Post on 07-Apr-2018
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Heart Failure
Pathophisiology, Assessment andInterventions
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:// . . / / . = & =http www medmovie com mmdatabase MediaPlayer aspx?ClientID 69 TopicID 563Heart failure video from American Heart association
What is Heart
Failure?
Chronic Condition
SystolicDiastolic Usually left Risk Factors
http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=563http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=563http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=5638/6/2019 CHF Prelim
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0
100,000
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700,000
'79
'81
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D
isch
Women
Men
Heart Disease and Stroke Statistics2004 Update. Available at:http://www.americanheart.org/downloadable/heart/1072969766940HSStats2004Update.pdf
CDC/NCHS: Hospital discharges include patients both living and dead
FHospitalizations
http://www.americanheart.org/downloadable/heart/1072969766940HSStats2004Update.pdfhttp://www.americanheart.org/downloadable/heart/1072969766940HSStats2004Update.pdf8/6/2019 CHF Prelim
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0
10
20
30
40
50
60
Within2 days
Within1 mo
Within6 mo
Patie
ntsReadm
2%
25%
50%
Aghababian RV. Rev Cardiovasc Med. 2002;3(suppl 4):S3
HF Readmission Rates
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Consequences of HeartFailure
High incidence in geriatrics High rate of hospital admissionsand readmissions Most common Medicare DRG group
Highest treatment cost thanother Medicare DRGs
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ommon Factors in Hospitalizationor HF Noncompliance with medical regimen /sodium and or fluid restriction Acute myocardial ischemia Uncorrected high blood pressure Atrial fibrillation and other arrhythmias ;Recent addition of negative inotropic drugs. .:e g
, , ,verapamil nifedipine diltiazem beta blockers Pulmonary embolus -Nonsteroidal anti inflammatory drugs Endocrine abnormalities
, /diabetes mellitus hyper hypothyroidism ( . ., ,Concurrent infections e g pneumonia viral)illnesses
-AHA 2010
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CARDIAC ANATOMY &PHYSIOLOGY
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.1 Normal Ventricle WallWidth
.2 Ventricular Septum
Watch a simple animation of how
http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=768http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=768http://www.youtube.com/v/H04d3rJCLCE?fs=1&hl=en_US&rel=0&color1=0x2b405b&color2=0x6b8ab6%22%3E%3C/param%3E%3Cparam%20name=%22allowFullScreen%22%20value=%22true%22%3E%3C/param%3E%3Cparam%20name=%22allowscriptaccess%22%20value=%22always%22%3E%3C/param%3E%3Cembed%20src=%22http://www.youtube.com/vhttp://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=7688/6/2019 CHF Prelim
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:Linked from Heal National digitallibrary
See the heart in action
http://library.med.utah.edu/kw/pharm/hyper_heart1.htmlhttp://library.med.utah.edu/kw/pharm/hyper_heart1.htmlhttp://library.med.utah.edu/kw/pharm/hyper_heart1.htmlhttp://library.med.utah.edu/kw/pharm/hyper_heart1.html8/6/2019 CHF Prelim
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- ( )eft sided LV heartfailure:ystolic failure The left ventricle loses its
.ability to contract normally The heart can't pumpwith enough force to push enough blood into
.circulation
:iastolic failure The left ventricle loses its(ability to relax normally because the muscle has
).become stiff The heart can't properly fill with
.blood during the resting period between each beat
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Heart Failure: Systolic
Decreased contraction of the leftventricle; weakened pump
Decreased Left Ventricular Ejection
Fraction (LVEF) Majority of HF in men
Causes: #1 Ischemic heart disease
(CAD, MI) Dilated Cardiomyopathy (30% familial)
Valvular Heart Disease
Viral Endocarditis
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-ight sided heartfailure -usually occurs as a result of left
.sided failure blood backs up in the body's veins causes swelling in the legs andankles
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Heart Failure: Diastolic
Often normal LVEF Decreased contraction and relaxation
during filling
50% of HF patients > age 75 More common in women Fewer treatment guidelines
Causes: HTN, Hypertrophic,Restrictive Cardiomyopathy,Pericardial constriction
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Cardiac Conduction System
Watch an animation of the normal heart's electrical system
( )See a normal heart s electrocardiogram ECG
http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=66&TopicID=774http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=66&TopicID=560http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=66&TopicID=560http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=66&TopicID=560http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=66&TopicID=7748/6/2019 CHF Prelim
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ongestive heartfailure
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Class How Patient Feels During Physical ActivityI No symptoms and no limitation in ordinary physical
activity.II Mild symptoms and slight limitation during ordinaryactivity. Comfortable at rest.III Marked limitation in activity due to symptoms, even
during less-than-ordinary activity. Comfortable onlyat rest.IV Severe limitations. Experiences symptoms even whileat rest.
eart Failure byClass
http://tmp/svah0.tmp/svh12.tmp/hyperlink-path:#208/6/2019 CHF Prelim
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Signs and Symptoms
Dyspnea( )r Shortness of Breath On exertion or at rest
Orthopnea ( )Paroxysmal Nocturnal Dyspnea PNDCough WHY?
