Congestive Heart Congestive Heart FailureFailure

And DiabetesAnd Diabetes

Definition: Definition: Also called “Left

Ventricular Dysfunction (LVD): The failure of the heart to meet the circulatory demands of the body

Results in fluid “congestion” in venous system

CHF Causes:CHF Causes:CAD: Chronic ischemiaPast MI: Impaired cardiac functionChronic HTN:Valve disordersCongenital DefectsMyocarditis/Endocarditis:

Infection of the heart muscle or valves

CHF Impact: CHF Impact:

Reduced functional capacity: Pulmonary EdemaPeripheral EdemaNa+ and H2O handling

problems

Associated Associated Complications:Complications:

Pulmonary Edema (Pneumonia)

Ventricular DysrrhythmiasAtrial Fibrillation

Treatment: Treatment: Rest: Give the heart a break “to

recover”** Diet: AHA guidelines, Na+ restrictionsDrugs:

DiureticsVasodilatorsDigitalisACE-Inhibitors

Reduce the work Of the heart

Increase the Strength of the heart * Does Both

Digitalis: LanoxinDigitalis: LanoxinFox Glove PlantsInhibit Na+/K+ ATPasesDig Toxicity:

Can induce fatal arrhythmiasCause HypokalemiaRequires constant monitoring of

levels because of long elimination time (t1/2 = 5-6 days)

ACE Inhibitors:ACE Inhibitors:Increase Na+/ H2O excretionCauses vasodilation reducing

both the preload and afterload of the heart

Increases Cardiac OutputBecoming more important in

CHF treatment – sometimes used with Dig

DiabetesDiabetes

Type I: IDDM

Type II: NIDDM

Common to Both:Common to Both:Chronic Hyperglycemia

Polydipsia: Excessive ThirstPolyuria: Excessive UrinationPolyphagia: Excessive Hunger

Long Term Complications:Vasculopathies: CAD, PVD, otherNeuropathies: Limbs, ANSGI, urinary and reproductive

dysfunctions

Different Pathogenesis:Different Pathogenesis:IDDM: IDDM: NIDDM:NIDDM: Insulin

deficiencyKetoacidosisRequiring

InsulinYounger

Onset*

Insulin Receptor Problem

Non-ketoacidosis

May need insulin

Older Onset**

Exercise Benefits: Exercise Benefits: IDDM:

Overall Health: Reduces complications

Self-Esteem Requires careful monitoring

NIDDM:Cornerstone in treatment planReduces complicationsSelf-Esteem

Exercise Guidelines: Exercise Guidelines: IDDM:IDDM:Exercise > 1 hour post insulinDecrease Insulin dose if necessaryExercise within 1-3 hours of mealsPre-exercise glucose: 100-250Monitor before / after / later to avoid

hypoglycemia

Let’s Call That A Wrap!Let’s Call That A Wrap!