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Chapter 35Cardio: Heart FailureHeart FailureInability of the heart to pump a sufficient amount of blood to meet thebody’s needs.Congestive Heart Failure The accumulation of blood and fluid within the organs and tissues dueto decreased circulation (Dig. & Lasix). The heart is a dual pump. (Right and Left Sides)May have Left or Right side heart failure, or both.Left side heart failure leads to ® side heart failure.No matter left or right heart failure, you have decreased cardiac output.With decreased cardiac output, mechanisms within the body help to increasethe cardiac output; this does more harm than good.*
Sympathetic Nervous System
: Attempts to increase Cardiac Output & raiseBP by speeding and increasing the contractions (this requiresextra Oxygen to the myocardium-- and oxygen is notavailable so the patient worsens).
* Blood Vessels:
Constrict to raise BP but in turn it makes the heart workharder because there is more peripheral resistance.
* Renin-angiotensin-aldosterone mechanism:
(in response to low blood flowto the kidney because of decreased cardiac output)--
Vasoconstriction, Sodium, & Water retention
which increases theworkload of the heart against the peripheral vascular resistance & morefluid to have to pump due to aldosterone saving sodium & water.Review: The kidneys release renin, which stimulates angiotensin I in the liverwhich in turn is converted to angiotensin II in the lung by the ACE enzyme.Angiotensin II is a potent vasoconstrictor which helps raise BP. It alsostimulates the adrenal cortex to release aldosterone which saves sodium andwater (because water ALWAYS follows salt). It increases fluid & pressure; andexcretes potassium.Creates a problem b/c you have more fluid for the heart to pump.
* Cells
: Switch from aerobic to anaerobic metabolism which increases lacticacid, lowers pH, and causes metabolic acidosis.CHF leads to metabolic acidosis.
 
Hint:IF it’s left it’s a lung if it’s right it’s anything else.Left Sided Heart Failure
Conditions that may lead to left-sided heart failure:1. High Blood PressureIncreases the workload of the (L) ventricle and in the end the (L)ventricle just gives out.2. Clients post MIMuscle doesn’t work as effectively and creates decreased cardiacoutput. So the heart fails b/c it pump the blood d/t the amount of muscledamage.3. Inflammatory heart conditionsAffects the blood flow thru the heart which decreases cardiac output.4. Hypervolemia/ rapid infusion of IV fluidsFluid overload.5. Tachycardia (hypoxemia)Fluid accumulates in the lungs in the pulmonary capillary bed (This impairsoxygen and carbon dioxide exchange).Don’t give it time for ventricles to fill up and heart gives out. Fluidbacks up in the 1
st
place it comes to: which is the lungs. Oxygen doesn’ttravel well thru water, CO2 does. You have more chance of transferring CO2than you do O2. When you have fluid in the lung- you do not get good O2exchange. The more fluid you have in the lung, the less Oxygen youexchange.
See Respiratory S/S
1. Extertional Dyspnea: (1
st
sign) Shortness of breath or dyspneaduring activity.Ex: Short of breath going to bathroom.2. Orthopnea: have to sit upright to breathe3. Paroxysmal nocturnal dyspnea: Awakened by breathlessness due tothe recumbent positioning during sleep & secretions pool inthe lungs (increased venous return to the heart).
** PINK, FROTHY SPUTUM**
When you lay flat it decreases venous return to the heart. So morefluid backs up into the lungs. That’s why a lot of CHF patients will come inearly in the morning. It’s due to the recumbent position when they sleep. They’ve laid flat for a long time and all that fluid has accumulated in thelungs while they’ve slept.4. HypoxiaMakes heart rate increase.5. Crackles in the lungRales- will not clear with cough- “death rattle”
Diagnostic Findings:
1. Chest X-ray shows heart enlargement & fluid in the lungs.Enlarged heart is compressing on the lung inhibiting full expansion.
 
2. Echocardiogram: shows ineffective pumping of the heart.Shows heart wall and valve function.3. ABG: Respiratory alkalosis early, then metabolic acidosis due to impairedgas exchange.4. Elevated BUN: (waste product) in the blood because of decreased renalperfusion due to decreased cardiac output.BUN is up because the BP is low, and you need so much BP for the kidneys tofilter.
Right-Sided Heart Failure
 The major cause of ® sided heart failure is
left sided heart failure
.Exception: MI’s that affect the
® ventricle can cause ® sided heartfailure.Cor Pulmonale
: Condition in which the heart is affected by lungdisease/damage.PAP: Normal: 20-30 systolic/8-12 diastolicExerts increased pressure in the pulmonary artery (comparable to HTNon the left side)If PAP is increased, the ® ventricle will have to work harder to get theblood thru the pulmonary artery b/c there is too much pressure on the otherside.® ventricle enlarges.Cor Pulmonale means (in a nutshell) ® side failure d/t lung disease:increased CO2 (vasoconstriction) Peripherial resistance increased: causesedema Hepatomegaly.**Lung disease increases carbon dioxide levels in the blood (COPD) andcauses
Pulmonary Arterial Vasoconstriction
which increases the force inwhich the ® ventricle has to pump blood to the lungs-- results in anenlargement of the ® ventricle (
Pulmonary HTN
due to vasoconstrictionof the pulmonary artery).X-ray would show an enlarged ® ventricle.When the ® ventricle fails, blood backs up in the venous system and yousystemic symptoms-- Peripheral symptoms:
® side heart failure exhibits urinary frequency d/t increasedurinary output.
1.
Weight Gain:
 
from edema
(heart can no longer circulate the blood so thebody allows it to seep from the intravascular system into tissues to try to getrid of some circulatory fluid volume.
Daily weight!!!!
2. Pitting
edema
in the feet and ankles. Seems to disappear over night (whilelying flat). it actually redistributes the edema while sleeping. When up andwalking (gravity) you see edema again.3.
Ascites
: Fluid in the abdomen.
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