Heart Failure Lecture Notes PDF

‫قسم تقنيات طب الطوارئ‬ ‫واالسعافات االولية‬ ‫المرحلة األولى‬ ‫مادة تمريض الباطني‪ /‬نظري‬ ‫المحاضرة الرابعة‬ ‫‪Heart Failure‬‬ ‫‪Prepared by‬‬ ‫‪PhD. Muntadher A. Thamer‬‬ Heart failure Heart failure is a clinical syndrome that results from the progressive process of re...

‫قسم تقنيات طب الطوارئ‬ ‫واالسعافات االولية‬ ‫المرحلة األولى‬ ‫مادة تمريض الباطني‪ /‬نظري‬ ‫المحاضرة الرابعة‬ ‫‪Heart Failure‬‬ ‫‪Prepared by‬‬ ‫‪PhD. Muntadher A. Thamer‬‬ Heart failure Heart failure is a clinical syndrome that results from the progressive process of remodeling, in which mechanical and biochemical forces alter the size, shape, and function of the ventricle's ability to pump enough oxygenated blood to meet the metabolic demands of the body. Definition of terms Preload: The amount of ventricular stretch prior to cardiac contraction determined by the pressure and volume of blood in the ventricle at the end of diastole. Afterload: The pressure and volume of blood in the ventricle during systole; The amount of resistance or the pressure against which the heart must overcome to pump blood during systole.  Heart failure Classification of Heart Failure Etiology of heart failure Disorders of heart muscle resulting in decreased contractile properties of the heart MI Hypertension valvular heart disease congenital heart disease cardiomyopathies dysrhythmias. Pathophysiology of heart failure Risk factors of heart failure 1. Hypertension. 2. Hyperlipidemia. 3. Diabetes. 4. CAD. 5. Family history. 6. Smoking. 7. Alcohol consumption. 8. Use of cardiotoxic drugs.  Clinical Manifestations 1. Left ventricular failure Signs of left ventricular failure are evident in the pulmonary system Cough, which may become productive with frothy sputum Dyspnea on exertion Orthopnea Paroxysmal nocturnal dyspnea Presence of crackles on auscultation Tachycardia Pulsus alternans Fatigue Pallor Cyanosis Confusion and disorientation  Clinical Manifestations 2. Right ventricular failure Signs of right ventricular failure are evident in the systemic circulation Pitting edema in the feet, legs, sacrum, back, and buttocks Ascites from portal hypertension Tenderness of right upper quadrant. Distended neck veins Pulsus alternans Abdominal pain, bloating Anorexia, nausea Fatigue Weight gain Nocturnal diuresis  Diagnostic Evaluation Echocardiography may show ventricular hypertrophy, dilation of chambers, and abnormal wall motion. ECG (resting and exercise)show ventricular hypertrophy &ischemia. Chest X-ray may show cardiomegaly, pleural effusion, and vascular congestion. Cardiac catheterization to rule out CAD ABG studies may show hypoxemia due to pulmonary vascular congestion. Liver function studies may be altered because of hepatic congestion.  Treatment of Heart Failure 1. General Measures 2. Reduction of Excess Volume Overload (Preload Reduction) 3. Improvement of Ventricular Function (Afterload Reduction) 4. Surgical and Revascularization Measures 1. 2. Reduction of Excess Volume Overload (Preload Reduction) The excess retention of salt and water increases the extracellular fluid and the blood volume. Removing this is needed to reduce the preload on the heart. Various types of diuretics are available for reduction of the excess fluid in the body. Includes Loop Diuretics: eg: Furosemide Thiazide and Thiazide-Like Diuretics: eg: Hydrochlorothiazide Potassium Sparing Diuretics: eg: Amiloride 3. Improvement of ventricular function (Afterload Reduction) Medications that antagonize the sympathetic nervous system and renin angiotensin aldosterone system are helpful in improving the ejection fraction in patients with HF. These medications act by promoting vasodilation which decreases systemic vascular resistance and afterload. Angiotensin Converting Enzyme Inhibitors (ACEIs): eg: Captopril, Enalapril. Angiotensin Receptor Blockers (ARBs): eg: Losartan, Valsartan. Beta Blockers (BBs): Metoprolol, Carvedilol. Ivabradine: This is a drug which reduces heart rate. Digoxin: It is indicated for ventricular rate control in atrial fibrillation. Hydralazine + Isosorbide Dinitrate: This combination is used in patients who cannot take ACEIs or ARBs due to side effects or renal dysfunction. 4. Surgical and Revascularization Measures 1. angioplasty or coronary artery bypass graft (CABG) 2. Valve repair surgery or valve replacement 3. Heart transplantation Heart failure  Nursing care plan Nursing Diagnoses: Decreased Cardiac Output related to impaired contractility and increased preload and afterload Nursing planning: Maintaining Adequate Cardiac Output Nursing Interventions: Place patient at physical and emotional rest to reduce work of heart. Evaluate frequently BP readings. Auscultate heart sounds frequently and monitor cardiac rhythm. Note presence of S3 or S4 gallop Monitor for premature ventricular beats. Administer pharmacotherapy as directed. Evaluation: Normal BP and heart rate  Nursing care plan Nursing Diagnoses: Impaired Gas Exchange related to alveolar edema due to elevated ventricular pressure Nursing planning: Improving Oxygenation Nursing Interventions: Raise head of bed Auscultate lung fields at least every 4 hours for crackles and wheezes Observe for increased rate of respirations Position the patient every 2 hours Encourage deep-breathing exercises every 1 to 2 hours Administer oxygen as directed. Evaluation: Respiratory rate 16 to 20, ABG levels within normal limits, no signs of crackles or wheezes in lung fields  Nursing care plan Nursing Diagnoses: Excess Fluid Volume related to sodium and water retention Nursing planning: Restoring Fluid Balance Nursing Interventions: Administer prescribed diuretic as ordered. Give diuretic early in the morning, nighttime diuresis disturbs sleep. Keep input and output record Weigh patient daily to determine if edema is being controlled: weight loss should not exceed (0.5 to 1 kg)/day. Evaluation: Weight decrease of (1 kg) daily, no pitting edema of lower extremities and sacral area Thank you