This document discusses congestive heart failure, including its causes, physiology, classification, signs and symptoms, diagnostic testing, and treatment. It defines heart failure as the heart's inability to pump enough blood to meet the body's needs. Common causes include heart attacks, ischemia, and valvular diseases. Treatment focuses on reducing preload and afterload, increasing contractility, and addressing any precipitating factors. Goals of admission orders are to stabilize the patient with medications, fluid management, and monitoring.
3. 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.
6. 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?
7. Afterload
• Def: Force opposing/stretching muscle
after contraction begins
• Measurement: SVR
• Really a function of:
– SVR
– Chamber radius (dilated cardiomyopathies)
– Wall thickness (hypertrophy)
8. 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
9. Classifying Heart Failure
• Anatomically
– Left versus Right
• Physiologically
– Systolic versus Diastolic
• Functionally
– How symptomatic is your patient?
10. 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