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Edema( Buildup of excess fluid in bodytissues )
, ,Swelling in feet ankles legs or abdomen
Weight gain
WHY? Due to decreased blood flow out of the
,weakened heart blood returning to the heart from the veins backs up causing
fluid to build up in tissues
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Persistent coughing or
wheezing ,Tiredness Fatigue Mental Impairment
Memory loss
/ /Confusion Disorientation Impaired thinking
/Anorexia NauseaFeeling of being full or sick to your stomach
Increased heart rate
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Risk Factors for heart failure
Coronary Artery Disease (CAD)
Atherosclerosis. the result may be chest pain (angina)
or, if blood flow becomes totallyobstructed, a heart attack.
high blood pressure which, over time,may lead to heart failure.
Watch an animation of atherosclerosis
Watch an animation of coronary artery disea
http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=573http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=535http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=535http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=5738/6/2019 CHF Prelim
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&A n g in a Pectoris A cute C oron aryS yn d rom e
Stable Angina Unstable Angina Angina Equivalents
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( )Past heart attack myocardial infarction Watch an animation of heart attack ( )High blood pressure hypertension Abnormal heart valves
Heart muscle disease
Watch an animation of dilated cardiomyopathy Watch an animation of hypertrophic cardiomyopathy
Risk Factors for heart failure
See an illustration of high blood pressure
Watch an animation of how the valves work
Watch an animation of heart valve disease
http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=536http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=558http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=558http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=565http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=564http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=564http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=727http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=727http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=773http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=773http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=727http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=564http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=565http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=558http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=5368/6/2019 CHF Prelim
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igns and Symptoms of anI , ,Uncomfortable pressure fullness squeezingor pain in the center of the chest that
lasts more than.a few minutes
( )Pain may radiate to other areas Chestdiscomfort
- , ,with light headedness fainting,sweating nausea
.or shortness of breath , / ,Anxiety nervousness and or cold sweaty.skin
paleness Increased or irregular heart rate A feeling of doom
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rrhythmias (>A fast heart rate 100 beats
)per minute is called
tachycardia . (
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Risk Factors for heart failure
Heart defects present at birth( )congenital heart disease Severe lung diseaseDiabetes Sleep Apnea
evere anemiaHyperthyroidism
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tion Fraction Heart Failure Measureme determines effectiveness of heart
pumping
measurement of how much blood the left
ventricle pumps out with
each contraction
.Normal may be between 55 and 70
> 40 may be evidence of heart failure
or
cardiomyopathy
,In severe cases EF can be very lowSee an illustration of the ejection fraction
http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=662http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=662http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=69&TopicID=6628/6/2019 CHF Prelim
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ardiogenic PulmonaryEdema Left ventricular failure Congenital heart defects Mitral valve or aortic disease Myocardial infarction
Systemic hypertension Excessive fl uid administration Rheumatic heart disease
)myocarditis Pulmonary embolus Renal failure
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Cardiogenic Pulmonary Edema S/SX
Cyanosis (due tohypoxemia)
paroxysmal nocturnaldyspnea ( PND)
Dyspnea, orthopnea Cheyne-Stokes
respiration
Increased Pulse
Increased B/P
Increased respirations
Cough and sputum(frothy and pink in
appearance)
Increased tactile andvocal fremitus
Crackles, rhonchi, and
wheezing
Abnormal X-Rays
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Watch an animation about angioplasty
edical Interventions foreart Failure ercutaneous coronary intervention( )PCI
(formerly referred to as)angioplasty
Coronary artery bypassSee an illustration of a coronary artery bypass
Valve replacement Watch an animation of how heart valves work
Watch an animation about heart valve surgery
Defibrillator implantation Watch an animation about implantable defibrillators
( )Left ventricular assist device LVADSee an illustration of a left ventricular assist device
http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=534http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=557http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=557http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=727http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=727http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=727http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=594http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=728http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=728http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=576http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=576http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=576http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=728http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=594http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=727http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=557http://www.medmovie.com/mmdatabase/MediaPlayer.aspx?ClientID=65&TopicID=5348/6/2019 CHF Prelim
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CARDIOVASCULARASSESSMENT
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oJugular VenousDistentionn Comes from back
pressurebuilding from
right heart intovenouscirculation
oVital Signsn Due to: Significant
increase in
sympatheticdischarge tocompensate.
