Congestive Heart Failure PDF

CONGESTIVE HEART FAILURE  Diastole Phase of the heartbeat when the myocardium relaxes and allows the chambers to fill with blood.  Systole Phase of the heartbeat when the myocardium contracts and pumps blood (away) from the chambers into the arteries....

CONGESTIVE HEART FAILURE  Diastole Phase of the heartbeat when the myocardium relaxes and allows the chambers to fill with blood.  Systole Phase of the heartbeat when the myocardium contracts and pumps blood (away) from the chambers into the arteries. Loading…  Normal function of the ♥: To provide the body with enough C.O so that metabolic needs of the peripheral tissue should be met.  Normal ♥: Loading…Normal C.O. = 4-6 L/min  When ♥ fails: When you fill the ♥ properly; inspite of it, the ♥ is unable to maintain enough C.O. to meet the demands of the body. No. 1 cause of mortality in the country-DOH 123,067 deaths Early Sx: Fatigue Edema in ankles, feet, and leg Weight gain Nocturia Sx that condition has worsen: Arrhythmia Chronic dry cough Cardiac wheezing SOB Sx that indicate a severe ♥ condition: Radiating chest pain Tachypnea Cyanosis Fainting CHF Stages: CLASS 1 CLASS 2 CLASS 3 CLASS 4  FACTORS THAT DETERMINE CHF: C.O. = HR X SV C.O. Loading… How much blood your heart can pump in a minute. For a healthy adult @ rest 4-6 L/min.  FACTORS THAT DETERMINE CHF: C.O. = HR X SV C.O. The ♥ is unable to maintain enough C.O. to meet the demands of the body.  FACTORS THAT DETERMINE CHF: C.O. = HR X SV HR The number of times each minute that your heart beats. A normal resting heart rate for adult's ranges from 60-100 bpm.  FACTORS THAT DETERMINE CHF: C.O. = HR X SV SV (Stroke Volume) The amount of blood ejected by the ♥ in one beat/rate. 60-120ml/beat Formula: SV = EDV - ESV  SV (Stroke Volume) SV = EDV – ESV EDV The volume of blood that is in the ventricles (RV & LV) “before” the heart contracts. “Pre-load”  SV (Stroke Volume) SV = EDV – ESV ESV The volume of blood in the ventricles after each ♥ contraction. “Afterload” DETERMINANTS OF SV: Intrinsic health of myocardium Pre-load After load  INTRINSIC HEALTH OF MYOCARDIUM SV L-SIDE OF THE ♥ : Factors: HR How many times the L-ventricle contracts/min? How healthy is the myocardium?  PRE-LOAD (=EDV) SV “ALL ABOUT THE HEALTH OF THE HEART” Amount of blood present in the ventricular cavity @ the end of diastole or just before the systole(ejection of blood). Normally: 55-70% of blood will be ejected by the ventricles. “EJECTION FRACTION”(EF) >70% High function 40% indication of ♥ failure < 30% severe ♥ rEF  AFTERLOAD (=ESV) SV “ALL ABOUT RESISTANCE” The volume of blood in the ventricles @ the end of contraction (systole), and @ the beginning of filling (diastole). *The pressure of the ♥ must work against PVR (RV), SVR (LV) and TPR (Arterioles)  Stroke Volume: Heath condition of myocardium Amount of Pre-load Level of resistance- should be overcome by the Afterload  ↑ Pre-load too much Normal Pre-load + ↑ resistance (Afterload) ♥ Will fail ↑ Pre-load: Mitral stenosis (LA & LV) Mitral valve regurgitation Over transfusion Aortic regurgitation (LV) L → R shunting of blood  ↑ Afterload: Systemic HPN Pulmonary HTN Aortic stenosis  Types of CHF according to C.O. HIGH OUTPUT FAILURE (H.O.F) There is an ↑ C.O. but the body’s demand is too much. ↑ Cellular demand ↑ HR ↓ SVR Activation RAAS = ↑ Pre-load ↑ C.O.  