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Transcript
CARDIAC FAILURE Cardiac failure -Definition A physiologic state in which the heart is unable to pump enough blood to meet the metabolic needs of the body at rest or during exercise even though filling pressures are adequate. Etiology Acute causes Acute M.I Dysrthymias Pulmonary emboli Thyrotoxicosis Hypertensive crisis Papillary muscle rupture VSD Chronic causes CAD Hypertension RHD Congenital heart disease Cardiomyopathy Pulmonary diseases Bacterial endocarditis Anaemia Valvular disorders Pathophysiology Left heart failure Hypertension Increase force of LV contraction Increase LV O₂ demand CM Increase LV hypoxia Decrease force of LV contraction Decrease B.P Increase LV preload Increase LA preload Pulmonary oedema Right heart failure pulmonary pathology Increase pulmonary vascular resistance Increase force of RV contraction RV hypoxia Decrease force of RV contraction Increase RV preload Increase RA preload Peripheral oedema Compensatory mechanisms Increase in SNS activity Ventricular hypertrophy Ventricular dilation Renin-angiotensin-aldosterone system ADH Endothelin Proinflammatory cytokines Counterregulatory mechanisms Natriuretric peptides Nitric oxide Clinical features Left heart failure- symptoms Dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea, nocturia dizziness, confusion, diaphoresis and cool extremities at rest Right ventricular failure - symptoms Weakness Anorexia Indigestion Weight gain Mental changes Left heart failure - signs Displaced apex beat Heart murmurs Tachypnea, tachycardia Crackles Dullness - lung fields to percussion and diminished breath sounds at the lung bases (pleural effusion) cyanosis, cough, hemoptysis Increased PAP Right-sided signs 1. Peripheral edema 2. Ascites 3. Hepatomegaly 4. Increased jugular venous pressure 5. Hepatojugular reflux 6. Anasarca 7. Spleenomegaly Investigations Echocardiography Chest roentogram Electrophysiology Angiography Blood tests Electrolytes (sodium, potassium), renal function, liver function tests, thyroid function tests, complete blood count, C-reactive protein B-type natriuretic peptide (BNP) Cardiac markers- M.I Pharmacological management Angiotensin-modulating agents Diuretics Beta blockers Positive inotropes Vasodilators Vasopressin receptor antagonists Human b – type natriuretric peptide Devices and surgery Bi-ventricular pacemaker Implantable cardioverter-defibrillator Ventricular assist devices Cardiac transplantation Nursing management High Fowlers position Legs in dependent position Oxygen Activity restrictions Emotional rest Allay the anxiety Monitor ECG, S. electrolytes Contd… Small meals than larger ones Monitor weight daily Maintain intake & output chart Restrict sodium & fluid intake Avoid activities that create valsalva response Self care needs Increase activity gradually & as tolerated Medications Thank you