Week 9 Heart Failure PDF

structural abnormality or dysfunction that results in the inability of the ventricle to fill or eject blood....

structural abnormality or dysfunction that results in the inability of the ventricle to fill or eject blood. Heart Failure Definition and Causes Myocyte damage or loss Causes of heart failure include: Abnormal loading conditions arrhythmias Ejection fraction (EF) < 40% Relaxation of the left ventricle (LV) is good, but contractility is the problem Previously called congestive heart failure Heart Failure with Reduced Ejection Fraction (HFrEF) Causes include Congestion in lungs/ peripheries Hypertrophic ventricles Can be 2y to chronic HTN Has more treatment options compared to left side vs right side HF Classifications of Heart Failure HFpEF Cell death (MI) Ejection fraction (EF) > 50% Contractility of the LV is good, but relaxation is the problem Heart Failure with Preserved Ejection Fraction (HFpEF) LV cannot relax enough during diastole, leading to reduced filling volume, reduced stroke volume, and reduced cardiac output Causes include chronic hypertension affecting LV hypertrophy and aortic stenosis Most common form of heart failure Outcomes remain poor, with high 90-day Acute Heart Failure rehospitalization and 1-year mortality rates Current guidelines recommend early diagnosis and initiation of treatment within the first 30-60 minutes of hospital admission Aims to reduce hospital presentations and manage symptoms Chronic Heart Failure Involves heart failure nurses in the community, up-titration of medications to target doses, and hospital avoidance Heart Failure strategies Sympathetic nervous system renin-angiotensin-aldosterone system Compensatory Mechanisms anti-diuretic hormone Natriuretic peptides BNP Beta-blockers The four pillars of guided medical therapy: Mineralocorticoid receptor antagonists (spironolactone, eplerenone) Treatments and Management ARNI (sacubitril/valsartan) SGLT2 inhibitors (dapagliflozin) Optimized therapy Heart failure nurse support Inotropic infusions (levosimendan, dobutamine) Implantable cardiac resynchronization Advanced heart failure therapies: therapy (CRT) with or without defibrillator Left ventricular assist device (LVAD) Biventricular assist device (BIVAD) Heart transplant Daily weight monitoring Finding the patient's "dry" weight Fluid restriction and fluid balance charting Nursing Interventions ECG monitoring Electrolyte monitoring Reviewing imaging reports (X-ray, echocardiogram) Patient education