CHF

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CHF

• Mary Sullivan
• Nursing 212

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CHF

• Definition- failure of the left ventricle to pump
  sufficient blood to meet the metabolic needs of
  the body for oxygen and nutrients
• Underlying mechanisms
• a) impairment of contractility
• b) decreased cardiac output

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CHF

• 700,000 people in US die of heart disease, 50
  (350,000) from CHF
• 2.5-3 million people have CHF
• 400,000-500,00 new cases diagnosed annually
• death rates highest in men, African Americans,
  and the elderly

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Risk Factors

• -Overt CAD
• -Advancing Age
• -Hypertension
• -Smoking
• - Hypercholesteremia
• -Obesity
• -Diabetes Mellitus

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Pathology of CHF

• Systolic failure-results in impaired ventricular
  emptying and low forward blood flow
• Diastolic failure-results in impaired ventricular
  filling with high filling pressure and venous
  engorgement in the pulmonary and systemic systems

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Mixed Systolic and Diastolic Failure

• -Seen in dilated cardiomyopathy (DCM)
• - Results in poor systolic function
• - Walls of the left ventricle unable to
  relax
• results
• - poor ejection faction
• - high pulmonary pressure
• - biventricular failure-ventricles
  dilated,
• - poor filling, unable to empty

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Characteristics of CHF

• - LV Failure
• -Decreased exercise tolerance
• -Diminished quality of life
• -Shortened life expectancy

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Symptoms of CHF

• Decreased Cardiac Output
• -decreased blood pressure
• -decreased renal perfusion
• -poor exercise tolerance
• -ventricular dysrhythmias

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LVF

• most common
• retrograde from LV to pulmonary system to RV
• increased pulmonary pressure cause fluid
  extravasation from pulmonary capillary bed to
  interstitium and alveoli resulting in pulmonary
  congestion/edema

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Causes of LVF

• CAD-Atherosclerosis
• Hypertension
• Dysrhythmias
• Cardiomyopathy
• Valvular problems-rheumatic disease
• Congenital

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Symptoms of LVF

• Dyspnea
• Orthopnea
• PND
• cough-dry, non-productive
• fatigue
• restlessness and anxiety

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RV Failure

• Causes backward flow to RA and then venous
  circulation
• systemic circulation results in
• - peripheral edema
• -hepatomegaly
• -splenomegaly
• -JVD jugular venous dissension
• -GI congestion

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RVF

• Primary cause of RVF is LVF
• LV fails resulting in increased Pulmonary
  Congestion, increased Pulmonary Pressure,
  Pulmonary Hypertension, RV Failure,and RV
  Hypertrophy

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CAUSES of RVF

• Cor Pulmonale
• COPD
• Asthma
• Emboli
• RV Infarction

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Symptoms of RVF

• Dependent Edema- feet, ankles, legs and
• thighs, genitalia area
• Hepatomegaly- ascites, pressure on the
• diaphragm and respiratory distress
• Gastrointestinal- anorexia, n/v
• Nocturia
• Weakness

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Diagnostic Studies

• History and Physical Examination
• Chest X-Ray (increased fluid in lungs ,
• increased size of heart)
• EKG - LV Hypertrophy
• Echocardiogram- (size)
• Cardiac Catheterization and Angiography
• Hemodynamic Monitoring (assess function
• by pressure readings)

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Acute Heart Failure-Pulmonary Edema

• Life Threatening
• Increased Pulmonary Venous Pressure caused by LVF
• Engorgement of Pulmonary Vascular System
• Lungs are less compliant
• Increased resistance to small airways-increased
  respirations, decreased PO2

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Acute Heart Failure-Pulmonary Edema

• Interstitial Edema-results in Tachycardia
• Alveolar Edema-airways filled with fluid
  resulting in decreased PO2, increased PCO2, and
  acidemia

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S/S of Acute Heart Failure

• Agitation
• Dyspnea-respirations above 30 minute
• Orthopnea
• Wheezing, Coughing
• BP elevated or lowered
• Lung Auscultation-rales, wheezes or rhonchi
• Skin- pale, cyanotic, cold or clammy

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GOALS OF TREATMENT

• Increase LV Function
• Decrease intravascular volume
• Decrease Venous Return
• Decrease Afterload
• Improve Gas Exchange and Oxygenation
• Increase Cardiac Output
• Decrease Anxiety

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Increase LV Function

• DIGITALIS
• -Digitalizing or Loading Dose
• -Maintenance or Daily Dose
• Toxic Effects include
• -n/v, anorexia
• -bradycardia, PVCs, Bigeminy,PAT
• -blurred, yellow, or green vision
• -weakness mental depression

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DECREASE INTRAVASCULAR VOLUME

• DIURETICS -decrease venous return, decrease
  preload, and increase cardiac output
• Quick Acting Loop Diuretics-
• Furosemide (Lasix)
• Ethacrynic Acid (Edecrin)
• Bumex

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DECREASE INTRAVASCULAR VOLUME

• Nitroglycerin Intravenously-
• -vasodilator
• -decreases volume by decreasing
• preload
• -increases coronary artery perfusion
• thus increasing oxygen to the
• myocardium

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Decrease Venous Return

• High Fowlers Position with feet dangling
• Rotating Tourniquets

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DECREASE AFTERLOAD

• Afterload- amount of work LV has to perform to
  eject blood to systemic circulation
• -IV Nitroprusside (Nipride)
• -vasodilator- decreases preload and
  afterload (arteriole and venous dilation)
• -increases myocardial contraction, in-
• creases PO2, decreases pulmonary
• congestion

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Decrease Afterload

• Morphine
• Ace Inhibitors- blocks angiotensin 11
• examples-Captopril (Capoten)
• Enalapril (Vasotec)
• Lisinopril (Prinivil,
  Zestril )

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Nursing Interventions

• - Promoting Rest
• -Positioning of Client
• -Relief of Anxiety
• -Avoid Stress
• - Client Education/ Home Care