Perfusion- Heart Failure

right sided hf clinical manifestation

edema in the feet and legs, edema in sacral area when in supine position, anorexia, nausea, liver engorgement, neck veins distended,

right sided HR manifestations

edema in the feet, sacral area when lying down and abdominal cavity and liver also jugular veins will be distended.

What cause heart failure in normal hearts

excessive demands placed on the heart.

for HF causes remember mneumonic

failure F- faulty hear valves A-arrythmias I- infaction L-lineage( congenital) U- uncontrolled hypertension R-recreational drugs E- envaders( virus, infection)

left sided failure clinical manifestations

fatigue, activity intolerance, dizziness, syncope pulmonary congestion, dyspnea, shortness of breath, cough, orthopnea, cyanosis, S3 may be present

what are some noncardiac pulmonary edema causes

primary pulmonary disorders, acute respiratory distress syndrome, trauma, sepsis, drug overdose, preeclampsia, nuerologival events

what does anp and dnp hormoes do

promote sodium and water excretion and inhibit the release of norepinephine. , renin and aDH,

left sided HF

pulmonary edema

pulmonary edema neurological manifestations

restleness feeling of impending doom anxiety

• Diastolic failure

results when the heart cannot completely relax in diastole, disrupting normal filling.

diastolic HF clinical manifestations

shorness of breath tahcypnea, crackes, distended neck veins, liver enlargemen, anorexia, and nausea.

II mild HF stage

some physical limitations due to fatigue shortness of breath or palpitations. client comfortable at rest

INTRA-ARTERIAL PRESSURE MONITORING

. Arterial lines are used to assess blood volume, to monitor the effects of vasoactive drugs, and to obtain frequent ABG determinations. . An indwelling arterial line, commonly called an art line or an A line, allows direct and continuous monitoring of systolic, diastolic, and mean arterial blood pressures and provides easy access for arterial blood sampling.

how do frank-starling mechanism works?

1-decreased cardiac output stimulates aortic baroreceptos 2-this stimulates the SNS. 3-Stimulation of SNS produces norepinephrine. 4-norepinephrine increases heart rate and contractility. 5- cardiac output increases ventricillar filling and myocardial stretch. 6- blood flow is sent to ye brain and other organs 7- it also decreases renal funtion. 8-decrease renal function makes the kidnes release renin. renin activate renin-angiotensis what is a potent vasoconstrictor. and also stimulates the adrenal cortex 9- adrenal corted releases adh that absorbs water and also causes more vasocontrition. all this resulting in more vascular volume

how to calculate MAP

2xdiastolic=systoly/3=MAP ex: 120/80 map=93

what is the ideal map levels

70-105 m,=mHg

what are some cardiac pulmonary edema causes

AMI, acute heart failure and valvular disease.

high ouput HF

Clients in hypermetabolic states (e.g., hyperthyroidism, infection, anemia, or pregnancy) require increased cardiac output to maintain blood flow and oxygen to the tissues. If the increased blood flow cannot meet the oxygen demands of the tissues, compensatory mechanisms are activated to further increase cardiac output, which in turn further increases oxygen demand.

LOW-OUTPUT heart FAILURE

Clients with heart failure resulting from coronary heart disease, hypertension, cardiomyopathy, and other primary cardiac disorders develop low-output failure and manifestations such as those previously described.

III moderate HF stage intervention

Class I interventions. Addition of diuretic, ACE inhibitor, ARB, and/or beta-blocker to medication regime. Additional drugs may include aldosterone inhibitor, digitalis, hydralazine, nitrates. Restrict dietary sodium. Monitor weight. Restrict fluids, as needed. Discontinue drugs that worsen condition. Surgical options may include biventricular pacing or implantable defibrillator.

