Heart Failure
inability of heart to produce an adequate CO
- CO = SV x HR
- common in over 65 yrs
Heart Failure Primary Risk Factors
- CAD
- HTN
- heart disease/defects
Contributing Risk Factors
- anemia
- tobacco use
- infection
- dysrhythmias
- diabetes
- obesity
Left Sided HF
- pulmonary congestion
- edema
Right Sided HF
- jugular venous distention
- hepato/splenomegaly
- ascites
- peripheral edema
Systolic HF
decrease in the left ventricular ejection fraction (EF)
-caused by: MI, increased afterload, cardiomyopathy, abnormalities
Diastolic HF
- pulmonary problems
- hypertrophy, stenosis, cardiomyopathy
Mixed Systolic & Diastolic HF
- DCM, poor ECF, high pulmonary pressures
- biventricular failure
- SNS activation & release of E & NE
Counter Regulatory Process
Natriuretic peptides: atrial natriuretic peptide (ANP) and b-type natriuretic peptide (BNP)
Clinical Manifestations: Chronic Heart Failure
- fatigue
- limited activity
- chest congestion & cough
- edema
- shortness of breath
Diagnostic Studies
- history & physical exam
- chest xray
- ECG
- EF
- stages & classes
ACCF/AHA Stages of HF
A: high risk without structural heart disease or symptoms of HF
B: structural heart disease, without sign or symptoms
C: structural heart disease with prior or current symptoms of HF
D: refractory HF
NYHA Function Class
I/II: no limitations
III: slight limitation
IV: unable to do physical activity
HF Complications
- pleural effusion
- pulmonary edema
- atrial fib
- loss atrial contraction
- high risk of fatal dysrhythmias
HF Meds
- same as HTN
- vasodilators: nitrates, hydralazine, & nitroprusside
- anticoagulants
- positive inotropes: dobutamine, digoxin, milrinone
Decrease intravascular volume
- Reduces venous return and preload
- Loop diuretics (e.g., furosemide)
- Ultrafiltration or aquapheresis
Decrease Venous Return (preload)
- Reduces the amount of volume returned to the LV during diastole
- High-Fowler’s position
- IV nitroglycerin
Decrease Afterload
- Improves CO and decreases pulmonary congestion
- IV sodium nitroprusside (Nipride)
- Morphine sulfate
- Nesiritide (Natrecor)
Acute Decompensated HF
pulmonary edema
- early: increase in RR & decrease in PaO2
- late: tachypnea, respiratory acidemia
Overall goals of therapy for ADHF and chronic HF
- Decrease patient symptoms
- Improve LV function
- Reverse ventricular remodeling
- Improve quality of life
- Decrease mortality and morbidity
Improve gas exchange and oxygenation
- Supplemental oxygen •Morphine sulfate
* Noninvasive ventilatory support (BiPAP)
Improve Cardia Function
For patients who do not respond to conventional pharmacotherapy •Inotropic therapy
•Digitalis
•B-Adrenergic agonists (e.g., dopamine)
•Phosphodiesterase inhibitors (e.g., milrinone) •Hemodynamic monitoring
