Congestive Heart Failure (LMS) PDF

CONGESTIVE HEART FAILURE. What is heart failure? - is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients. - was often referred as “Congestive heart failure (CH...

CONGESTIVE HEART FAILURE. What is heart failure? - is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients. - was often referred as “Congestive heart failure (CHF)” - CHF is recognized as a clinical syndrome characterized by signs and symptoms of fluid overload and inadequate tissue perfusion.  Two types of Heart failure Systolic Heart failure - the most common type. It occurs when the heart muscle doesn’t contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body. It is characterized by a weakened heart muscle. Diastolic Heart failure - the less common type. It occurs when the heart contracts normally, but the ventricles do not relax properly making it difficult for the ventricle to fill. It is characterized by a stiff and a noncompliant heart muscle.  How to know if it is systolic or diastolic HF? An assessment of “ejection fraction (EF)” is performed by ECG to assist in determining the type of HF. EF can be calculated by: amount of blood present at the end of diastole – amount of blood present in the left ventricle at the end of systole. Then calculating the percentage of blood that is ejected. Or by Formula: EF (%) = AB / TAB. Where, EF = Ejection Fraction. AB = Amount of Blood Pumped out of the Ventricle. TAB = Total Amount of Blood in Ventricle. The ejection fraction formula uses the blood amount in ventricles. NORMAL EF : 55% - 65% of the ventricular volume In diastolic HF, normal EF. In systolic HF, severely reduced EF. causes Atherosclerosis CAD Hypertension Valvular diseases Cardiomyopathy  Signs and symptoms Right-sided Left-sided heart failure – heart failure – aka right ventricular failure. aka left ventricular failure. Peripheral and viscera Pulmonary congestion occurs. congestion occurs. The sign and symptoms are related to congestion and poor perfusion. These can also be related to the ventricle that is most affected.  Left-sided HF Right sided HF Pulmonary congestion Peripheral tissues and viscera congestion  dyspnea  orthopnea  dependent edema (edema in lower ext)  Paroxysmal nocturnal dyspnea  Abdominal bloating  Cough (recumbent or exertional)  Pulmonary crackles that do not clear with  Ascites cough  Low oxygen saturation  Hepatomegaly  S3 or ventricular gallop  Weight gain Low Perfusion/ Low Cardiac Output  Oliguria Low perfusion/ low cardiac output  Nocturia  anorexia  Altered digestion  Dizziness  nausea  Restlessness  abdominal pain  Confusion  Cool Clammy skin  generalized weakness  fatigue  distended jugular veins  NYHA CLASSIFICATION OF HEART FAILURE Stage Main symptoms Class I You don’t experience any symptoms during typical physical activity. You’re likely comfortable at rest, but normal Class II physical activity may cause fatigue, palpitation and shortness of breath. You’re likely comfortable at rest, but there’s Class III a noticeable limitation of physical activity. Even mild exercise may cause fatigue, palpitations, or shortness of breath. You’re likely unable to carry on any amount Class IV of physical activity without symptoms, which are present even at rest.  AMERICAN COLLEGE OF CARDIOLOGY AND AHA CLASSIFICATION CLASSIFICATION CRITERIA STAGE A Patients at high risk for developing left ventricular dysfunction but without symptoms of CHF STAGE B Patients with left ventricular dysfunction who have not developed symptoms of HF STAGE C Patients with left ventricular dysfunction with current symptoms of HF STAGE D Patients with refractory end-stage HF requiring specialized interventions  How is it diagnosed? Laboratory tests serum electrolytes, BUN, Creatinine, Liver function test, thyroid stimulating hormone, CBC, routine urinalysis. B-type Natriuretic Peptide blood test (BNP) key diagnostic indicator of HF, high levels occur in persons with heart failure. ECG, EF, Echocardiogram, Cardiac Catheterization, stress test  MEDICAL MANAGEMENT PHARMACOLOGICAL THERAPY 1. ACE Inhibitors (Lisinopril, Enalapril) 2. Angiotensin II Receptor Blocker (Valsartan, Losartan)  Decreases BP and afterload,  relieves signs and symptoms of HF,  prevents progression of HF KNC: Observe hypotension, increased potassium, cough, worsening renal function  PHARMACOLOGICAL THERAPY 3. Peripheral Vasodilator, Nitrovasodilator (Hydralazine, Dinitrate) Dilates blood vessels Decreases BP and afterload KNC: Observe hypotension  PHARMACOLOGICAL THERAPY 5. Beta-blockers (Metaprolol, Carvidelol)  Dilates blood vessels and decreases afterload  decreases signs and symptoms of HF  Improves exercise capacity KNC: Observe hypotension, decreases HR, dizziness and fatigue  PHARMACOLOGICAL THERAPY 6. Diuretics Loop Diuretics : Furosemide (Lasix) Thiazide diuretics : Metolazone (Zaroxolyn)  decreases fluid volume overload  Decreases signs and symptoms of HF KNC: Observe for electrolyte imbalances, renal dysfunction, decreased BP. Carefully monitor I&O and daily weight. 