CARDIAC FAILURE

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.

Etiology Acute causes  Acute M.I  Dysrthymias  Pulmonary emboli  Thyrotoxicosis  Hypertensive crisis  Papillary muscle rupture  VSD

Chronic causes  CAD  Hypertension  RHD  Congenital heart disease  Cardiomyopathy  Pulmonary diseases  Bacterial endocarditis  Anaemia  Valvular disorders

Pathophysiology Left heart failure Hypertension Increase force of LV contraction Increase LV O ₂ demand Increase LV hypoxia Decrease force of LV contraction Increase LV preload Increase LA preload Pulmonary oedema Decrease B.P CM

Right heart failure pulmonary 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

Compensatory mechanisms  Increase in SNS activity  Ventricular hypertrophy  Ventricular dilation  Renin-angiotensin-aldosterone system  ADH  Endothelin  Proinflammatory cytokines

Counterregulatory mechanisms  Natriuretric peptides  Nitric oxide

Clinical features Left heart failure- symptoms  Dyspnoea  Orthopnoea  Paroxysmal nocturnal dyspnoea, nocturia dizziness, confusion, diaphoresis and cool extremities at rest

Right ventricular failure - symptoms  Weakness  Anorexia  Indigestion  Weight gain  Mental changes

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

Right-sided signs 1. Peripheral edema 2. Ascites 3. Hepatomegaly 4. Increased jugular venous pressure 5. Hepatojugular reflux 6. Anasarca 7. Spleenomegaly

Investigations  Echocardiography  Chest roentogram  Electrophysiology  Angiography

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

Pharmacological management  Angiotensin-modulating agents  Diuretics  Beta blockers  Positive inotropes  Vasodilators  Vasopressin receptor antagonists  Human b – type natriuretric peptide

Devices and surgery  Bi-ventricular pacemaker  Implantable cardioverter-defibrillator  Ventricular assist devices  Cardiac transplantation

Nursing management  High Fowlers position  Legs in dependent position  Oxygen  Activity restrictions  Emotional rest  Allay the anxiety  Monitor ECG, S. electrolytes

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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