Heart failure

circulation of blood through the heart

IVC, RA, tricuspid, RV, pulmonary, pulm artery, lungs, pulm vein, LA, bicuspid, LV, aortic, aorta, body

what does HF develop from

myocardial insult decreases body's O2 demands and CO

HF is

inadequate pump or fill of heart

HF causes interference with

preload, afterload, myocardial contractility, HR

preload

blood in vent before contraction/end of diastole

afterload

resistance heart overcomes to eject blood during systole

ejection fraction

SV (amount of blood ejected from vent) /EDV (amount of blood in vent before ejection)

what do we want ejection fraction to be? what EF is considered HF?

55-75%, <40%

HF patho

myocardial injury and dysfunction causes compensatory mechanisms that leads to remodeling

left sided HF

back up to lungs causes pulm congestion and edema

left sided HF results from inability of LV to

empty adequately during systole or fil adequately during diastole

left sided HF manifestations

tachy, crackles, pulm edema, change in mental status/confusion, shallow resp, dry cough, frothy pink sputum, S3 and S4

what s/s will a patient in left sided HF complain of

weakness, anxiety, dyspnea, paroxysmal nocturnal dyspnea, orthopnea, nocturia

right sided HF

blood back up to body causing fluid to move into tissues and organs

most common cause of right sided HF

left sided HF (pressure on lungs causes back up into RV and it increases workload and eventually fails)

other causes of right sided HF

RV infarction, pulm embolism, cor pulmonale

manifestations of right sided HF

tachy, murmur, JVD, edema, weight gain, ascites, anasarca, hepatomegaly

what s/s will a pt with right sided HF complain of

fatigue, anxiety, RUQ pain (liver), anorexia, GI bloat, nausea

what is cor pulmonale

type of RHF caused by pulmonary HTN NOT due to LHF

chronic heart failure

outpt dx, slow worsening cardiac function, caused by other cardiac event/disease

acute decompensated HF (ADHF)

inpt dx, urgent, body can't keep up, pt present w SOA d/t excess fluid caused by cardiac overload

dx HF

H&P, EKG changes, CXR (cardiomegaly, pleural effusion), echo (outline and size)

what labs help dx HF

BNP and ProBNP

the higher the BNP,

the more severe the s/s

chronic HF collaborative therapy

tx cause, O2 2-6 L, rest, daily weight, restrict sodium, LVAD, txp

drug therapy for chronic HF

ACE inhibitor, ARB, beta blocker, diuretic, nitrate, digoxin

teaching for digoxin

slow HR, increase contractility, narrow therapeutic index, hypokalemia aggravates toxicity

what should we do prior to giving digoxin

monitor potassium, take apical pulse for full min and hold if <60

digoxin antidote

digoxin immune fab (digibind)

s/s digoxin toxicity

brady, h/a, dizzy, confusion, nausea, visual disturbance

spironolactone for HF

helps decrease sodium/water retention to help offload the LV, hold onto potassium

LVAD

bridge to txp or destination therapy

key things to know about monitoring pt with an LVAD

can't take BP so doppler, heart tones cannot be heard d/t hum, only do CPR if pump is off

ADHF collaborative therapy

tx cause, VS/UO hourly, EKG and pulse ox, trend ABG, high fowlers helps ease workload of heart, O2 mark or bipap, daily weight

ADHF drug therapy

diuretic, vasodilator, morphine, positive inotrope

what is the goal of drug therapy with ADHF

decrease intravascular volume, decrease afterload, increase LV function, decrease anxiety