Htn Heart Failure 2010


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Htn Heart Failure 2010

  1. 1. Hypertension
  2. 2. Objectives <ul><li>Describe the mechanisms of blood pressure elevation </li></ul><ul><li>List risk factors for hypertension & CHF </li></ul><ul><li>Describe the clinical manifestations of hypertension & CHF and their significance for therapeutic management and nursing care </li></ul>
  3. 3. Hypertension <ul><li>A systolic blood pressure greater than 140mm Hg and a diastolic pressure greater than 90mm Hg over a sustained period </li></ul><ul><li>Heart is working harder putting heart & blood vessels under strain </li></ul><ul><li>High BP can contribute to myocardial infarction, stroke, renal failure & atherosclerosis </li></ul>
  4. 4. Primary (Essential) Hypertension <ul><li>Elevated BP without an identified cause </li></ul><ul><li>Accounts for 90 – 95% of all cases </li></ul><ul><li>Exact cause unknown </li></ul><ul><li>Contributing factors include increased SNS activity, overproduction of Na-retaining hormones & vasoconstrictors, ↑ Na intake, obesity, diabetes mellitus & excessive alcohol intake </li></ul>
  5. 5. Pathophysiology of Primary Hypertension <ul><li>For arterial pressure to rise there must be an increase in either CO or SVR </li></ul><ul><li>Hallmark of hypertension is a persistent elevation in systemic vascular resistance (SVR) </li></ul>
  6. 6. Secondary Hypertension <ul><li>Elevated BP with a specific cause that often can be identified & corrected </li></ul><ul><li>Causes include narrowing of aorta, renal diseases, endocrine disorders, neurological disorders, medications & pregnancy-induced hypertension </li></ul>
  7. 8. Risk Factors <ul><li>Increasing age </li></ul><ul><li>Excessive alcohol intake </li></ul><ul><li>Smoking </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>Elevated serum lipids </li></ul><ul><li>Excessive dietary sodium </li></ul><ul><li>Gender (men & post-menopausal women </li></ul><ul><li>Family history </li></ul><ul><li>Obesity </li></ul><ul><li>Sedentary lifestyle </li></ul><ul><li>Lower socio-economic groups </li></ul><ul><li>Stress </li></ul>
  8. 9. Clinical Manifestations <ul><li>“ Silent killer” – frequently asymptomatic until severe & target organ diseases has occurred </li></ul><ul><li>Severe hypertension may produce symptoms as result of effects on blood vessels & increased workload of heart </li></ul><ul><li>Can include fatigue, reduced activity tolerance, dizziness, palpitations, angina & dyspnoea </li></ul><ul><li>Headaches, nosebleeds & dizziness usually only occur with very high or very low BP </li></ul>
  9. 10. Risk factors for CV Problems in Hypertensive Pts <ul><li>Major Risk Factors </li></ul><ul><li>Smoking </li></ul><ul><li>Lipidemia </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>Over 60yrs </li></ul><ul><li>Gender (men & postmenopausal women) </li></ul><ul><li>Family history </li></ul><ul><li>Complications -Target Organ Damage </li></ul><ul><li>Heart diseases </li></ul><ul><li>Stroke or TIA </li></ul><ul><li>Nephropathy </li></ul><ul><li>Peripheral arterial disease </li></ul><ul><li>Retinopathy </li></ul>
  10. 11. Heart Failure
  11. 12. Heart Failure
  12. 13. Glossary <ul><li>Cardiac Output </li></ul><ul><li>Stroke volume </li></ul><ul><li>Syndrome </li></ul><ul><li>Hypertrophy </li></ul><ul><li>Cardiomyopathy </li></ul><ul><li>Hepatomegaly </li></ul><ul><li>Splenomegaly </li></ul><ul><li>Tachypnoea </li></ul><ul><li>Orthopnoea </li></ul><ul><li>Rhonchi </li></ul><ul><li>Crackle </li></ul>
  13. 14. Heart Failure <ul><li>Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients </li></ul><ul><li>A clinical syndrome characterized by signs and symptoms of fluid overload or of inadequate tissue perfusion </li></ul><ul><li>Signs & symptoms results when the heart is unable to generate a CO sufficient to meet the body’s demands </li></ul>
  14. 15. Heart Failure <ul><li>Most often this is a lif-long diagnosis that is managed with lifestyle changes and medications to prevent acute congestive episodes </li></ul><ul><li>Congestive heart failure (CHF) is usually an acute presentation of heart failure (HF) </li></ul>
  15. 16. HF <ul><li>Incidence increases with age </li></ul><ul><li>Incidence similar in men & women </li></ul><ul><li>The most common reason for hospitalization in adults over 65 yrs </li></ul><ul><li>Medical management is based on the type, severity and cause of HF </li></ul>
