Congestive Heart Failure Case Study. Congestive Heart Failure.
Lecture 1-Heart Failure
Transcript of Lecture 1-Heart Failure
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Definition
By Mayo Clinic staff
Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enoughblood to meet your body's needs. Over time, conditions such as narrowed arteries in your heart(coronary artery disease) or high blood pressure gradually leave your heart too weak or stiff to
fill and pump efficiently.
You can't reverse many conditions that lead to heart failure, but heart failure can often be treated
with good results. Medications can improve the signs and symptoms of heart failure. Lifestylechanges, such as exercising, reducing the salt in your diet, managing stress, treating depression,
and especially losing excess weight, can improve your quality of life.
The best way to prevent heart failure is to control risk factors and conditions that cause heart
failure, such as coronary artery disease, high blood pressure, high cholesterol, diabetes orobesity.
(http://www.heartfailure.org/eng_site)
-Heart failure is a progressive disorder in which damage to the heart causes weakening of the
cardiovascular system. It manifests by fluid congestion or inadequate blood flow to tissues. Heart failure
progresses by underlying heart injury or inappropriate responses of the body to heart impairment.
Symptoms and
Signs
Swollen Ankles or Legs
Swollen ankles or legs, known as peripheral edema, may be a result ofright-sided heart failure since flui
pumped to the lungs at an efficient rate. In right-sided heart failure, fluid backs up in the veins, leaks outcapillaries and accumulates in tissues. Also, a decrease in blood flow to the kidneys can lead to an increa
retention. Diuretics are often prescribed to get rid of this excess fluid and reduce the strain on the heart.
In the absence of heart failure, peripheral edema may commonly be due to obesity or venous insufficienstretched venous valves.
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Weight Gain or LossExcess fluid in the body may cause an increase in weight. Similarly, when excess fluid is excreted, your
fall. Weight increases by about two pounds for each extra quart of fluid. You may notice that your weighbefore you notice swelling of the ankles or extremities. Inform your doctor of changes of more than five
Causes of Heart Failure
For heart failure to occur, there must be an unresolved impairment of the heartthat 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 bynon-functioning valves or a genetic predisposition. Heart failure can be worsened
by a poor diet and lifestyle. Its development follows the scheme below:
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Conditions That May Lead To Heart Failure
Coronary Artery Disease (CAD)
This is the most common cause of heart failure in the U.S. today. CAD causingobstruction to the coronary arteries prevents blood flow and, therefore, oxygen
delivery to the heart. CAD is a manifestation of atherosclerosis, which can affect
any artery of the body. Risk factors for CAD also include smoking, highcholesterol, hypertension, and diabetes.
HypertensionThis is more commonly known as high blood pressure. It is a condition that is
treatable and simple to diagnose with a blood pressure cuff. Although mostindividuals will not have symptoms, hypertension is detected by a simple
measurement with a blood pressure cuff and stethoscope. It is also a risk factor forCAD, stroke, peripheral vascular disease, or kidney impairment.
Valvular Heart Disease
A condition that occurs when the valves between the chambers of the heart arefaulty, either due to birth defect or injury.
CardiomyopathyA disease of the heart muscle. This can be one of many varieties. It can arise
because of genetic causes, a viral infection, or consumption of toxins (lead,alcohol, etc.). In peripartum cardiomyopathy, women who have recently given
birth can develop heart muscle impairment. In many cases, the condition is called
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"idiopathic", which means it has occurred of uncertain origin or cause.
In addition to those causes above, the following factors also can play a role in
determining if heart failure will affect you:
1. family history of heart failure2. diabetes3. marked obesity4. heavy consumption of alcohol, or drug abuse5. failure to take medications6. large salt intake in diet7. sustained rapid heart rhythms
Many other conditions can actually simulate heart failure symptoms - it is
important to seek evaluation from a medical professional for a definitivediagnosis. Some of these are:
1. lung impairment2. anemia3. kidney impairment4. pericardial disease (rare)
Heart Failure and Your Circulation
Two important causes of heart failure are Coronary Artery Disease andHypertension.
Coronary Artery Disease (also known as CAD)
Cause
Coronary Artery Disease is a condition
where fatty deposits and cell-proliferation build-up in the arteriessupplying the heart muscle. These
plaques form commonly in a conditioncalled atherosclerosis. Genetic factors
or a diet of foods high in cholesterol orsaturated fat that result in high blood
cholesterol can increase your risk for
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this disease. Fatty deposits formsilently; no symptoms arise until they
are large enough to significantlyrestrict blood flow to an area of heart
muscle. When this occurs, angina
pectoris (chest tightness or discomfort)usually results. Normally a 70% orgreater blockage in the diameter of a
coronary artery will cause symptoms ofchest discomfort or pain with exercise.
