Left Ventricular Heart Failure
Two Diagnostic tests
Blood test Electrocardiogram (ECG)
mode of action and side effects of Frusemide
Diuretic: Main choice for treatment of overload. Decrease sodium reabsorption at various sites within the nephrons thereby enhancing sodium and water loss. This decreases intravascular volume. Frusemide can be administered by IV and act rapidly in the kidneys.
Pathological changes to cause signs and symptoms
Fatigue: Is caused by decreased Co2, impaired perfusion to vital organs, decreased oxygenation of the tissues and anaemia. Dyspnoea: Caused by increased pulmonary pressures secondary to interstitial and alveolar oedema. Dyspnoea can occur with mild exertion or at rest. Oedema: When the heart is unable to maintain adequate blood flow throughout the circulatory system, the excess fluid pressure within the blood vessels can cause shifts into the interstitial spaces. Left-sided heart failure can cause pulmonary edema, as fluid shifts into the lungs. Pulmonary edema is a condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately. Nocturia: Has decreased CO will also have impaired renal perfusion and decreased urinary output during the day. When the person lies down at night, fluid movement from interstitial spaces back into the circulatory system is enhanced. This causes increased renal blood flow and diuresis. Paroxysmal nocturnal dyspnoea: Occurs when the patient is asleep. It is caused by the reabsorption of fluid from dependent body areas when the patient is recumbent. Resulting in a feeling of suffocation and has a strong desire to seek relief by sitting up.
Three potential risk factors
High blood pressure- Your heart works harder than it has to if your blood pressure is high. Coronary artery disease- Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle. Diabetes- Having diabetes increases your risk of high blood pressure and coronary artery disease. Sleep apnoea- The inability to breathe properly while you sleep at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart. Valvular heart disease- People with valvular heart disease have a higher risk of heart failure. Alcohol use- Drinking too much alcohol can weaken heart muscle and lead to heart failure. Tobacco use- Using tobacco can increase your risk of heart failure. Obesity- People who are obese have a higher risk of developing heart failure.
Client education
Informed consent, explain medication and side effects to paitient and family.
Describe the condition
Left-sided heart failure is the most common type of heart failure. The left heart ventricle is located in the bottom left side of your heart. This area pumps oxygen-rich blood to the rest of your body. Left-sided heart failure occurs when the left ventricle doesn't pump efficiently. This prevents your body from getting enough oxygen-rich blood. The blood backs up into your lungs instead, which causes shortness of breath and a build-up of fluid (pulmonary edema).
Two Medications
Nitroprusside Frusemide
Why changes occurred in original diagnostic test
Pulmonary congestion occurs because the left side of the heart is unable to pump the blood out to the body due to the infarction of the left ventricle; this causes a build-up of blood in the left side of the heart which then flows back into the lungs and causes congestion. Enlarged heart occurs because the heart muscle is working harder to push blood around the rest of the body. The extra effort causes the heart muscles to become thicker and stiffer which can cause an enlargement.
5 signs and symptoms
Pulmonary oedema • Nocturia • Fatigue • Paroxysmal nocturnal dyspnoea • Shortness of breath (Dyspnoea)
Some possible causes
The most common cause of heart failure is coronary artery disease, which is a disorder that causes narrowing of the arteries that supply blood and oxygen to the heart. Cardiomyopathy, which is a disorder of the heart muscle that causes the heart to become weak. • a congenital heart defect • a heart attack • heart valve disease • certain types of arrhythmias, or irregular heart rhythms • high blood pressure • diabetes • HIV • AIDS
Describe Electrocardiogram (ECG)
This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack that may be underlying heart failure.
Describe blood tests
To check for a chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) may help in diagnosing heart failure if the diagnosis isn't certain when used in addition to other tests.
mode of action and side effects of Nitroprusside
Vasodilator: Sodium nitroprusside is a vasodilator which reduces both preload and afterload, which in turn improves myocardial contraction, increasing CO and reducing pulmonary congestion. Relaxation of vascular smooth muscle and consequent dilation of peripheral arteries and veins. Dilatation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end diastolic pressure and pulmonary capillary wedge pressure . Side effects include: symptomatic rapid hypotension and is therefore administered in the ICU.