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HEART FAILURE (HF) A condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs. It indicates a myocardial disease in which there is a problem with contraction of the heart (systolic dysfunction) or filling of the heart (diastolic dysfunction) that may or may not cause pulmonary or systemic congestion.

Causes: A. CHRONIC Heart Failure LEFT Sided C – oughing & dyspnea H – emoptysis O – rthopnea P – ulmonary congestion  Dx Procedures: (Left Sided) 1. CXR – cardiomegaly 2. Echocardiography – cardiomyopathy 3. ABG – respiratory acidosis 4. CVP – indicates hydration status

RIGHT Sided H – epatomegaly E – dema A – scitis D – istended neck vein (Right Sided) 1. CXR – cardiomegaly 2. CVP – pressure at R atrium 3. Echocardiography –cardiomyopathy 4. Liver Enzymes – elevated

 Managements: 1. High Fowlers, sodium restriction, oxygenation, enhance relaxation. 2. Reduce afterload (rest, Vasodilators) 3. Reduce preload (Diuretics, Rotating tourniquet – prevents venous return but not arterial blood flow) 4. Increase cardiac contractility (Digitalis/Lanoxin)  has positive inotropic effect, negative chronotropic & dromotropic effect, and has a cumulative effect (hence has toxicity).  Remember that Hypokalemia, old age, acute MI, severe arrhythmia potentiates toxicity. B. ACUTE Decompensated Heart Failure (a.k.a. Pulmonary Edema) – Chronic stable heart failure may easily decompensate. This most commonly results from an intercurrent illness (such as pneumonia), myocardial infarction (a heart attack), arrhythmias, uncontrolled hypertension, or a patient's failure to maintain a fluid restriction, diet or medication. Clinical Manifestations:  Restless, anxious  Cyanotic, cold moist skin  Distended neck vein with weak, rapid pulse  “Drowning in secretions” with increasing quantities of mucoid sputum Managements: 1. Oxygenation, high fowlers 2. Suction secretions 3. Remain with the pt, give concise & simple information 4. IV infusions & meds (morphine, diuretics) 5. Monitoring medications, VS, ECG changes

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