Mahus chf

255 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
255
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
3
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Mahus chf

  1. 1. Congestive Heart Failure Mr. Mahadev prasad, Inscol Academy, Lecture
  2. 2. Congestive Heart Failure • 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.
  3. 3. Predisposing Cardiac Diseases • • • • • • Myocardial infarction Chronic ischemia Cardiomyopathy Arrhythmias Diastolic dysfunction Valvular diseases – Aortic Stenosis – Mitral Stenosis – Mitral Regurgitation
  4. 4. Cardiac Physiology (remember this?) • CO = SV x HR • HR: parasympathetic and sympathetic tone • SV: preload, afterload, contractility
  5. 5. Preload • Def: Passive stretch of muscle prior to contraction • Measurement: Swan-Ganz – LVEDP • Really a function of LVEDV • Affected by compliance – Low compliance = higher LVEDP @ lower LVEDV – False high estimate of preload • Frank-Starling right?
  6. 6. Afterload • Def: Force opposing/stretching muscle after contraction begins • Measurement: SVR • Really a function of: – SVR – Chamber radius (dilated cardiomyopathies) – Wall thickness (hypertrophy)
  7. 7. Contractility • Def: Normal ability of the muscle to contract at a given force for a given stretch, independent of preload or afterload forces • In other words: – How healthy is your heart muscle? • Ischemia, Hypertrophy (?), Muscle loss
  8. 8. Classifying Heart Failure • Anatomically – Left versus Right • Physiologically – Systolic versus Diastolic • Functionally – How symptomatic is your patient?
  9. 9. Left versus Right Failure Left Heart Failure - Dyspnea - Dec. exercise tolerance - Cough - Orthopnea - Pink, frothy sputum Right Heart Failure - Dec. exercise tolerance - Edema - HJR / JVD - Hepatomegaly - Ascites
  10. 10. Systolic versus Diastolic • Systolic– “can’t pump” – – – – – Aortic Stenosis HTN Aortic Insufficiency Mitral Regurgitation Muscle Loss • Ischemia • Fibrosis • Infiltration • Diastolic- “can’t fill” – – – – – Mitral Stenosis Tamponade Hypertrophy Infiltration Fibrosis
  11. 11. Clinical Data • CXR – – – – Kerley’s lines : A and B Pulmonary Edema Cephalization Pleural Effusions (bilateral)
  12. 12. Cardiomyopathy Pulmonary Edema
  13. 13. Clinical Data • HEART SOUNDS!!! • Systolic Murmurs – Mitral Regurg – Aortic Stenosis • Diastolic Murmurs – Mitral Stenosis – Aortic Insufficiency • S3: Rapid filling of a diseased ventricle
  14. 14. Treatment of CHF • Treat Precipitating Factor(s)!!!! • • • • • Adjust Heart Rate Decrease Preload Decrease Afterload Increase Contractility Increase Oxygenation
  15. 15. Treatment of CHF • Oxygen – nasal, BiPAP, intubation • Morphine • Preload Reduction – – – – Loop diuretics Nitrates ACE Morphine
  16. 16. Treatment of CHF • Afterload Reduction – IV NTG, Nitroprusside – Hydralazine – ACE • Ionotropic Support – Dopamine / Dobutamine – Amrinone / Milrinone – Digoxin (chronic)
  17. 17. Treatment of CHF • Beta-Blockers – Chronic > Acute – Carvedilol (Coreg), Metoprolol (Toprol XL) • Fluid Balance – Restrict fluid / salt intake – Monitor I/Os and daily weight – Dialysis if needed • Aspirin
  18. 18. Precipitating Factors • • • • • • Infection Pulm Embolus Noncompliance Arrhythmia Myocardial Infarction Stress reaction • • • • • Sodium Intake Medications!!! Anemia Thyroid disorders Endocarditis
  19. 19. Admission Orders • • • • • • • • Admit: Telemetry or ICU EKG STAT, then daily x 3 days 2D Echo CXR Labs: BMP, CBC, Coags, LFTs Pulse ox (ABG) Oxygen ASA 325mg daily
  20. 20. Admission Orders • Nitroglycerin – Paste: 1” ACW TID – Holding parameters – IV: 50mg in 250cc D5W – Titrate • Morphine 1-5mg IV q10-20 min prn • Lasix 20-200mg IV (q 6-8 hours) • ACEi – Captopril 6.25-50mg PO q8h – Enalapril 2.5-20mg PO BID (0.625-2.5mg IV q6h) • Hydralazine 10-100mg PO q6-8 h
  21. 21. Admission Orders • Beta Blocker – Probably not acutely – Start Coreg or Toprol XL prior to discharge • • • • Fluid Restrict 1000ml daily Low salt diet Daily patient weights Daily I/Os
  22. 22. Admission Orders • Dobutamine 500mg in 250cc D5W – 3-10ug/kg/min • Digoxin – Probably not acutely – Titrate to effective dose prior to discharge • IABP – Cardiogenic shock unresponsive to above tx • Dialysis – Critical renal failure patients

×