Significance

1.CAD & Age

2. Diabetes

3. Smoking

4. Obesity

5. High serum cholesterol

1. Acute MI

2. Dysrhythmias

3. PE

4. Thyrotoxicosis

5. Hypertensive crisis

6. Rupture of papillary muscle IE mitral valve

7. Ventricular septal defects

8. Myocarditis

1. CAD

2. Hypertension

3. Rheumatic heart disease

4. Congenital heart disease

5. Cor Pulmonale

6. Cardiomyopathy

7. Anemia

8. Bacterial endocarditis

9. Valvular disorders

..Due to

1. Sudden change in heart's ability to pump

2. Secondary to chronic condition

3. Primarily is the ventricles

1. Cannot meet body's metabolic needs; demand excced supply

2. Unable to remove waste products

3. Double pump, one side or the other may fail

Impaired contractile function IE MI

mechanical abnromalities IE valve disease

increased after-load - HTN

Decreased ejection fraction

increased LVED and PAWP (pre-load and afterload)

1. presence of pulmonary congestion

2. pulmonary HTN

3. ventricular hypertrophy

4. normal ejection fraction

left ventricular hypertrophy from

1. HTN

2. Aortic stenosis

3. hypertrophic cardiomyopathy

1. orthopnea

2. PND

3. Cough-hemoptysis

4. dyspnea on exertion

5. rapid/irregular pulse

6. anxiety

7. dyspnea

8. elevated BP

9. S3/S4 sounds

10. Shallow respirations-32-40

11. decreased urine output

12. restlessness

13. confusion

1. Gradual weight gain

2. Dependent edema

3. Ascites

4. Hepatomegaly

5. JVD

6. Nausea

7. Fatigue

8. Anorexia

9. GI bloating

1. Fluid accumulates and creates pulmonary congestion

2. Fluid escapes into alveoli

3. Impairs gas exchange

can cause

JVD

hepatomegaly

splenomegaly

vascular congestion of GI tract

peripheral edema

1. CXR

2. ECG - shows ejection fraction

3. ABGs - bad labs are in left side failure

4. Increased Na+ and BUN

5. Decreased CO

6. ECG

7. Lung scan/pulmonary arteriography - right side failure

8. Liver enzymes - hepatomegaly the enzymes increase

9. Thyroid function tests

9. CBCs

10. Stress -testing

11. Cardiac catheterization - PAWP/LVED

SNS

Ventricular Dilation

Hypertrophy

Hormonal Release

1. pleural effusion

2. dysrhythmias - due to electrical fiber stretch from hypertophy

3. left ventricular thrombus

4. hepatomegaly

Decreasing intravascular volume; use diuretics to reduce venous return - decreases preload

Drugs to manage CHF/decompensated HF

Diuretics

1. Loop - Lasix, Bumetanide - decreases volume, admin by IV and kidney action rapidly. Associated with increased risk of fatal dysrhythmias, renal dysfunction, enhanced RAAS and SNS activation.

Overall, they actually increase systemic resistance(afterload), decrease preload and cause F/E imbalances

Drugs to manage CHF/decompensated HF

Vasodilator

1. IV Nitro - helps decrease preload increasing the heart 02 supply

When titrating IV nitro, BP is monitored frequently (every 5-10 minutes) to avoid symptomatic hypotension

2. IV sodium nitroprusside (Nipride) - reduces pre-and after-load; DRUG OF CHOICE for ADHF and PE.

When titrating IV Nipride, BP is monitored frequently (every 5-10 minutes) to avoid symptomatic hypotension

3. Morphine sulfate - reduces pre/after-load; used in treating ADHF and PE. Dilates both pulmonary and systemic blood vessels

4. Nesiritide (Natrecor) - IV therapy for ADHF - causes both arterial/venous dilation; reduces PAWP and increases CO without increasing 02 consumption or dysrhythmias and increases renal perfusion

Drugs to manage CHF/decompensated HF

Positive Inotrope

1. Digitalis Glycosides - improves LC function by increasing contractility and increases 02 consumption; requires a loading dose and time to work, not recommended for inital treatment

2. Beta adrenergic agonist  - Dopamine (Intropin), Dobutamine (Dobuterx), Epinephrine, Norepinephrine (Levophed)  short term treatment in ICU/stepdown; can cause tolerance, ventricular irritablity and heart 02 consumption

S/S

- visual disturbances IE yellow vision

- dysrhythmias - late sign of toxicity

-hypokalemia - caused by diuretics, biggest cause of toxicity

Hyperkalemia

ACE inhibitor

action/use

vasodilators; FIRST LINE THERAPY IN CHRONIC HF; used in both systolic/diastolic HF; tissue perfusion maintained due to increased CO, diuresis improved by suppresion of Aldosterone; decreases PAP, right and left artieral and ventrical pressure;

ACE inhibitor

side effects

hypotension

hacking cough

allergic reaction - facial edema

renal insufficiency

ACE inhibitor

Names

-PRILS

Captopril - Capoten

Benaepril - Lotensin

Enalapril - Vasotec

Anti-coagulants

Use

Anti-coagulants

Side effects

Anemia

Bleeding

Hypovolemia

Bronchodilators

uses

DASH

2-4g Sodium diet ; milk, cheese, bread, cereal, canned soups and canned veggies restricted

1. Activity intolerance

2. Excess fluid volume

3. Impaired gas exchange

4. Anxiety

5. Deficient knowledge