CONGESTIVE HEART FAILURE

CHF – CONGESTIVE HEART FAILURE - Inability of heart to pump blood towards systemic circulation

1.) Left sided heart failure:

Predisposing factors:

1.) 90% mitral valve stenosis – due RHD, aging

RHD affects mitral valve – streptococcal infection

Dx: - Aso titer – anti streptolysine O 300 total units

- Steroids

- Penicillin

- Aspirin

Complication: RS-CHF

Aging – degeneration / calcification of mitral valve

Ischemic heart disease

HPN, MI, Aortic stenosis

S/Sx

Pulmonary congestion/ Edema

1. Dyspnea
2. Orthopnea (Diff of breathing sitting pos – platypnea)
3. Paroxysmal nocturnal dysnea – PNO- nalulunod
4. Productive cough with blood tinged sputum
5. Frothy salivation (from lungs)
6. Cyanosis
7. Rales/ crackles – due to fluid
8. Bronchial wheezing
9. PMI – displaced lateral – due cardiomegaly
10. Pulsus alternons – weak-strong pulse
11. Anorexia & general body malaise
12. S3 – ventricular gallop

Dx

1. CXR – cardiomegaly
2. PAP – Pulmonary Arterial Pressure

PCWP – Pulmonary CapillaryWedge Pressure

PAP – measures pressure of R ventricle. Indicates cardiac status.

PCWP – measures end systolic/ diastolic pressure

PAP & PCWP:

Swan – ganz catheterization – cardiac catheterization is done at bedside at ICU

(Trachesostomy – bedside) - Done 5 – 20 mins – scalpel & trachesostomy set

CVP – indicates fluid or hydration status

Increase CVP – decrease flow rate of IV

Decrease CVP – increase flow rate of IV

3. Echocardiography – reveals enlarged heart chamber or cardiomayopathy

4. ABG – PCO2 increase, PO2 decrease hypoxemia resp acidosis

2.) Right sided HF

Predisposing factor

1. 90% - tricuspid stenosis
2. COPD
3. Pulmonary embolism
4. Pulmonic stenosis
5. Left sided heart failure

S/Sx

Venous congestion

- Neck or jugular vein distension

- Pitting edema

- Ascites

- Wt gain

- Hepatomegalo/ splenomegaly

- Jaundice

- Pruritus

- Esophageal varies

- Anorexia, gen body malaise

Diagnosis:

1. CXR – cardiomegaly

2. CVP – measures the pressure at R atrium

Normal: 4 to 10 cm of water

Increase CVP 10 – hypervolemia

Decrease CVP 4 – hypovolemia

Flat on bed – post of pt when giving CVP

Position during CVP insertion – Trendelenburg to prevent pulmonary embolism & promote ventricular filling.

3. Echocardiography – enlarged heart chamber / cardiomyopathy

4.Liver enzyme

SGPT ( ALT)

SGOT AST

Nsg mgt: Increase force of myocardial contraction = increase CO

3 – 6L of CO

1. Administer meds:

Tx for LSHF: M – morphine SO4 to induce vasodilatation

A – aminophylline & decrease anxiety

D – digitalis (digoxin)

D - diuretics

O - oxygen

G - gases

a.) Cardiac glycosides

Increase myocardial = increase CO

Digoxin (Lanoxin). Antidote: digivine

Digitoxin: metabolizes in liver not in kidneys not given if with kidney failure.

b.) Loop diuretics: Lasix – effect with in 10-15 min. Max = 6 hrs

c.) Bronchodilators: Aminophillin (Theophyllin). Avoid giving caffeine

d.) Narcotic analgesic: Morphine SO4 - induce vasodilaton & decrease anxiety

e.) Vasodilators – NTG

f.) Anti-arrythmics – Lidocaine

2. Administer O2 inhalation – high! @ 3 -4L/min via nasal cannula

3. High fowlers

4. Restrict Na!

5. Provide meticulous skin care

6. Weigh pt daily. Assess for pitting edema.

Measure abdominal girth daily & notify MD

7. Monitor V/S, I&O, breath sounds

8. Institute bloodless phlebotomy. Rotating tourniquet or BP cuff rotated clockwise q 15 mins = to promote decrease venous return

9. Diet – decrease salt, fats & caffeine

10. HT:

a) Complications :shock

Arrhythmia

Thrombophlebitis

MI

Cor Pulmonale – RT ventricular hypertrophy

b.) Dietary modifications

c.) Adherence to meds