Heart Failure

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Heart Failure

  1. 1. HEART FAILURE Harmeet Kaur Kang Lecturer
  2. 2. Definition <ul><li>Heart failure is the term used when heart is unable to pump enough blood to meet the metabolic needs of body at rest or during exercise even though filling pressures are adequate. </li></ul>
  3. 3. Key words <ul><li>Preload : stretch of myocardial fibres at end diastole. </li></ul><ul><li>Afterload : force that the ventricle must develop to eject the blood during each contraction. </li></ul>
  4. 4. Key words <ul><li>Cardiac output : stroke volume X heart rate. </li></ul><ul><li>Stroke volume : the amount of blood ejected from the ventricle with each contraction. </li></ul>
  5. 5. Etiology & risk factors <ul><li>Abnormal load on heart. </li></ul><ul><li>Abnormal muscle function. </li></ul><ul><li>Other conditions that exacerbate heart failure. </li></ul>
  6. 6. Abnormal load on heart Overloading of the heart Excessive stretch Decreased contraction Decreased cardiac output
  7. 7. Abnormal muscle function <ul><li>Muscles replaced by scar tissue eg: MI </li></ul><ul><li>Externally compress the heart </li></ul><ul><li>Decreased diastolic relaxation and diastolic blood pressure </li></ul><ul><li>Hampers forward flow through heart. </li></ul>
  8. 9. Other factors <ul><li>Emotional stress </li></ul><ul><li>Dysrhythmias </li></ul><ul><li>Infections </li></ul><ul><li>Anemia </li></ul><ul><li>Thyroid disorders </li></ul><ul><li>Pregnancy </li></ul><ul><li>Paget’s disease. </li></ul>
  9. 10. Other factors <ul><li>Nutritional deficiency. </li></ul><ul><li>Pulmonary disease. </li></ul><ul><li>Hypovolemia. </li></ul>
  10. 11. Pathophysiology <ul><li>Diseased Normal </li></ul><ul><li>myocardium myocardium </li></ul><ul><li>Unable to meet the demands </li></ul><ul><li>Activation of compensatory system </li></ul><ul><li>(sympathetic stimulation fails ) </li></ul><ul><li>Increased residual volume in left ventricle </li></ul>
  11. 12. Pathophysiology (contd..) <ul><li>Decreased ability to receive blood from left atrium </li></ul><ul><li>Left atrium work hard to eject blood </li></ul><ul><li>Dilation and hypertrophy </li></ul><ul><li>Pulmonary edema and congestion </li></ul>
  12. 13. Pathophysiology (contd…) <ul><li>Increased pressure in pulmonary vascular </li></ul><ul><li>system </li></ul><ul><li>Right ventricular dilation&hypertrophy </li></ul><ul><li>Fails </li></ul><ul><li>Engorgement of systemic venous system </li></ul><ul><li>Congestion in GIT,Liver viscera,Kidneys,Legs,sacrum </li></ul>
  13. 14. Pathophysiology (contd..) <ul><li>Conditions that causes RVF </li></ul><ul><li>- Pulmonary diseases (PAH,Pulmonary </li></ul><ul><li>embolism,COPD,cor pulmonale) </li></ul><ul><li>- Constrictive Pericarditis </li></ul><ul><li>- Tricuspid and pulmonary valvular </li></ul><ul><li>disorders </li></ul><ul><li>- RV infarction </li></ul>
  14. 15. Pathophysiology (contd..) <ul><li>Cardiac reserve (Hearts ability to increase the output in response to stress(5 the times the normal) </li></ul><ul><li>But in the diseased heart, it fails to respond to body’s increased demands </li></ul><ul><li>Compensatory mechanism will be initiated </li></ul>
  15. 16. Pathophysiology contd.. <ul><li>Compensatory mechanisms are </li></ul><ul><li>-Ventricular dilation: Lengthening of the muscle fibers Increased volume of heart chambers Increased preload and cardiac out put leads to reduced contractibility when stretched beyond capacity Increased oxygen demand hypoxia </li></ul>
  16. 17. Pathophysiology (contd..) <ul><li>Ventricular hypertrophy-Increase in the diameter of muscle fibers </li></ul><ul><li>Size and weight of heart increases </li></ul><ul><li>Increased oxygen demand </li></ul><ul><li>Hypoxia and reduced contractibility </li></ul>
  17. 18. Pathophysiology(contd..) <ul><li>Increased sympathetic stimulation </li></ul><ul><li>Increased heart rate and peripheral vascular resistance </li></ul><ul><li>Reduced renal flow and increased renal conservation of water and sodium </li></ul><ul><li>Fluid overload and increased workload </li></ul>
  18. 19. Forms of heart failure <ul><li>Systolic versus diastolic failure </li></ul><ul><li>Systolic-Inability to contract normally </li></ul><ul><li>Diastolic-Inability to relax or fill normally </li></ul><ul><li>High output versus low output </li></ul><ul><li>Low output-IHD, HT,cardiomyopathy,pericardial diseases </li></ul><ul><li>Highoutput-Hyperthyroidism,anemia,pregnancy,paget disease </li></ul>
