

• Education
• The #1 Skill you need On Board for education.
• Put them in a Knee-to-Chest position
• Or, as they get older, they learn to squat.

Congenital Defect: Not Managed with Meds: Needs Surgery

Kawasaki Disease

• Boards Favorite
• Etiology: Viral infection; unknown etiology

WBC Labs to Watch

1. Neutrophils for bacterial
2. Lymphocytes for viral
3. Eosinophils for allergy or parasites.

Key Facts About Kawasaki's and Coronary Arteries!

Key:

• Viral infection (attacking w/ Lymph) causes inflammation. Attacks inflammation of Vessels.
• Attacks coronary arteries. Coronary arteries provide hearts blood supply.

Coronary Arterties can lose their Structure in Kawaskai's

In general, attack inflammation and lose structural integrity > Will balloon out, weakening into aneurysms > Can rupture!!> hemorrhage, big-time.

• Check heart with echo auscultate EKG > look good? if coronary arteries weakened and turned aneurysms. Check heart!
• High priority to watch heart > the first and foremost. Aneurysm ruptures? Mortality.

Other Important Symptoms

Develop High Fever: 104-105 ranges Any child w/ fever at 104 - 105: seizures!

Two Major Considerations

• Hemorrhage
• Seizures. Prioritization? Protect against Aneurysm rupturing in heart.

control fever: not getting around that. need aggressive.

Key Facts About Immune In pediatric's Patient

• Boost their immune system with vaccine
• Kid to fight it off w/ given aspirin.
• Thin out blood, fever.

Caution Giving Aspirin and More Info

Do NOT give viral infection like Reyes syndrome with exception to Kawasaki where the doctor specifically said ok. Messes w/ liver • Inflamed encephalitis (brain)

Important Crash Characteristics In Kawasaki Dx

Conjunctivitis ( no big deal > distractor) Rash (Also Distractor) Aneurysm or fever, FOA as first indicator!! Hand/feet swelling Strawberry Tounge ( again the distarctor)

Do Not Miss and Key Treatment Kawasaki

• Artery Aneurysm b/c of hemorrhage
• Or fever! For the board: check hemorrhage versus fever!
• In order first, and then if pt given the boost, and doctor orders give no vaccine.
• Vaccine defer for 12 mth.

Patents Ductus Arteriosus

• Keep blood in uniform to not burden their lungs until 0x 72 hours after birth.
• That gives us, the machine sound of a "mur-mur"

To Address Murmur

• At 0x - 073 normal!
• To Address +073- Check NSAIDS !
• NSAIDS: end in methacin -ind= PDA =NSAIDS
• if Still No resolution? Surgery would be ok!

Pt in Ultero Facts; All Normal

• Need Bypass Lung .
• Have good Oxygen to keep blood nice and normal.

PDA Contraindications

• Not good w/ moms
• • Causes,
• Premature PDA closure

Cautious Recommendations

Don't Give NSAIDs, Especially 3th trimester! Continous

• Tylenol ok!

Moms Who Recommend Clots

• Not immediately to do any clotting preventives.
• If the patient has developed clots , that's when to give IV Heparin

Septal Defects

R/L Hearts has Septal Defect to treat... ( a "defect" or a "hole" in the heart). Ventricles (VSD) or Atrium (ASD) As growing starts will require de oxygenated to mix In with Oxygenated - that may not be fully oxygenated.

Hearts Action at Work

• the Heart works as a hard bc the body thinks its not receiving enough blood.
• HyperTrophy , which leads to heart failure

Assessments for Action

• • Know murmur for identify.
• S/S In septal at first :
• Grunting Lethargy
• That needs to happen asap or that would be the defect, or have long term solutions of open or repaired =
• A Septal is not a good candidate at all!!!!!
• We listen when they r born obvious w Pt in check with " murmurs sound and where at" that helps.

How To Support Those Who had Surgeries

• When to start check at 1 with a nurse and will then pic up murmurs as well !
• Important to Know after effects with those septals..
• To Identify at Murmur !
• Some may resolve , but others may not = and have to fix with surgery to perform

Otherwise = heart cant work.