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Heart Failure

Lori Baker, RN BSN. Cardiovascular Disorders. Heart Failure. TERMS. Cardiac Output Heart rate x stroke volume That is, amount of volume with each beat multiplied by the number of beats 5L/min Compensatory mechanisms. Compensatory Mechanisms.

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Heart Failure

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  1. Lori Baker, RN BSN Cardiovascular Disorders Heart Failure

  2. TERMS • Cardiac Output • Heart rate x stroke volume • That is, amount of volume with each beat multiplied by the number of beats • 5L/min • Compensatory mechanisms

  3. Compensatory Mechanisms • Sympathetic nervous system detects low cardiac output • HR speeds up • Epinephrine and norepinephrine • Raises CO • Increases oxygen needs of heart

  4. Compensatory Mechanisms • Increase to heart means decrease to kidneys • Renin-angiotensin-aldosterone system • ADH released to conserve water • UOP decreases • Fluid retention develops • Adds to heart failure problem • Cycle continues

  5. Increased Workload = … • Enlarged chambers • Increased muscle mass • Increased oxygen demand

  6. What Start’s It? • CAD • MI • Cardiomyopathy • Valve problems • HTN • Ischemia

  7. Left-Sided Heart Failure • Major cause – HTN • Due to peripheral vascular resistance (PVR) • HTN also causes hypertrophy

  8. Left-Sided Heart Failure • Other causative factors • Restriction of blood flow from LV • Aortic stenosis • Coarctation of aorta • Impairment of myocardial contractility • MI • Cardiomyopathy • Backward blood flow • MR

  9. Left-Sided Heart Failure • S/S • Pulmonary • Dyspnea • Orthopnea • Increased pulmonary pressures • Crackles/rales • Tachycardia • Chest pain • AMS • Pulmonary edema

  10. Right-Sided Heart Failure • Major cause – left-sided heart failure • Other causative factors • Increased pulmonary pressures (from chronic or acute lung disease) • Cor pulmonale • Restriction of blood flow from the RV • Pulmonary stenosis • Abnormal flow of blood from LA to RA • Atrial septal defect (ASD)

  11. Right-Sided Heart Failure • S/S • Systemic • JVD • Peripheral edema • Organomegaly • Hepatomegaly • Splenomegaly • Nocturia

  12. Heart Failure (general) • Diagnostic Tests • CXR – congestion, cardiomegaly • ABG’s • EKG • Ischemia • A-fib • Hemodynamic monitoring • ECHO • Cardiac cath • Renal and liver studies

  13. Heart Failure (general) • Treatment • Goal is to increase cardiac output • Oxygen • Mechanical ventilation • Semi-or high-Fowler’s • Bed/chair rest initially • VS • UOP • Daily weight

  14. Heart Failure (general) • Meds • ACE inhibitors • Captopril (Capoten) • Diuretics • Furosemide (Lasix) • Beta-blockers • Metoprolol (Lopressor) • Meds • Inotropes • Digoxin (Lanoxin) • Aldosterone antagonist • Aldactone • Vasodilators • Nitroglycerin

  15. Heart Failure (general) • Pacemaker

  16. Heart Failure (general) • IAPB (intra-aortic balloon pump)

  17. Heart Failure (general) • VAD (ventricular assist devises)

  18. Heart Failure (general) • Cardiomyoplasty

  19. Questions ???????????

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