An abrupt closure of a coronary artery
due to a blood clot forming (associatedwith a fissure of a plaque) can cause a
heart attack (or myocardial infarction).
Symptoms
Angina Pectoris - A constricting chestdiscomfort or pressure that can radiate
outward in the torso, left arm, neck andaw. Sustained symptoms at rest could
represent a heart attack.
Diagnosis
Screening tests for CAD are treadmilltesting, stress echocardiograms and
tracer studies. Coronary arteriographyis the gold standard for diagnosing
CAD. In this procedure a catheter isinserted into the leg or arm and guided
toward the opening of the blood vesselsthat supply the heart. A dye is then
injected directly into the coronaryarteries while x-ray movies are
recorded.
Treatment
Medical management includes:
y drugs to reduce the heart's needfor oxygen
y drugs to lower blood pressurey drugs that dilate the coronary
arteries
y drugs to reduce the amount ofcholesterol in the body
Other alternatives are coronary
angioplasty and stent implantation orcoronary artery bypass grafts.
Hypertension (High Blood Pressure)
Cause
Blood pressure refers to the pressure ofblood against the walls of arteries and
is measured in units of millimeters ofmercury (mmHg), which is a reference
to the fluid historically used with bloodpressure cuffs. Blood pressure is
always measured by two numbers onthis scale. The range of the first
Symptoms
Usually none, but headaches andflushing are sometimes evident.
Diagnosis
Blood pressure cuff(sphygmomanometer), Chest X-ray and
echocardiogram (to observe
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number is usually 100-140 mmHg,which is referred to as systolic (the
peak pressure in the arteries after theheart contracts). The range of the
second number is usually 60-90 mmHg
and is referred to as diastolic (theminimum pressure reached in thearteries when the heart relaxes just
before the next contraction). The usualcause of hypertension is not known -
the brain's "set-point" for a usual BPincreases. Uncommonly, renal artery
stenosis (a blockage of the arteries)going to the kidneys or hormone
producing tumors can also be causes.For a more thorough explanation, click
here!
hypertrophy).
TreatmentHypertension is managed with a
combination of hygienic approaches
and medication. A low salt diet,exercise, weight loss when obesity ispresent, and stress reduction may all
help. Most individuals also requiremedication to maintain a blood
pressure lower than 140/90. If theblood pressure has caused cardiac
remodeling (see diagram) reducingblood pressure can encourage the heart
to return to its former shape andfunction.
Heart Failure and Your Neuroendocrine System
Paradoxically, activity of the neuroendocrine (body regulation) system, that
normally functions to maintain the circulation, can actually worsen heart failure ifsustained over time. By following the feedback control it is programmed to, it
inadvertently adds strain to the heart. Examine the scenario below where the bodyis entering the early stages of heart failure due to blocked heart arteries. Click here
to see a quick overview of the neuroendocrine system, if necessary.
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With time, the heart failure becomes worse and worse. High blood volumes and
remodeling increase heart size over time, which further impacts its ability toadequately eject blood. In this way, a system designed to support our heart has
caused it to fail when attempting to compensate for heart injury.
Why would the body do this to itself? Consider that the design of this system has
evolved in such a way as to protect our body not from heart damage, but fromexterior threats. For example, if one suffers an injury where blood is being lost
(see example), survival is dependent on maintaining an adequate blood pressure toall vital organs. If blood is lost, then blood pressure in our arteries will drop
accordingly. Fluid retention serves to keep high blood volumes to buffer the lossdue to injury. By constricting our arteries as shown before, the remaining blood
gets mobilized more efficiently to tissues at an adequate pressure. Therefore,possibly the situation shown in the chart isn't so much an error in design of the
neuroendocrine system so much as a misapplication of a control mechanisminitiated by initial heart and circulatory impairment.
Heart Failure and Your Heart
Once the heart has been injured, the body will attempt to compensate for reduced
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blood flow. Unfortunately, many of the countermeasures actually increase strainon the heart and further the development of heart failure.
The heart, after suffering damage or being placed under physical stress by high
blood pressure, will begin to change its own shape. This deforming of the
ventricles' shape is known as remodeling or hypertrophy. This remodeling occursin two primary patterns - concentric and dilated (as shown below):
Key
h = Thickness c = Concentricr = Radius n = Normal
d = Dilated
These diagrams represent cross-sections of the left ventricle, the chamber that
supplies the body with oxygenated blood flow. The triangular notches are cut into
each ventricle to demonstrate how the wall has changed in shape and thickness.
For comparative terms, the normal heart essentially looks like a football. When
the wall thickens in concentric circles (lower left), The heart works less effectivelyand takes on the shape of a large fist. This may be caused by hypertension, a
blocked aortic valve, or underlying genetics. Dilation of the ventricle walls (lowerright) gives the weakened heart a beach-ball shape and an inefficient contraction.