n BPelevated ifcompensated
n Pulse rateelevated tocompensate for
Cardiovascular Assessment
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:Auscultation:Heart Decreased heart sounds Extra heart sounds
Lungs Anterior and posterior All lobes aerated? , ,Rales rhonchi wheezes
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Abdomen nlarged liver
,in prolonged and severe cases maylead to jaundice
plenomegalymay indicate infective endocarditis
ulsation(can indicate an aortic aneurysm an)insensitive but specific finding
Auscultate the abdomen for any bruitssuggestive of vascular disease
luid wave
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Extremities ; ,Edema when how to check
: ; ;PAD rashes vasculitis
,lack of hair decreased;pulses
cool to touch :Venous Insufficiency
;varicosities brawny lookUlcers
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Monitoring & Prevention
Sudden weight gain or weight loss
Weigh at the same time each morning,preferably before breakfast and after
urinating. Notify the MD if a gain 3+ pounds /day,
or 5+ pounds in one week, or perother MD determined perameter
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Symptoms Dyspnea at rest or on exertionReduction in exercise capacityParoxysmal nocturnal dyspnea(PND) or nocturnal cough
EdemaAscites or scrotal edema
Less specific presentations ofHF
Early satiety, nausea andvomiting, abdominal discomfortWheezing or coughUnexplained fatigue
Confusion/deliriumDepression/weakness
Table 4.3: Symptoms Suggesting the Diagnosis of HF (HF Society of America)
P h ysica l C h a n g e s toreport
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Medications
Lowering High Blood Pressure
Managing Cholesterol Levels
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Medications
Antihypertensives
diuretics, angiotensin-converting enzyme (ACE) inhibitors,
angiotensin-2 receptor antagonists, beta-blockers and calcium channel blockers.
may also be prescribed for heart failure and arrhythmia patients.
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o Direct effects of diureticsnNatriuresis, diuresisnElectrolyte excretion K, Ca, Mg
oIndirect effects of diureticsnVolume depletion, decreased circulating volumenDecreased renal perfusion and ADH releasenDecreased GFRnIncreased renin production; RAAS activationnIncreased SNS activation
nIncreased water and sodium retention
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CE Inhibitors* ( , )isinopril Zestril Prinivil* ( )nalapril Vasotec ,i d e E f f e ct s l o w b l o o d p r e ss u r e h i g h, / ,o t a s s i u m s w e l l i n g o f mo u t h l i p s d r y c o u g hAldosterone Antagonists* ( )pironolactone Aldactone* ( )plerenone Inspra
: - , ,Side Effects low blood pressure high potassium breast( )enlargement or tenderness with spironolactone rare
( )ngiotensin II Receptor Blockers ARBs* ( )osartan Cozaar* ( )alsartan Diovan* ( )rbesartan Avapro ,i d e E f f e ct s lo w b l o o d p r e ss ur e h i g h, / ,o t a s s i u m s w el l i n g o f m o u t h l i p s d r y c o u g h
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eta Blockers* ( , )etoprolol Lopressor Toprol* ( )arvedilol Coreg* ( )tenolol Tenormin , ,i de e f f e ct s lo w b l oo d p r e ss ur e d i z z i ne ss lo w,e ar t r a t e t i r e d n e s s
iuretics* ( )urosemide Lasix* ( )umetanide Bumex* ( )etolazone Zaroxolyn , ,i d e e f f e c t s lo w b l oo d p r e ss ur e d i z z i ne ss,r e q u e n t u r i n a ti o n l o w p o ta s s i u m
:IGOXIN( , )Slows heart rate helps pump more blood with each beat* ( , , )igitalis Lanoxin Digoxin Digitek
, - ,Side Effects slow heart rate yellow tinted vision loss, , , , ,of appetite stomach pain nausea diarrhea tiredness
.weakness
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References 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and
Management of Heart Failure in Adults: A Report of the American
College of Cardiology Foundation/American Heart Association TaskForce on Practice Guidelines: Developed in Collaboration With theInternational Society for Heart and Lung Transplantation Circulation119: 1977-2016; published online before print asdoi:10.1161/CIRCULATIONAHA.109.192064
American College of Cardiology. [Online].Available:www.acc.org/clinical/topic/topic.htm
American Heart Association. [Online]. Available:www.americanheart.org
CNN.com. Diseases and Conditions: Pulmonary edema. [Online]. Available:www.cnn.com/
HEALTH/library/DS/00412.html
Kane, R.L., Ouslander, J.G., & Abrass, I.B. (2004). Essentials of clinical geriatrics(3rded.). New York:
McGraw Hill.
Quality Net (2010). Polish your practice Heart failure.