  19. 20. Forms (contd..) <ul><li>Acute versus chronic </li></ul><ul><li>Acute –Acute large MI </li></ul><ul><li>Chronic-Dilated cardiomyopathy multivalvular heart disease </li></ul><ul><li>Right sided versus left sided </li></ul><ul><li>RVF-PAH,Pulmonary stenosis,pulmonary embolism, </li></ul><ul><li>LVF-Aortic stenosis,Post MI </li></ul>
  20. 22. Types (contd..) <ul><li>Backward versus forward H F </li></ul><ul><li>backward-ventricles fail to fill normally Increased pressure in the atrium and venous system sodium and water retention edema </li></ul><ul><li>Forward-Inadequate discharge of blood in to the arterial system </li></ul>
  21. 23. Pathophysiology <ul><li>Ventricular dilatation. </li></ul><ul><li>Ventricular hypertrophy. </li></ul><ul><li>Increased sympathetic nervous stimulation. </li></ul>
  22. 24. Clinical features <ul><li>LVF-Dyspnea(PND) </li></ul><ul><li>Orthopnea </li></ul><ul><li>cough(frothy&blood tinged sputum) </li></ul><ul><li>chyne stoke respiration </li></ul><ul><li>pulmonary edema (extreme </li></ul><ul><li>breathlessness,anxiety,frothy sputum, </li></ul><ul><li>nasal flarring) </li></ul>
  23. 25. C/F Contd <ul><li>Cardiovascular signs – </li></ul><ul><li>Enlarged left laterally displaced apical </li></ul><ul><li>impulse, Heart gallop(S 3 & S 4 )pulses alternas </li></ul><ul><li>Cerebral hypoxia- Anxiety,Irritability,Restlesness,confusion,Impaired memory, Insomnia </li></ul><ul><li>Renal changes-Oliguria,fatigue and muscular weakness </li></ul>
  24. 26. C/F Contd <ul><li>RVF-Peripheral edema and venous congestion, </li></ul><ul><li>Hepatomegaly and abdominal pain </li></ul><ul><li>Cardiac cirrhosis and ascitis </li></ul><ul><li>Anorexia,nausea and bloating </li></ul><ul><li>cardiac cachexia </li></ul><ul><li>Pitting edema </li></ul><ul><li>Jugular vein distention, Increased CVP </li></ul><ul><li>Anxiety and depression </li></ul>
  25. 27. Diagnostic tests <ul><li>X-ray </li></ul><ul><li>ECG </li></ul><ul><li>Echocardiography </li></ul><ul><li>Blood tests </li></ul><ul><li>ABG analysis </li></ul><ul><li>Pulse oximetry. </li></ul>
  26. 28. Medical management <ul><li>Removal of precipitating factors </li></ul><ul><li>Correction of underlying causes </li></ul><ul><li>Prevention of deterioration of cardiac function </li></ul><ul><li>Control of CHF state </li></ul>
  27. 29. Immediate management <ul><li>Positioning – high fowlers position </li></ul><ul><li>Oxygen administration(8–10 Lts,40-70%) </li></ul>
  28. 30. Medical management <ul><li>Oxygen inhalation. </li></ul><ul><li>Digitalis. </li></ul><ul><li>Diuretics. </li></ul><ul><li>Inotropic agents. </li></ul>
  29. 31. Management contd <ul><li>Digitalis-Increases ventricular emptying,slow conduction of impulses through AV node,Increases stroke volume and cardiac output </li></ul><ul><li>-Effective in systolic heart failure </li></ul><ul><li>-0.25 6 hourly for adults,for elderly 0.125 mg 6 hourly </li></ul><ul><li>-Reduce dose in renal impairment </li></ul><ul><li>-Should not be given in heart failure with high output </li></ul><ul><li>- Digitalis toxicity should be monitored </li></ul>
  30. 32. Management contd <ul><li>Dopamine and dobutamine </li></ul><ul><li>Low output failure </li></ul><ul><li>Dopamine-2-10 microgram/kg/mt </li></ul><ul><li>Dobutamine-2.5-10 microgram/kg/mt </li></ul><ul><li>Phosphodiesterase inhibitors:Amrinone, Milrinone </li></ul><ul><li>Anticoagulants </li></ul><ul><li>Antiarrythmics </li></ul><ul><li>ACEI </li></ul><ul><li>Aldosterone antagonist;spironolactone25mg /day </li></ul><ul><li>Beta adrenergic blockers </li></ul>
  31. 33. Dietary management <ul><li>Fluid restriction. </li></ul><ul><li>Sodium restriction. </li></ul><ul><li>Potassium supplementation with diuretics. </li></ul>
  32. 34. Other management <ul><li>Assist devices. </li></ul><ul><li>Intra- aortic balloon pump. </li></ul>
  33. 35. Palliative management <ul><li>Heart transplantation. </li></ul>
  34. 36. Nursing management <ul><li>Decreased cardiac output. </li></ul><ul><li>Fluid volume overload. </li></ul><ul><li>Impaired gas exchange. </li></ul><ul><li>Altered peripheral tissue perfusion. </li></ul><ul><li>Risk for activity tolerance. </li></ul><ul><li>Impaired skin integrity. </li></ul><ul><li>Risk for digitalis toxicity. </li></ul>

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