This prohibits blood from leaving the heart as it normally would. This remodelingpattern follows damage from a heart attack, sustained hypertension, viral
infection, or genetic causes.
Heart failure occurs when the heart can't pump blood to the body as quickly asneeded. Blood returning to the heart faster than the heart can eject it congests the
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system behind it. Decreased blood flow to organs, such as the kidneys, causes thebody to retain more fluid which complicates the problem further. The relationship
between the heart and other organs can be a delicate one - once one is injured, itcan send off a cascade of events that damage other organs and worsens heart
failure.
Medical Tests and Findings
Chest X-ray
Your doctor can use an x-ray to look at your heart, lungs, and blood vessels. He orshe can see if your heart is enlarged or if there is fluid around your lungs.
Pulmonary congestion shows up as cloudy areas on the x-ray. A chest x-rayrequires only a brief exposure to x-rays and is generally considered safe.
EchocardiogramThe echocardiogram is a procedure used to visualize the pumping action of the
heart. It is an ultrasound examination of the heart that can also measure blood flowinto and out of the heart.
ElectrocardiogramThis test also known as an "ECG" or"EKG", measures the electrical activity of
the heart. An electrocardiogram can check the heart's rhythm, evidence ofenlargement, and the presence of a prior or recent heart attack. Electrical wires
with adhesive ends are attached to the skin on your chest, arms, and legs. Theelectrical activity of the heart is then recorded on a piece of paper.
TracerStudies
Radioactive tracers given through a hand or arm IV are another tool used in thediagnosis of heart failure. Radioactivity is detected as the blood moves through the
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heart. In this way, doctors can outline the chambers of the heart, measure theejection fraction, and assess blood flow to regions of the heart muscle.
Treadmill Test
This test is known as a "stress test" because your heart's activity is being
monitored with an electrocardiogram during exercise. By walking on a treadmillfor specific intervals of time at differing intensity levels, your doctor can see ifyour symptoms are brought on by exertion and if they correlate with patterns on an
electrocardiogram.
Stress tests can be done using radioactive tracers such as thallium, Sesta MIBI, andMyoview. First, the tracer is injected into an IV tube in the arm before and during
exercise on the treadmill. After exercise, pictures of the heart can be taken to seewhere the tracer has been deposited, telling the doctor which areas are getting
enough blood and which are not.
Alternatively, stress testing can be done without exercise. The effects of stress onheart blood flow can be simulated through the use of an IV drug such as adenosineor persantine that dilates heart blood vessels, or dobutamine that increases heart
rate and function.
CatheterizationDoctors can insert a catheter, or small tube, into a leg (femoral) artery via a needle
stick and direct it to a region of the heart with x-ray guidance. Once in place, thecatheter can measure pressures in the heart and direct a dye used to visualize heart
chambers or blood vessels. This visualization technique is called angiography. Thex-rays show areas of narrowing or blockage. Catheters are also used to open
blocked heart arteries with angioplasty and stenting.
FROM MOSBY:
NURSING CARE OF CLIENTS WITH HEART FAILURE:
ASSESSMENT:
1. Baseline vital signs, breath sounds2. Daily weight; circumference of edematous extremities; abdominal girth3. Hemodynamic status (CVP, PAWP)4. Electrolytes levels ( sodium, chloride, potassium)5. Intake and output
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B. ANALYSIS/ NURSING DIAGNOSES:
1. Decreased cardiac output related to impaired cardiac function.2. Excess fluid volume related to impaired excretion of sodium and water.3. Impaired gas exchange related to excessive fluid in interstitial space.
C. PLANNING/ IMPLETATION:
1. Maintain the client in high- Fowlers position.2. Elevate extremities except when the client is in acute distress.3. Frequently monitor vital signs.4. Change position frequently.5. Monitor intake and output and daily weight.6. Restrict fluid as ordered.7. Monitor invasive lines.8. Refer to cardiac glycosides, antihypertensives, and diuretics for additional nursing actions.
D. EVALUATION/ OUTCOMES:
1. Maintains adequate tissue perfusion.2. Reduces peripheral edema/ ascites.3. Verbalizes understanding of pharmacologic and diet therapy.
Coronary computed tomography angiography (CTA) is a heart imaging test that helps determineif fatty or calcium deposits have narrowed a patients coronary arteries. Coronary CTA is a
special type of x-ray examination. Patients undergoing a coronary CTA scan receive an iodine-
containing contrast material as an intravenous (IV) injection to ensure the best possible images.
There are many things in life that will catch your eye, but only a few will catch your heart..pursue
those.
the heart is the only broken instrument that works
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