NCMA219

Congestive Heart Failure

  • inability of the heart to pump an adequate amount of blood to the systemic circulation

  • causes are structural abnormalities

  • where sodium goes water follows

  • aldosterone is salt saving

  • more plasma in the blood will make it difficult for the heart leading to heart failure

Left Side Heart Failure (Oxygenated)

  • leads to pulmonary congestion

Symptoms:

  • dyspnea

  • orthopnea

  • rales / crackles

  • blood tinged frothy sputum

  • wheezing

  • dizziness

  • syncope (hypoxic episode of the brain)

  • weakness

Right Side Heart Failure (Unoxygenated)

  • lead to systemic congestion

Symptoms:

  • Neck vein engorgement (distended jugular vein)

  • Ascites (abdominal edema)

  • Peripheral edema (arms and legs)

  • Leg Varicosities (pressure on the legs)

  • Weight Gain (fluid retention)

IF NOT CORRECTED, decrease blood flow that will lead to impaired myocardial function

Impaired Myocardial Function

  • tachycardia

  • decrease urine output

  • fatigue

  • weakness

  • restlessness

  • anorexia

  • pale, cold extremities

  • weak peripheral pulses

  • decrease blood pressure

  • cardiomegaly

Pulmonary Congestion

  • tachyo

Systemic Venous Congestion

  • weight gain

  • hepatomegaly

  • peripheral edema

  • ascites

  • neck vein distention

Therapeutic Management

  1. improve cardiac function, digitalis therapy and ACE inhibitors (lanoxin/digoxin)

  • check heart rate if below 60 or above 120

Digitalis Toxicity

  • bradycardia

  • GI manifestations (vomiting, nausea, anorexia)

  • Dysrythmmias (most dangerous)

  • Altered visual perceptions (halos)

DRUG ALERT

  • toxicity: therapeutic serum digoxin levels range from 0.8 to 2mcg/L

  • dosing: infants rarely receive more than 1ml (50mcg, or 0.05mg)

  • because ACE inhibitors also block the action of aldosterone the addition of potassium supplements or spinorolactone (aldactone) to the drug regimenof patients raking diuretics and an ACE inhibitor may cause hyperkalemia

  • a fall in the serum potassium level enhances the effects of digoxin increasing the risks of digoxin toxicity. increased serum potassium levels diminish digoxins effect. therefore, serum potassium levels (normal range 3.5 to 5.5 mmol/L) must be carefully monitored

  • give digoxin at regular intervals usually every 12 hours such as at 8am and 8pm

  • administer drug carefully by slowly directing it to the side and back of the mouth

  • if the child vomits do not give second dose

  • if more than two doses are missed, notify physician for possible heart failure

  1. remove accumulated fluid/sodium, decrease cardiac workload by reducing circulating volume

  • diuretics such as furosemide (lasix), thazides (diuril), potassium sparing (aldactone)

  1. decrease cardiac demand

  • provide a neutral thermal environment to prevent cold stress in infants

  • treating any existing infections

  1. improve tissue oxygenation and decrease 02 consumption, supplemental humidified oxygen is given

  • 02 is also a drug hence an appropriate order is needed

  • captoprio (capoten),