Download Heart Failure

Lori Baker, RN BSN
Cardiovascular Disorders
HEART FAILURE
TERMS
• Cardiac Output
– Heart rate x stroke volume
– That is, amount of volume with each beat
multiplied by the number of beats
– 5L/min
• Compensatory mechanisms
Compensatory Mechanisms
• Sympathetic nervous system detects low
cardiac output
• HR speeds up
– Epinephrine and norepinephrine
• Raises CO
– Increases oxygen needs of heart
Compensatory Mechanisms
• Increase to heart means decrease to
kidneys
• Renin-angiotensin-aldosterone system
– ADH released to conserve water
– UOP decreases
– Fluid retention develops
– Adds to heart failure problem
– Cycle continues
Increased Workload = …
• Enlarged chambers
• Increased muscle mass
• Increased oxygen demand
What Start’s It?
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CAD
MI
Cardiomyopathy
Valve problems
HTN
Ischemia
Left-Sided Heart Failure
• Major cause – HTN
– Due to peripheral vascular resistance (PVR)
– HTN also causes hypertrophy
Left-Sided Heart Failure
• Other causative factors
– Restriction of blood flow from LV
• Aortic stenosis
• Coarctation of aorta
– Impairment of myocardial contractility
• MI
• Cardiomyopathy
– Backward blood flow
• MR
Left-Sided Heart Failure
• S/S
– Pulmonary
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Dyspnea
Orthopnea
Increased pulmonary pressures
Crackles/rales
Tachycardia
Chest pain
AMS
Pulmonary edema
Right-Sided Heart Failure
• Major cause – left-sided heart failure
• Other causative factors
– Increased pulmonary pressures (from chronic
or acute lung disease)
• Cor pulmonale
– Restriction of blood flow from the RV
• Pulmonary stenosis
– Abnormal flow of blood from LA to RA
• Atrial septal defect (ASD)
Right-Sided Heart Failure
• S/S
– Systemic
• JVD
• Peripheral edema
• Organomegaly
– Hepatomegaly
– Splenomegaly
• Nocturia
Heart Failure (general)
• Diagnostic Tests
– CXR – congestion, cardiomegaly
– ABG’s
– EKG
• Ischemia
• A-fib
– Hemodynamic monitoring
– ECHO
– Cardiac cath
– Renal and liver studies
Heart Failure (general)
• Treatment
– Goal is to increase cardiac output
– Oxygen
– Mechanical ventilation
– Semi-or high-Fowler’s
– Bed/chair rest initially
– VS
– UOP
– Daily weight
Heart Failure (general)
• Meds
– ACE inhibitors
• Captopril (Capoten)
– Diuretics
• Furosemide (Lasix)
– Beta-blockers
• Metoprolol (Lopressor)
• Meds
– Inotropes
• Digoxin (Lanoxin)
– Aldosterone antagonist
• Aldactone
– Vasodilators
• Nitroglycerin
Heart Failure (general)
• Pacemaker
Heart Failure (general)
• IAPB (intra-aortic balloon pump)
Heart Failure (general)
• VAD (ventricular assist devises)
Heart Failure (general)
• Cardiomyoplasty
Questions ???????????