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Heart Failure Cardiac Insufficiency What is Heart Failure? Heart failure is a progressive disorder in which damage to the heart causes weakening of the cardiovascular system. It is when the heart is no longer able to pump enough blood to sustain the body’s metabolic needs. What causes Heart Failure? For heart failure to occur, there must be an unresolved impairment of the heart that compromises its ability to work as a pump. The source of this can be a cutoff of blood supply, an increase in workload due to high blood pressure caused by non-functioning valves or a genetic predisposition. Heart failure can be worsened by a poor diet and lifestyle. The scenario below where the body is entering the early stages of heart failure due to blocked heart arteries Heart Failure Classifications Left Ventricular Failure Right Ventricular Failure Left Ventricular Failure The inability of the left side of the heart to pump into the systemic circulation. An increase pressure in the left side of the heart backs up into the pulmonary system & the lungs become congested with fluid. Left Ventricular Failure Fluid then leaks through the engorged capillaries & permeates air spaces in the lungs. If during each heart beat the right ventricle pumps out just one more drop of blood than the left, with in 3 hours the pulmonary blood volume will have expanded by 500 mL causing Pulmonary edema & Pleural effusion Right Ventricular Failure The inability of the right side of the heart to adequately pump venous blood into the pulmonary circulation. Most often cause is from the increase pressure from blood backing up from a failing left ventricle But right ventricular failure can also be a result of chronic pulmonary disease and pulmonary hypertension Right Ventricular Failure When the right ventricle cannot pump blood forward into the lungs results in peripheral congestion. It is unable to empty its blood volume therefore it cannot accommodate all the venous blood that is normally returned to the right side of the heart. Right Ventricular Failure Venous blood is reflected backwards into the systemic circulation. An increase venous volume and pressure force fluid out into the interstitial tissue causing peripheral edema. As a result of those failures, symptoms can be due to: Forward Heart Failure - The inability of the heart to pump blood at a sufficient rate to meet the oxygen demands of the body at rest or at exercise. Backward Heart Failure - The ability of the heart to pump blood at a sufficient rate ONLY when heart filling pressures are abnormally high. Congestive Heart Failure - Fluid in the lungs or body, resulting from inadequate pumping from the heart and high heart filling and venous pressures. Signs and Symptoms: Edema- from right ventricular failure Angina- chest or arm discomfort due to a blockage of the coronary arteries; enough oxygen when blood flow to the heart muscle is reduced. Shortness of Breath Nocturnal Dyspnea Orthopnea Fatigue- Sluggishness may be the result of your organs not getting enough oxygen. Loss of Appetite- Fluid accumulation in the digestive organs can cause you to feel full. Medical Test Chest X-ray: Pulmonary congestion shows up as cloudy areas on the x-ray Medical Test Echocardiogram Electrocardiogram Tracer Studies Treadmill Test / Stress Test Catheterization BUN Creatine Liver function values B-type natriuretic peptide (BNP) Treatment Cardiac Glyosides: digoxin (Lanoxin) Diuretics: furosemide (Lasix) Sedative and Analgesics: Morphine & Temazepam (Restoril) Nitrates: Nitroglycerin ACE Inhibitors: Captopril (Capoten) B-Adrenergic Blockers: Carvedilol (Coreg) Inotropic Agents: Dobutamine (Dobutrex) Potassium Supplements Surgical Procedure Percutaneous Transluminal Coronary Angioplasty (PTCA) Angioplasty Stenting Coronary Artery Bypass Graft Surgery Valve Surgery Heart Transplantation Surgical Procedure: Left Ventricular Assist Device An electrically driven mechanical pump about 1.5 pounds an electronic controller power supply- 2 external batteries, via a cable through the abdomen The pump is Placed in the abdominal cavity, the LVAD takes blood from the left ventricle and pumps it into the aorta. The LVAD normally pumps at a rate of 60-80 beats per minute, but can increase to 120 beats per minute with exercise. Prevention Low in sodium- High in potassium Exercise Weight Management Stress Smoking Alcohol