Complications from Heart Disease: A Brief Review

Heart Failure (HF)

  • Clinical syndrome from structural/functional cardiac disorders impairing ventricular filling/ejection.

  • Myocardial disease involving contraction (systolic failure) or filling (diastolic failure).

  • Often chronic, progressive; managed with lifestyle and medications.

  • Often called Congestive Heart Failure (CHF) due to congestion/edema.

  • Incidence increases with age; common hospitalization reason for those over 6565 years.

Clinical Manifestations of HF

  • Right-sided failure: RV cannot eject sufficient blood; venous system backup. Symptoms: peripheral edema, hepatomegaly, ascites, anorexia, nausea, weakness, JVD, weight gain.

  • Left-sided failure: LV cannot pump effectively; increased pulmonary venous pressures. Symptoms: pulmonary congestion with dyspnea, cough, crackles, impaired oxygen exchange.

  • Chronic HF often biventricular.

  • S3S_3 heart sound.

Medical Management of HF

  • Reduce etiologic/contributory factors.

  • Decrease cardiac workload (afterload, preload).

  • Prevent exacerbations.

  • Medications: ACE inhibitors, ARBs, Hydralazine + Isosorbide Dinitrate (combination), Beta-blockers, Diuretics, Digitalis.

Nursing Process for HF

  • Assessment: Health history, mental status, lung/heart sounds (S3S_3), fluid status (daily weight, I&O), medication response.

  • Activity Intolerance: Bed rest for acute exacerbations; encourage 30−4530-45 minutes daily physical activity; pacing activities; avoid extreme weather; conserve energy; elevate HOB.

  • Fluid Volume Excess: Assess fluid overload symptoms, daily weight, I&O, diuretic therapy, fluid/sodium restriction.

  • Patient Teaching: Medications, low-sodium diet/fluid restriction, monitoring for fluid excess/hypotension/exacerbation symptoms (daily weight), exercise, stress management, infection prevention, when to contact HCP, integrate family.

Pulmonary Edema

  • Acute event where LV cannot handle blood volume overload, increasing pulmonary vascular pressure and causing fluid movement into alveolar space, leading to hypoxemia.

  • Manifestations: Restlessness, anxiety, dyspnea, cool/clammy skin, cyanosis, weak/rapid pulse, cough, lung congestion (moist, noisy respirations), frothy/blood-tinged sputum, decreased LOC.

  • Management: Prevention, early recognition, upright position with dangling legs, minimize exertion/stress, oxygen, medications (diuretics like Furosemide, IV vasodilators like NTG).

Cardiogenic Shock

  • Life-threatening condition with high mortality.

  • Decreased CO leads to inadequate tissue perfusion and shock.

  • Manifestations: HF symptoms, shock state, hypoxia.

  • Management: Correct underlying problem, medications (diuretics, positive inotropic agents, vasopressors), circulatory assist devices (e.g., Intra-aortic balloon pump - IABP).

Thromboembolism

  • Increased risk in cardiac disorders/HF due to decreased mobility/circulation.

  • Pulmonary Embolism (PE): Blood clot from legs obstructs pulmonary vessels; most common thromboembolic problem in HF.

  • Management: Prevention, anticoagulant therapy.

Pericardial Effusion and Cardiac Tamponade

  • Pericardial Effusion: Fluid accumulation in pericardial sac.

  • Cardiac Tamponade: Restriction of heart function due to pericardial fluid, leading to decreased venous return and CO.

  • Manifestations: Ill-defined chest pain/fullness, pulsus paradoxus, engorged neck veins, labile/low BP, shortness of breath.

  • Cardinal signs of Tamponade: Falling systolic BP, narrowing pulse pressure, rising venous pressure, distant heart sounds.

  • Management: Pericardiocentesis, Pericardiotomy.

Sudden Cardiac Death/Cardiac Arrest

  • Emergency Management:

    • A - Airway

    • B - Breathing

    • C - Circulation (CPR)

    • D - Defibrillation for pulseless VT and VF

    • Therapeutic hypothermia.