Adrenergic response Fluid overload Tricuspid valve regurgitation

Release of catecholamines --- (epinephrine& Congestion of the blood into the R side of the heart
norepinephrine)
Backflow to the systemic circulation ---- Manifestation:
Vasoconstriction --- (especially in the kidneys) Increase preload and afterload Edema
Increase ICP Ascites
Renal perfusion Increase stress on the ventricular wall Anorexia and nausea
Pump failure Jugular distention
Increase GFR “counterregulatory mechanism” dizziness
Decrease contractility
Oliguria Release of natriuretic peptide
Decrease CO Manifestation:
1) HYPOtension
Release of renin Vasodilation 2) TACHYcardia
Pump failure 3)
4)
TACHYpnea
Altered hemodynamics
“angiotensinogen” Diuresis and natriuresis * NPA: systolic = 20-30mmHg
Diastolic: = 8-12mmHG
“cardiogenic shock”
Angiotensin I Increase workload ---- *NPWCP: 8-12 mmHg ( L ventricular appears @ a
wedge between 14-18mmHg

*NCI= 2.5-4L/min/m2
ACE Decrease contractility
5) cold clammy skin

Angiotensin II Increase end-diastolic blood volume

Dilation of ventricles

Manif Thickness of the muscle walls

Vasoconstriction Stimulates adrenal cortex estati
on: “cardiomegaly”
SV, CO Aldosterone
EDE
Decrease CO
MA
Na+ & water retention ---

PHARMACOLOGIC TREATMENT:
1) CARDIAC GLYCOSIDES: Digoxin (lanoxin)
! watch out for toxicity that can result
dysrhytmias
 Be alert for incidence of chest pain
 Auscultate lung fields for adventitious
breath sounds
 Evaluate arterial blod gas (ABG)
 Administer O2 theraphy
 Perform neurologic chech q1  using GCS

2) VASODILATOR THEREAPHY:
Nitroglycerin ( Tridil)
! adverse effe3ct may include worsening of
hypotension

3) DIURETIC THERAPHY:
! may cause hyponatremia, hypokalemia
and hypovolemia

NURSING INTERVENTION:

 Establish continuous ECG monitoring

 Monitor hemodynamic parametes with
SWAN-GANZ catheter
 Be alert to adverse responses of drug
theraphy
 Monitor BP and mean arterial pressure
(MAP)
 Maintain MAP greater than 60mmHg
 Measure and record urine output
 Obtain daily Wt
 Evaluate serum electrolytes for
hypokalemia and hyponatremia