HIGH OUTPUT FAILURE (H.O.F) ↑ Cellular demand COPD, Hyperthyroidism, thyrotoxicosis, Severe anemia, Pregnancy, Paget’s disease, Beri-beri, Arterio-Venous Fistulas (AVF)  Types of CHF according to C.O. LOW OUTPUT FAILURE (L.O.F) ↓ C.O. Normal Cellular demand Intrinsic problems Disease in myocardium Ischemic ♥ disease Infiltrative disease – Amyloid ♥ tissue  Types of CHF according to C.O. LOW OUTPUT FAILURE (L.O.F) ↓ C.O. Normal Cellular demand Extrinsic problems Drugs induced: Cardiotoxic Alcohol, Chemotherapeutic drugs, Inotropic drugs drugs Overdose: Beta- blockers, Ca-channel blockers  L.O.F. ↑ Venous filling ↓ ↑ Pre-load too much = ↑ EDV (↑ blood volume) ↓ ↑ Ventricular pressure ↓ ↑ The stretch of myocardium = ↑ ♥ contractility (*If myocardium is stretched beyond physiologic limits) Pierre-Simon Laplace Law Pressure= Tension/ Radius Tension = 600u Radius = 5cm Normal Pressure = 120mmHG  L.O.F. ↑ Afterload = ↑ Pressure Rate & Rhythm problems: severe bradyarrhythmia & Loading… tachyarrhythmia  LEFT-SIDED HEART FAILURE (LV FAILURE) Most common Causes: Too much ↑ in Preload & ↑ Afterload @ the LV, MI LV hypertrophy → unable to eject blood properly Produces: S3 sound → Volume overload S4 sound → Pressure overload “♥murmurs” Clinical Sx: Edema Congestion of Pulmonary system LEFT-SIDED HEART FAILURE (LV FAILURE) ↑ Pulmonic Vein Pressure – LA Blood will be pushed/regurgitate back to the lungs Cause leakage to the pulmonary capillaries Pulmonary/Alveolar edema Pulmonary congestion Non-compliant Lungs Compensatory mechanism: Intercoastal muscle will overwork Difficulty in breathing Paroxysmal Nocturnal Dyspnea & Orthopnea  LEFT-SIDED HEART FAILURE (LV FAILURE) Bronchial edema Chronic dry cough Bronchial narrowing Sx: Frothy-pink sputum Cardiac wheezing * Overtime this will lead to pulmonary HTN (Pulmonary Artery-RV –Right-Sided ♥ Failure)  RIGHT-SIDED HEART FAILURE (RV FAILURE) Rare condition Cor pulmonale 2° to LVF Right-side of the ♥ becomes hypertrophic d/t pulmonary HTN ↓ Pulmonic valve stenosis & Pulmonic valve regurgitation ↓ Volume overload & ↑ Pressure @ the RV  RIGHT-SIDED HEART FAILURE (RV FAILURE) Volume overload & ↑ Pressure @ the RV ↓ RA will have a difficulty to drain blood into the RV ↓ Backfires pressure to the systemic circulation (SVC)(IVC) ↓ (SVC) ↑ Pressure in the jugular vein “Jugular Vein Distention”  RIGHT-SIDED HEART FAILURE (RV FAILURE) ↑ Pressure SVC ↓ ↑ es hydrostatic pressure in systemic circulation ↓ Plasma fluid will leak/ooze out of the blood vessel ↓ Anasarca  RIGHT-SIDED HEART FAILURE (RV FAILURE) (IVC) ↑es pressure @ the portal circulation ↓ blood will be dumped down to the hepatic circulation ↓ Impaired the drainage of hepatic venous blood to the IVC ↓ Hepatomegaly and splenomegaly RIGHT-SIDED HEART FAILURE (RV FAILURE) Hepatomegaly ↓ Ascites  BI- VENTRICULAR HEART FAILURE Pulmonary edema Congested systemic & LVF Portal circulation RVF CONGESTIVE HEART FAILURE A heart that always understands also gets tired Treatment Goals: To improve Sx; to enhance well being & quality of life ACE Inhibitors Used if EF is ↓ ed ↓ Preload ↓ Afterload ↓ Arrythmia ↓es Stress in the ♥ suffix “pril” Captopril, Enelapril, Lisonipril,Ramipril, Fosinopril  ACE Inhibitors SE: C ough A ngioedema P roteinuria T aste changes HypOtension P regnancy R ashes I ncrease K and Renin levels L ow Angiotensin II Aldosterone  Betablockers Diuretics ↓ Afterload Vasodilator Loop diuretics = ↓ GFR & failing ♥ K sparing diuretics  Inotropic drugs Positive Inotropes Stronger ♥ muscle contraction Cardiac myocytes ↑ C.O. Epinephrine/Norepinephrine Dopamine Digoxin  Inotropic drugs Negative Inotropes ♥ muscle contracts w/less force Verapamil Clonidine (Catapres)