II mild HF stage intervention

Class I interventions. ACE inhibitor or ARB, and beta-blocker as indicated. Surgical options include coronary artery repair and valve repair or replacement.

hepatomegaly

HF can led to complications in other organs like: congestive hepatomegaly splenomegaly engorgement of the portal venous system result in abdominal pressure, ascites, and gastrointestinal problems liver function impaired myocardial distention can presiipitate dysrhytmias pluera effusions cardiogenic

stages of HF

I-mild II mild III moderate IV- severe

IV severe HF intervention

Interventions for Classes I, II, and III. Evaluation for available options. Interventions include heart transplant, ventricular assist devices, surgery, research therapies, continuous infusion of intravenous heart pump medication, and palliative or hospice care.

pulmonary edema respiratory manifestations

Respiratory: tachypnea paroxymal nocturnal dypnea labored repirations cough productuve of frothy pink sputum dypnea crackles wheezes orthopnea

I Mild HF state interventions

Regular exercise. Smoking cessation. Treatment of hypertension. Treatment of hyperlipidemia. Discontinuation of alcohol or illegal drug use. Possible addition of ACE inhibitor or angiotensin II receptor blocker (ARB), or beta-blocker to medication regime.

sytolic HF results from

loss of myocaridal cells as result of ischemia., infarction, cardiomyopathy, or inflamation

What mechanism does the heart uses to compensate

The frank-starling mechanism neuroendocrine responses) activation of the SNS and renin-angiotensin system) myocardial hypertrophy

• Chest x-ray

may show pulmonary vascular congestion and cardiomegaly in heart failure.

what is paroxymal norcturnal dyspnea

a frightening condition in which the client awakens at night acutely short of breath, also may develop. Paroxysmal nocturnal dyspnea occurs when edema fluid that has accumulated during the day is reabsorbed into the circulation at night, causing fluid overload and pulmonary congestion.

pulmonary edema is

a medical emergency

Heart failure can be

acute or chronic

effective cardiac output depends on

adequuate functional muslce mas and ht ability of the ventricles to work together

cardiac output

amount of blood pumped form the ventricles in 1 minute.

IV severe

any degree of physical activity results in increased discomfort cardiac dysfuntion at rest.

Arterial blood gas levels

are determined to evaluate gas exchange in the lungs and tissues

• Atrial natriuretic peptide (ANP) or brain natriuretic peptide: (BNP

are hormones released by the heart muscle in response to changes in blood volume. Blood levels of these hormones increase in heart failure.

• Serum electrolytes

are measured to evaluate fluid and electrolyte status. Serum osmolarity may be low because of fluid retention. Sodium, potassium, chloride, calcium, and magnesium levels are measured.

The main goals of invasive hemodynamic monitoring

are to evaluate cardiac and circulatory function and the response to interventions

• Urinalysis,

blood urea nitrogen, and serum creatinine are obtained to evaluate renal function.

what can cause pulmonary edema

cardiac and noncardiac disorders.

what is used to asssess cardiac performance

cardiac output especially left ventricular function

HF risk factor are

coronary artery disease smoking obesity substance abuse hypertension diabetes other causes includes cardiomyopathy heart valce disease arrythmias congenital heart defects severe lung disease sleep apnea infection and trauma

impaired myocardial funtion HF causes

coronary heart disease cardiomyopathy rheumatic fever infectivnve endocaditis

pulmonary edema symptoms

cough, pink frosthy hypoxemia increase HR, RR, shortness of breath crackes at the lungs confusion, anxiety low O2 levels

diatolic HF results from

decreased ventricular compliance caused by hypertrophic an cellular chagnes , and impaired relaxation.

increase cardiac workload HF causes

hypertension valve disorders anemias congenital heart defects

selected causes of heart failure,

impaired myocardial function increased cardiac workload acute noncardiac conditions

hemodinamic parameters

include heart rate, arterial blood pressure, central venous or right atrial pressure, pulmonary pressures, and cardiac output.

III moderate HF stage

increased physical limitations less than normal physical activity client comfortable at rest

The normal range for CVP

is 2-8 cm H 2 O or 2-6 mmHg

• A normal ejection fraction

is 50%-70%.

• Heart failure

is a condition in which the heart is unable to pump enough blood into circulation to meet the body's needs

Paroxysmal nocturnal dyspnea

is a frightening condition in which the client awakens at night acutely short of breath, also may develop

• Cardiac output (CO)

is a product of heart rate (HR) and stroke volume (SV).

what is cardiac output

is a product of the HR and stroke volume.

chronic HF

is a progressive deterioration of the heart muscle as a result of cardiomyopathies, valvular disease or coronary heart disease

• Cardiogenic pulmonary edema

is a sign of severe cardiac decompensation (the loss of effective compensation).

what is pulmonary edema

is an abnormal accumulation of fluid in the interstitial tissue and alveoli of the lung.