7. Digitalis : Digoxin (Lanoxin)  Improves cardiac contractility  Decreases sign and symptoms of HF KNC: Observe for bradycardia and digitalis toxicity  IV INFUSIONS 1.Milrinone (Primacor) - is a pulmonary vasodilator used in patients who have heart failure. It is a phosphodiesterase 3 inhibitor that works to increase the heart's contractility and decrease pulmonary vascular resistance. Milrinone also works to vasodilate which helps alleviate increased pressures (afterload) on the heart, thus improving its pumping action. 2. Dobutamine (Dobutarex) - is a medication used in the treatment of cardiogenic shock and severe heart failure. It may also be used in certain types of cardiac stress tests. It is given by injection into a vein or intraosseous as a continuous infusion. The amount of medication needs to be adjusted to the desired effect. Onset of effects is generally seen within 2 minutes. ADDITIONAL THERAPY 1. supplemental oxygen  OTHER INTERVENTIONS 1. Implantable Cardioverter Defibrillator For patients with dysrhythmia 2. Cardiac synchronization Therapy  For patients with HF who doesn’t improve with standard therapy  NUTRITIONAL THERAPY 1. Low NA intake (no more than 2 g/day) diet 2. Avoid excessive fluid intake Reduces fluid retention  reduces symptoms of peripheral and pulmonary congestion  LIFESTYLE CHANGES  Restriction of dietary sodium  Smoking cessation  Avoidance of alcohol intake  Weight reduction when indicated  Regular exercise SURGICAL PROCEDURES 1. CABG (Coronary Artery Bypass Grafting Surgery 2. Heart Valve Surgery (Balloon Valvuloplasty) 3. Implantable Left Ventricular Assist Device (LVAD) 4. Heart transplant (for end-stage HF)  Nursing Interventions 1. Promoting Activity tolerance Type of physical activity should be encouraged. Patient’s response to activities must be monitored. 2. Managing fluid volume Oral diuretics must be given in the morning so that diuresis will not interfere at night rest. Fluid status must be monitored thru auscultation of lungs, monitoring body weight, assisting patient to adhere low NA diet. Patient is positioned or taught how to assume a position that facilitates breathing Assess for skin breakdown and institutes preventive measures. 3. Controlling anxiety Promote physical comfort and provide psychological support. Educate patient and family about techniques for controlling anxiety. 4. Minimizing powerlessness Take time to listen actively to patients, it will encourage them to express their concerns. 5. Monitor and manage potential complications Watch out for hypokalemia, hyperkalemia, hyponatremia, dehydration and hypotension, hyperuricemia 6. Promoting home care and continuing care Provide patient education that involves patient and family to promote understanding. Instruct them about medication management, low sodium diet, moderate alcohol consumption, activity and exercise recommendations, smoking cessations, how to recognize signs and symptoms and when to contact healthcare provider. THAAAANNNNNNNNNK YOOOU! It is characterized by a weakened heart muscle. What type of HF is this? The ejection fraction falls lower than 55% of ventricular volume. What type of HF is this? It is known as the primary cause of HF. Left-side heart failure : Pulmonary Congestion; Right-side heart failure : ________________ What type of heart sound occurs in pulmonary congestion? I have a heart failure. I am comfortable at rest, but I experience fatigue, palpitation and shortness of breath during normal physical activity. In what NYHA classification of heart failure do I belong? What is the amino acid polypeptide that is released by the heart in response to excessive stretching of heart muscle? What is its normal value? I am a patient who cannot tolerate ACE Inhibitors because of its side effect which is dry persistent cough. What type of medication is used as an alternative? I have an end-stage HF. It is the only option left for my long-term survival.