Left and Right Sided Heart Failure Internship
Risk Factors
CAD High Blood Pressure Heart attack Diabetes Apnea Heart Defects Valvular Heart Disease Drinking/Smoking/Drug Abouse Obesity and a Sedentary Lifestyle Average age is 75 >1/2 are women
Causes
CAD - Most common for Left Left HF - Most common for Right CAD / Heart Attack Atherosclerosis (build up) Hypertension Damaged or Defect Valves Cardiomyopathy (heart muscle damage) Myocarditis (muscle inflammation) Congenital Heart Defects Heart Arrhythmia Chronic Diseases (hyper/hypo thyroidism, HIV, buid up of iron or protein (hemochromatosis or amyloidosis)
Importance of V4r
Elevation in II, III, aVF Greater Elevation in lead III than lead II with Positive V4R Inferior wall MI, Right Ventricular Failure, Possible loss of preload with NTG. these patients could be preload dependent and the vasodialation could tank their pressure.
Paramedic Treatment
IV/IO 12 Lead Ekg/V4R if inferior is suspected Nitrates CPAP 02
Left sided Heart Failure Signs
Left ventricle heaves Pulsus alternans, (alternating pulses, strong weak), Increased heart rate, PMI displaced inferiorly and posteriorly. (LV hypertrophy), decreased PaO2, slight increase in PaCO2, (poor O2 exchange), Crackles, pulmonary edema s3 and s4 heart sounds Pleural effusion Changes in mental status Restlessness, confusion
Common Medications
Loop Diuretics - Lasix Thiazide Diuretics - Microzide (hydrochlorothiazide/HCTZ) Vasodialators help lower resistance. (nitro) + inotropic agents help increase output Beta-blockers treat systolic heart failure (metoprolol) Potassium Sparing Diuretics - Aldosterone blocking agents are used to treat patients with right-heart failure and liver congestion (aldactone, Inspra) Dobutamine improves hemodynamics / organ perfusion Digoxin improves hemodynamics without activating neurohormones or negatively affecting heart rate, blood pressure or renal function, and can be used alone or in combination with vasoactive agents and ACE inhibitors. (lisinopril)
Causes of Right Sided Heart Failure
Right sided heart failure may result from an acute condition such as right ventricle infarction or pulmonary embolism. Cor Pulmonale (right ventricular dilation and hypertrophy caused by pulmonary disease) can also cause right sided HF. The primary cause of heart failure is left sided heart failure. In this situation, left sided heart failure results in pulmonary congestion and increased pressure in the blood vessels of the lung (pulmonary hypertension). Eventually, chronic pulmonary hypertension (increased right ventricular afterload) results in right sided hypertrophy and HF.
Right Sided heart failure Pathophysiology
Right sided heart failure occurs when the right ventricle fails to contract effectively. right sided heart failure causes a backup of blood into the right atrium and venous circulation. Venous congestion in the systemic circulation results in jugular venous distention, hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract, and peripheral edema.
Right sided Heart Failure Signs
Right ventricle heaves Murmurs Jugular venous distention Edema (e.g. pitting, pedal, scrotum, sacrum,) weight gain increase heart rate ascites (accumulation of fluid in the peritoneal cavity) Anasarca (massive generalized body edema) Hepatomegaly (liver enlargement)
Left Sided Heart Failure Symptoms
Weakness, fatigue, anxiety, depression, dyspnea, shallow respiration up to 32-40 min, Paroxysymal Nocturnal Dyspnea, Orthopnea (SOB in recumbent position, dry hacking cough, nocturia, frothy pink tinged sputum (advanced pulmonary edema) (Patients will often sleep sitting up with pillows and will have difficulty breathing when flat)
Right sided heart failure Symptoms
fatigue, anxiety depression, dependent bilateral edema, right upper quadrant pain, anorexia and GI bloating, nausea
Left sided heart Failure Pathophysiology .
the most common form of heart failure is left sided. Left sided HF results from left ventricular dysfunction. This prevents normal, forward blood flow and causes blood to back up into the left atrium and pulmonary veins. The increased pulmonary pressure causes fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli. this manifests as pulmonary congestion and edema.