CARDIAC FAILURE. Cardiac failure -Definition A physiologic state in which the heart is unable to...
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CARDIAC FAILURE
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Cardiac failure -Definition
A physiologic state in which the heart is
unable to pump enough blood to meet the
metabolic needs of the body at rest or during
exercise even though filling pressures are
adequate.
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Etiology
Acute causes
Acute M.I
Dysrthymias
Pulmonary emboli
Thyrotoxicosis
Hypertensive crisis
Papillary muscle rupture
VSD
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Chronic causes CAD Hypertension RHD Congenital heart disease Cardiomyopathy Pulmonary diseases Bacterial endocarditis Anaemia Valvular disorders
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PathophysiologyLeft heart failure
Hypertension
Increase force of LV contraction
Increase LV O₂ demand
Increase LV hypoxia
Decrease force of LV contraction
Increase LV preload
Increase LA preload Pulmonary oedema
Decrease B.P
CM
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Right heart failurepulmonary pathology
Increase pulmonary vascular resistance
Increase force of RV contraction
RV hypoxia
Decrease force of RV contraction
Increase RV preload
Increase RA preload
Peripheral oedema
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Compensatory mechanisms
Increase in SNS activity
Ventricular hypertrophy
Ventricular dilation
Renin-angiotensin-aldosterone system
ADH
Endothelin
Proinflammatory cytokines
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Counterregulatory mechanisms
Natriuretric peptides
Nitric oxide
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Clinical features
Left heart failure- symptoms
Dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea, nocturia
dizziness, confusion, diaphoresis and cool
extremities at rest
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Right ventricular failure - symptoms
Weakness
Anorexia
Indigestion
Weight gain
Mental changes
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Left heart failure - signs Displaced apex beat Heart murmurs Tachypnea, tachycardia Crackles Dullness - lung fields to percussion and
diminished breath sounds at the lung bases (pleural effusion)
cyanosis, cough, hemoptysis Increased PAP
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Right-sided signs
1. Peripheral edema
2. Ascites
3. Hepatomegaly
4. Increased jugular venous pressure
5. Hepatojugular reflux
6. Anasarca
7. Spleenomegaly
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Investigations
Echocardiography
Chest roentogram
Electrophysiology
Angiography
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Blood tests
Electrolytes (sodium, potassium), renal
function, liver function tests, thyroid function
tests, complete blood count, C-reactive protein
B-type natriuretic peptide (BNP)
Cardiac markers- M.I
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Pharmacological management
Angiotensin-modulating agents
Diuretics
Beta blockers
Positive inotropes
Vasodilators
Vasopressin receptor antagonists
Human b – type natriuretric peptide
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Devices and surgery
Bi-ventricular pacemaker
Implantable cardioverter-defibrillator
Ventricular assist devices
Cardiac transplantation
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Nursing management
High Fowlers position
Legs in dependent position
Oxygen
Activity restrictions
Emotional rest
Allay the anxiety
Monitor ECG, S. electrolytes
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Contd…
Small meals than larger ones
Monitor weight daily
Maintain intake & output chart
Restrict sodium & fluid intake
Avoid activities that create valsalva response
Self care needs
Increase activity gradually & as tolerated
Medications
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Thank you