Heart Failure PDF

# Heart Failure <br> The image shows a diagram of a heart with labels for the different parts of the heart. <br> # Learning Objectives At the end of this session, students will be able to: - Define HF - Understand the mechanism of controlling HF symptoms. - NYHA Classification of HF. - List...

# Heart Failure <br> The image shows a diagram of a heart with labels for the different parts of the heart. <br> # Learning Objectives At the end of this session, students will be able to: - Define HF - Understand the mechanism of controlling HF symptoms. - NYHA Classification of HF. - List types of HF - Identify risk factors and causes of HF - Illustrate the clinical manifestations - Predict complications - Provide diagnostic tests for HF. - Demonstrate appropriate nursing process <br> # Definition Heart failure is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients. <br> # Etiology of Heart Failure - The loss of a critical quantity of functioning myocardial cells after injury to the heart due to: - Ischemic Heart Diseases - Hypertension - Idiopathic Cardiomyopathy - Infections (e.g., viral myocarditis) - Toxins (e.g., alcohol or cytotoxic drugs) - Valvular Diseases - Prolonged Arrhythmias <br> # Classification of Heart Failure - **Onset:** - Acute Heart Failure - Chronic Heart Failure - **Affected Side Of The Heart:** - Left Heart Failure - Right Heart Failure - **Stages Of Heart Failure Severity:** - New York Heart Association - American Heart Association/American College of Cardiology <br> # Physical Examination - Auscultate heart rate and palpate peripheral pulses - Auscultate the chest for crackles and wheezing - Examine the heart for enlargement - Determine mentation status by asking the patient about memory, ability to concentrate. <br> # Heart Failure Classification | | **NYHA Classification o Functional Capacity** | **Description** | | --- | --- | --- | | | NYHA class I | Asymptomatic | | | NYHA class II | Symptoms with moderate exertion | | | NYHA class III | Symptoms with minimal exertion | | | NYHA class IV | Symptoms at rest | <br> # New Classification Based On Symptoms | | **New Classification Based On Symptoms** | **Corresponding NYHA class** | | --- | --- | --- | | | Asymptomatic | NYHA class I | | | Symptomatic | NYHA class II/III | | | Symptomatic with recent history of dyspnea at rest | NYHA class IIIB | | | Symptomatic with dyspnea at rest. | NYHA class IV | <br> # Vicious Cycle Of Heart Failure - The document shows a diagram with a vicious cycle of heart failure. - **Myocardial Disease / Injury**, **Impaired Ventricular Performance**, **Cardiac Workload**, **Ventricular Remolding**: Dilation & Hypertrophy **RAAS**: Vasoconstriction, Na/H2O Retention, **Cardiac Output**, **SNS**: HR, Contractility, Vasoconstriction <br> # Clinical Manifestations - The signs and symptoms of HF are most often described in terms of the effect on the ventricles. - **Right Sided Heart Failure:** (Right Ventricular Failure) - **Left-Sided Heart Failure:** (Left Ventricular failure), causes different manifestations than right-sided heart failure (right ventricular failure). <br> # Left Sided Heart Failure - **Symptoms** - Dyspnea on Exertion - Paroxysmal Nocturnal Dyspnea - Tachycardia - Cough - Hemoptysis <br> # Right Sided Heart Failure - **Symptoms:** - Abdominal Pain - Anorexia - Nausea - Bloating - Swelling <br> # What Are The Symptoms Of Heart Failure? - Think **FACES...** - Fatigue - Activities Limited - Chest Congestion - Edema or Ankle Swelling - Shortness of Breath <br> # Diagnosis - Response to treatment - ECG - CXR - ECHO - Angiography <br> # Treatment <br> # Nursing Management: Heat Failure - **Nursing Considerations** - Respiratory - Supplemental Oxygen - Good Lung Assessment - **Monitoring** - Hemodynamic Monitoring - Daily Weights - I&O's - Laboratory Results - i.e., electrolytes, BNP & digoxin levels - **Maintain** - Small Frequent Meals; Low In Salt - Skin Integrity <br> # Goals Of Treatment - Reduce the respiratory and cardiac workload - Reduce agitation of patient - Induce diuresis & vasodilatation - Reduce respiratory rate - Decrease heart rate - Establish the cause and treat. <br> # Therapy For Heart Failure The document shows a diagram for therapy of heart failure: - **Myocardial Dysfunction**, **Increased Load**, **Neurohomonal Activation**: Drug Therapy, **Cardiomyocyte Dysfunction**, **Drug Therapy**: Gene Therapy, **Cell Death**: Cell Transplantation, **Heart Failure**: Heart Transplantation <br> # Treatment Considerations - **Non Pharmacologic** - Diet: - Salt Restriction - Fluid Restriction - Weight Loss - Lipid Control - Alcohol - Smoking - Exercise - Cardiac Rehab - Palliative Services - Social Support - **Pharmacologic** <br> # Pharmacologic Interventions - **Good Evidence To use the following exist:** - ACE-Inhibitors - Beta Blockers - Spironolactone - Diuretics <br> # Angiotensin Converting Enzyme Inhibitors - **Indication:** All HF patients with sDysfunction (symptomatic or not). - **Goal:** Reduce morbidity & Mortality - **Dose:** Ideal dose controversial, start low and increase to common dose - **Precautions:** - Baseline Serum K+ and Cr. at initiation of therapy required. - Careful monitoring if sBP <100mmHg, or if elevated serum Cr. - Titrate as tolerated if administered with b-blockers. <br> # Beta Blockers - **Limit the donkey's speed, thus saving energy** - The image shows a donkey cart being pulled with a speed limit sign. <br> # Spironolactone - **Indication:** Symptom at rest or new onset of symptom in last 6mo. Beneficial for moderate to severe HF. - **Dose:** 25mg OD - **Precautions:** Monitor kidney function & K+, >25mg is rarely indicated. <br> # Diuretics - **Indication:** To control fluid overload (Edema, Ascites, WT gain) - **Goal:** Improve morbidity - **Dose:** - Usually Furosemide, start @ 20mg/d and incr/decr as needed - Diuretics can be stopped if fluid overload resolves. - **Precautions:** K+ wasting, typically given with KCI supplements, Monitor serum K+. <br> # ACE-Inhibitors - **Evidence For Use:** Systemic reviews & RTCs show that ACE-Inhibitors: - Reduced ischemic events - Improve exercise capacity - Slow disease progression - Decrease hospitalization & mortality for heart failure compared with placebo. <br> # Digoxin - **Indication:** - HF + A.fib - Patients still symptomatic despite use of Diuretics, ACEI & b-Blockers. - PRN use to control dyspnea at rest (existing or new onset) - **Goal:** Improve morbidity - **Dose:** 0.125-0.25mg/d - **Precautions:** - Digoxin levels (when toxicity is suspected). - Pushed to backburner b/c of recent discovery that it can incr risk of death from any cause amongst women (not men) w/HF and decr LVEF. <br> # Cardiac Resynchronization Therapy - **Increase the donkey's (heart) efficiency** - The image shows a donkey on roller blades pulling many sacks. <br> # Complications - Intractable heart failure - patient becomes progressively refractory to therapy. - Cardiac dysrhythmias - Digitalis toxicity (from decease renal function). - Pulmonary emboli, pneumonia - Cardiogenic shock