The normal PA pressure

is approximately 25/10 mmHg; normal mean pulmonary artery pressure is approximately 15 mmHg

cardiac reserve

is the ability of hte heart to increase cardiac putput to meet metabolic demand

Acute failure

is the abrupt onset of a myocardial injury (e.g., a massive MI)

acute HF

is the abrupt onset of a myocardial injury, resulting in suddenly decrased cardiac funtioning

• Cardiac output

is the amount of blood pumped from the ventricles in 1 minute.

The mean arterial pressure (MAP)

is the average pressure in the arterial circulation throughout the cardiac cycle. It reflects the driving pressure, or perfusion pressure, an indicator of tissue perfusion.

The mean arterial pressure (MAP)

is the average pressure in the arterial circulation throughout the cardiac cycle. MAP=diastolic+pulse pressure/3

• Afterload

is the force needed to eject blood into the circulation

• Contractility

is the natural ability of cardiac muscle fibers to shorten during systole.

• The ejection fraction

is the percentage of blood in the ventricle that is ejected during systole.

hemodynamic monitoring

is the study of forces involved in blood circulation. Hemodynamic monitoring is used to assess cardiovascular function in the client who is critically ill or unstable.

• Stroke volume

is the volume of blood ejected with each heartbeat and is determined by preload, afterload, and myocardial contractility.

Preload

is the volume of blood in the ventricles at end diastole (just before contraction.

Is heart failure permanent

it is a longterm effect of coronary heart disease and MI when left ventricular damage is extensive enough to impair cardiac output.

left sided HF

left sided causes: any condition that cause sytolic disfunction coronary heart failure hypertension dilated cardiomyopathy. valvular heart disease hypertrophic cardiomyopathy

I mild HF stage

no limitation of physical activity no shortness of breath noted with normal physical activity

Is heart compesation long term

no, over time it will hasten the deterioration of cardiac function.

does client with heart failure have cardiac reserve

no, they have minimum or no cardiac reserve.

other manifestation of HF

nocturia, weight gain ,

when does ventricular remodeling occur

occurs as the heart chambrs and myocardium adapt to fluid volume and pressure increases, cardiac muscles enlarge.

• Systolic failure

occurs when the ventricle fails to contract adequately to eject a sufficient volume of blood into the arterial system.

arterial pressure monitory access

offers immediate access for blood gas measurements and blood testing.

Right sided HF

often caused by conditons that restrict blood flow to the lungs such as chroninc pulmonary disease. left side heart failure can cause right sided HF

SYstolic vs diatolic HF

systolic: ventricles fail to contract Diastolic: heart cannot relax, disrupting normal filling

heart failure classifications

sytolic vs diastolic left sided vs right sided failure low output vs hight pitput acute vs chronic failure

pulmonary edema cardiovascular manifestations

tachycardia cool, clammy skin hypotension hypoxemia cyanosis ventricular gallop

• Thyroid function

tests can indicate hyperthyroidism and hypothyroidism, which can produce symptoms resembling those of heart failure

what hormones counterbalance renin-angiotensin-aldosterone

the atrial natriuretic peptide (ANP) and the brain natriuretic peptice( bnp)

cardiac descompesation

the loss of effective compensation.

pulmonary edema

the main cause is left heart failure.

cardiac output is regulated by

the oxygen needs of the body. if oxygen needs increase, cardiac output increases

Hemodynamic monitoring systems measure

the pressure within a vessel and convert this signal into an electrical waveform that is amplified and displayed.

what is stroke volume

the volume of blood iejeccted with each heart beat

compesantory mechanism of the heart can cause

vascular congestion, congestive heart failure

what damage cardiac reserve

ventricular damage

ECG

ventricular enlargement and to detect dysrhythmias, myocardial ischemia, or infarction.

acute noncardiac conditions HF causes

volume overload hyperthyroidism fever, infection massive pulmonary embolus

systoic HR clinical manifestations

weakness, fatigue, decreased exercise tolerance,

• Echocardiography

with Doppler flow studies is performed to evaluate left the ventricular function.

whenis perfusion jeopardize based on MAP

with map of less the 50 and more than 105n may indicate hypertension

Heart Failure Diagnostic Tests

• Atrial natriuretic peptide (ANP) or brain natriuretic peptide: (BNP) *• Serum electrolytes *• Urinalysis *Liver function tests *• Thyroid function • Chest x-ray *ECG, • Echocardiography ,• Arterial blood gas