  16. 17. Types of HF <ul><li>Two types identified by assessment of left ventricular functioning </li></ul><ul><li>Diastolic heart failure – alteration in ventricular filling </li></ul><ul><li>Systolic heart failure – alteration in ventricular contraction </li></ul>
  17. 18. Pathophysiology of HF <ul><li>Results from a variety of CV diseases but leads to some common abnormalities that result in decreased contraction (systole), decreased filling (diastole) or both </li></ul><ul><li>Significant myocardial dysfunction usually present before patient experiences signs & symptoms of HF </li></ul>
  18. 19. Systolic Failure <ul><li>Most common cause of HF </li></ul><ul><li>Left ventricle loses ability to generate enough pressure to eject blood forward through the high pressure aorta </li></ul><ul><li>Caused by impaired contractile function e.g.. MI, hypertension, cardiomyopathy & cardiac valvular disease </li></ul>
  19. 20. Diastolic HF <ul><li>Impaired ability of ventricles to fill during diastole resulting in decreased stroke volume </li></ul><ul><li>Characterised by high filling pressures & resultant venous engorgement in both pulmonary and systemic vascular systems </li></ul><ul><li>Usually the result of LV hypertrophy from hypertension </li></ul>
  20. 21. Diastolic & Systolic Heart Failure
  21. 22. Mixed Systolic and Diastolic Failure <ul><li>Seen in dilated cardiomyopathy </li></ul><ul><li>Biventricular failure </li></ul>
  22. 23. Left-sided Failure <ul><li>Most common form </li></ul><ul><li>Blood backs up through the left atrium into pulmonary veins </li></ul><ul><li>↑ pulmonary pressure causes fluid to escape from the pulmonary capillary bed into the alveoli </li></ul><ul><li>Pulmonary congestion and oedema result </li></ul>
  23. 24. Right-sided Failure <ul><li>Primary cause is L) sided failure </li></ul><ul><li>Causes backward flow to the right atrium and venous circulation </li></ul><ul><li>Venous congestion in the systemic circulation results in peripheral oedema, hepatomegaly, splenomegaly, vascular congestion of GI tract & jugular vein distension </li></ul>
  24. 25. Risk Factors <ul><li>CAD </li></ul><ul><li>↑ age </li></ul><ul><li>Hypertension </li></ul><ul><li>Obesity </li></ul><ul><li>Cigarette smoking </li></ul><ul><li>Diabetes mellitus </li></ul><ul><li>High cholesterol </li></ul><ul><li>Maori descent </li></ul>
  25. 26. Acute Congestive Heart Failure Clinical Manifestations <ul><li>Typically presents as pulmonary oedema </li></ul><ul><li>Most common cause is LVF secondary to CAD </li></ul><ul><li>Agitation </li></ul><ul><li>Pale or cyanotic, cold, clammy skin </li></ul><ul><li>Severe dyspnoea, tachypnoea, orthopnoea </li></ul><ul><li>Wheezing, coughing, production of frothy, blood-tinged sputum </li></ul><ul><li>Crackles, wheezes & rhonchi throughout lungs </li></ul>
  26. 27. Heart Failure
  27. 28. Chronic Congestive Heart Failure Clinical Manifestations <ul><li>Depend on pt’s age, type & extent of heart disease & which ventricle is failing to pump effectively </li></ul><ul><li>Fatigue </li></ul><ul><li>Dyspnoea – Paroxysmal nocturnal dyspnoea </li></ul><ul><li>Tachycardia </li></ul><ul><li>Oedema </li></ul><ul><li>Nocturia </li></ul><ul><li>Skin changes </li></ul><ul><li>Chest pain </li></ul><ul><li>Weight changes </li></ul><ul><li>Behavioural changes – restlessness, confusion, ↓ attention span </li></ul>
  28. 29. Pitting Oedema
  29. 30. Heart Failure
  30. 31. Signs & Symptoms
  31. 32. Glossary <ul><li>Cardiac Ouput = heart rate X stroke volume </li></ul><ul><li>Stroke volume = amount of blood pumped by ventricle with each contraction </li></ul><ul><li>Syndrome = collection of signs and symptoms </li></ul><ul><li>Hypertrophy = increase in the size of an organ </li></ul><ul><li>Cardiomyopathy = any disease that affects the structure and function of the heart </li></ul><ul><li>Hepatomegaly = abnormal enlargement of the liver </li></ul><ul><li>Splenomegaly = abnormal enlargement of the spleen </li></ul><ul><li>Tachypnoea = abnormal rapid rate of breathing </li></ul><ul><li>Orthopnoea = abnormal condition when a person must sit or stand to breathe deeply or comfortably </li></ul><ul><li>Rhonchi = abnormal sounds heard on auscultation of an obstructed airway </li></ul><ul><li>Crackle = abnormal respiratory sound heard on auscultation of the chest, characterized by discontinuous bubbling noises </li></ul>