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Congestive Heart Failure J.O. Medina,RN,MSN,FNP,CCRN Education Specialist Nurse Practitioner Critical Care&EmergencyServices California Hospital Medical.

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Presentation on theme: "Congestive Heart Failure J.O. Medina,RN,MSN,FNP,CCRN Education Specialist Nurse Practitioner Critical Care&EmergencyServices California Hospital Medical."— Presentation transcript:

1 Congestive Heart Failure J.O. Medina,RN,MSN,FNP,CCRN Education Specialist Nurse Practitioner Critical Care&EmergencyServices California Hospital Medical Center

2 Congestive Heart Failure and Pulmonary Edema  Overview  Definition – heart failure is inability of the heart to pump enough blood to meet the metabolic demands of the body  Diagnosed by  Manifestations of inadequate tissue perfusion  Signs and symptoms of intravascular volume overload  Over 2 million Americans have heart failure  10% will die in one year; 50% in five years  America’s highest volume DRG

3 Congestive Heart Failure and Pulmonary Edema  Pathophysiology  Neurohormonal theory  Increased TNF – alpha – cachectin  Endothelin – vasoconstrictor released by endothelial cells  Natriuretic Peptides released by atrial and ventricular stretch and counterbalance effects of endothelin  Common causes  CAD; MI;HTN  Dilated cardiomyopathy  Aortic stenosis ; Aortic regurgitation  Mitral regurgitation

4 Atrial / Brain Natriuretic Peptides

5 Congestive Heart Failure and Pulmonary Edema  Types  Forward vs. backward failure  Forward failure – inadequate tissue perfusion to meet metabolic demands of the body  Backward failure – seen in pulmonary and systemic congestion  Right vs. left failure  May involve RV, LV or both  Usually LV failures precedes RV failure, producing symptoms of pulmonary congestion  RV failure is usually result of LV failure but may occur with primary pulmonary hypertension

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7 Congestive Heart Failure and Pulmonary Edema  Systolic vs. diastolic failure  Systolic failure – inability of the ventricles to eject adequate volume  Diastolic failure – inability of ventricles to relax and fill  High output vs. low output failure  Most HF – result of low contractility producing low CO  High output HF occurs when acute metabolic needs are not met even with high CO

8 Congestive Heart Failure and Pulmonary Edema  Acute vs. chronic failure  Acute failure – heart is overwhelmed by abrupt alteration in cardiac function and unable to bring compensatory mechanisms to play  Chronic failure – compensatory mechanisms have time to partially of completely restore cardiac function  Refractory vs. compensated HF  Compensated – body or medical therapies are working and heart is responding  Refractory – heart is not responding to therapies

9 Congestive Heart Failure and Pulmonary Edema  New York Heart Association Classification of Heart Failure  Class I - no limitations with ordinary activity  Class II – slight limitations of physical activity  Class III – marked limitations of physical activity  Class IV – inability to engage in any physical activity without symptoms

10 Congestive Heart Failure and Pulmonary Edema  Clinical Presentation  Intravascular and interstitial fluid overload  SOB; Dyspnea on exertion;Orthopnea  Paroxysmal nocturnal dyspnea  Non-productive cough; crackles; wheeze  Weight gain; S3;sinus tach; atrial dysrhythmias  Displaced PMI ; systolic murmur ; GI symptoms  Inadequate tissue perfusion  Decreased exercise tolerance  Unexplained fatigue  Unexplained mental confusion  Decreased urine output  Arrythmias  Peripheral vasoconstriction

11 JVD / Pitting Edema

12 Congestive Heart Failure and Pulmonary Edema  Diagnosis  CXR – cardiomegaly; pulmonary vascular congestion;pleural effusions  Echocardiogram – dilated cardiac chambers; hypertrophy; vascular insufficiency and/or stenosis; wall motion abnormalities (akinesis, hypokinesis; dyskinesis); low EF  EKG – tachycardia; arrythmias; chamber enlargement; ischemia/infarction  Cardiac Catheterization – increased PA/PCWP; low EF and low CO with high LVEDP; valvular dysfunction and CAD

13 Congestive Heart Failure and Pulmonary Edema  Management  Goals of therapy  Reduce Preload Venodilators NTG ; diuretics ; ace inhibitors Morphine Dopamine (low dose)  Optimize Heart rate Digoxin  Reduce Afterload Arteriodilators Ace inhibitors; hydralazine Nitroglycerin ; nitroprusside  Improved contractility Digoxin Dopamine; dobutamine; amrinone

14 Congestive Heart Failure and Pulmonary Edema  Atrial Natriuretic Peptide (ANP)  Adrenergic Blockade  Nitric Oxide Synthetase  Spirolactone

15 Congestive Heart Failure and Pulmonary Edema  Pulmonary Edema  Severe pulmonary congestion due to excess fluid in interstitial and/or alveolar spaces  Pathogenesis same as HF  Can develop spontaneously; day or night; at rest; following exercise or stressful event; or in conjunction with HF

16  Pulmonary Edema  Clinical Presentation  Mentation – anxious; restless ; agitation  CV signs – tachycardia with increased BP (unless compensatory mechanisms fail -  BP); S3; PAWP >25 mmHg; CI <2.2  Pulmonary Signs – orthopnea;  O2 levels; crackles; pink frothy sputum; wheezes  Peripheral signs – skin diaphoretic; cool; pale or cyanotic  Diagnosis  CXR – diffuse interstitial edema with cloudy lung fields  ABG – hypoxemia; respiratory acidosis Congestive Heart Failure and Pulmonary Edema

17  Pulmonary Edema  Furosemide  Morphine  NTG  Oxygen  Positive inotropes  Aminophylline IV : for bronchospasm

18 Alveoli With Fluid

19 Questions ?


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