1. Heart Failure Cardiac Insufficiency

2. What is Heart Failure? Heart failure is a progressive disorder in which damage to the heart causes weakening of the cardiovascular system. Heart failure is a progressive disorder in which damage to the heart causes weakening of the cardiovascular system. It is when the heart is no longer able to pump enough blood to sustain the body’s metabolic needs. It is when the heart is no longer able to pump enough blood to sustain the body’s metabolic needs.

3. What causes Heart Failure? For heart failure to occur, there must be an unresolved impairment of the heart that compromises its ability to work as a pump. The source of this can be a cutoff of blood supply, an increase in workload due to high blood pressure caused by non-functioning valves or a genetic predisposition. Heart failure can be worsened by a poor diet and lifestyle. For heart failure to occur, there must be an unresolved impairment of the heart that compromises its ability to work as a pump. The source of this can be a cutoff of blood supply, an increase in workload due to high blood pressure caused by non-functioning valves or a genetic predisposition. Heart failure can be worsened by a poor diet and lifestyle.

4. The scenario below where the body is entering the early stages of heart failure due to blocked heart arteries

5. Heart Failure Classifications Left Ventricular Failure Left Ventricular Failure Right Ventricular Failure Right Ventricular Failure

6. Left Ventricular Failure The inability of the left side of the heart to pump into the systemic circulation. An increase pressure in the left side of the heart backs up into the pulmonary system & the lungs become congested with fluid.

7. Fluid then leaks through the engorged capillaries & permeates air spaces in the lungs. Fluid then leaks through the engorged capillaries & permeates air spaces in the lungs. If during each heart beat the right ventricle pumps out just one more drop of blood than the left, with in 3 hours the pulmonary blood volume will have expanded by 500 mL causing Pulmonary edema & Pleural effusion If during each heart beat the right ventricle pumps out just one more drop of blood than the left, with in 3 hours the pulmonary blood volume will have expanded by 500 mL causing Pulmonary edema & Pleural effusion

8. Right Ventricular Failure The inability of the right side of the heart to adequately pump venous blood into the pulmonary circulation. Most often cause is from the increase pressure from blood backing up from a failing left ventricle But right ventricular failure can also be a result of chronic pulmonary disease and pulmonary hypertension

9. When the right ventricle cannot pump blood forward into the lungs results in peripheral congestion. When the right ventricle cannot pump blood forward into the lungs results in peripheral congestion. It is unable to empty its blood volume therefore it cannot accommodate all the venous blood that is normally returned to the right side of the heart. It is unable to empty its blood volume therefore it cannot accommodate all the venous blood that is normally returned to the right side of the heart.

10. Right Ventricular Failure Venous blood is reflected backwards into the systemic circulation. Venous blood is reflected backwards into the systemic circulation. An increase venous volume and pressure force fluid out into the interstitial tissue causing peripheral edema. An increase venous volume and pressure force fluid out into the interstitial tissue causing peripheral edema.

11. As a result of those failures, symptoms can be due to: Forward Heart Failure - The inability of the heart to pump blood at a sufficient rate to meet the oxygen demands of the body at rest or at exercise. Forward Heart Failure - The inability of the heart to pump blood at a sufficient rate to meet the oxygen demands of the body at rest or at exercise. Backward Heart Failure - The ability of the heart to pump blood at a sufficient rate ONLY when heart filling pressures are abnormally high. Backward Heart Failure - The ability of the heart to pump blood at a sufficient rate ONLY when heart filling pressures are abnormally high. Congestive Heart Failure - Fluid in the lungs or body, resulting from inadequate pumping from the heart and high heart filling and venous pressures. Congestive Heart Failure - Fluid in the lungs or body, resulting from inadequate pumping from the heart and high heart filling and venous pressures.

12. Signs and Symptoms: Edema- from right ventricular failure Edema- from right ventricular failure Angina- chest or arm discomfort due to a blockage of the coronary arteries; enough oxygen when blood flow to the heart muscle is reduced. Angina- chest or arm discomfort due to a blockage of the coronary arteries; enough oxygen when blood flow to the heart muscle is reduced. Shortness of Breath Shortness of Breath Nocturnal Dyspnea Nocturnal Dyspnea Orthopnea Orthopnea Fatigue- Sluggishness may be the result of your organs not getting enough oxygen. Fatigue- Sluggishness may be the result of your organs not getting enough oxygen. Loss of Appetite- Fluid accumulation in the digestive organs can cause you to feel full. Loss of Appetite- Fluid accumulation in the digestive organs can cause you to feel full.

13. Medical Test Chest X-ray: Pulmonary congestion shows up as cloudy areas on the x-ray Chest X-ray: Pulmonary congestion shows up as cloudy areas on the x-ray

14. Medical Test Echocardiogram Echocardiogram Electrocardiogram Electrocardiogram Tracer Studies Tracer Studies Treadmill Test / Stress Test Treadmill Test / Stress Test Catheterization Catheterization BUN BUN Creatine Creatine Liver function values Liver function values B-type natriuretic peptide (BNP) B-type natriuretic peptide (BNP)

15. Treatment Cardiac Glyosides: digoxin (Lanoxin) Cardiac Glyosides: digoxin (Lanoxin) Diuretics: furosemide (Lasix) Diuretics: furosemide (Lasix) Sedative and Analgesics: Sedative and Analgesics: Morphine & Temazepam (Restoril) Morphine & Temazepam (Restoril) Nitrates: Nitroglycerin Nitrates: Nitroglycerin ACE Inhibitors: Captopril (Capoten) ACE Inhibitors: Captopril (Capoten) B-Adrenergic Blockers: Carvedilol (Coreg) B-Adrenergic Blockers: Carvedilol (Coreg) Inotropic Agents: Dobutamine (Dobutrex) Inotropic Agents: Dobutamine (Dobutrex) Potassium Supplements Potassium Supplements

16. Surgical Procedure Percutaneous Transluminal Coronary Angioplasty (PTCA) Percutaneous Transluminal Coronary Angioplasty (PTCA) Angioplasty Angioplasty Stenting Stenting Coronary Artery Bypass Graft Surgery Coronary Artery Bypass Graft Surgery Valve Surgery Valve Surgery Heart Transplantation Heart Transplantation

17. Surgical Procedure: Left Ventricular Assist Device An electrically driven mechanical pump about 1.5 pounds An electrically driven mechanical pump about 1.5 pounds an electronic controller an electronic controller power supply- 2 external batteries, via a cable through the abdomen power supply- 2 external batteries, via a cable through the abdomen The pump is Placed in the abdominal cavity, the LVAD takes blood from the left ventricle and pumps it into the aorta. The LVAD normally pumps at a rate of 60-80 beats per minute, but can increase to 120 beats per minute with exercise. The pump is Placed in the abdominal cavity, the LVAD takes blood from the left ventricle and pumps it into the aorta. The LVAD normally pumps at a rate of 60-80 beats per minute, but can increase to 120 beats per minute with exercise.

18. Prevention Low in sodium- High in potassium Low in sodium- High in potassium Exercise Exercise Weight Management Weight Management Stress Stress Smoking Smoking Alcohol Alcohol