CARDIAC FAILURE

Cardiac failure -Definition

A physiologic state in which the heart is

unable to pump enough blood to meet the

metabolic needs of the body at rest or during

exercise even though filling pressures are

adequate.

Etiology

Acute causes

Acute M.I

Dysrthymias

Pulmonary emboli

Thyrotoxicosis

Hypertensive crisis

Papillary muscle rupture

VSD

Chronic causes CAD Hypertension RHD Congenital heart disease Cardiomyopathy Pulmonary diseases Bacterial endocarditis Anaemia Valvular disorders

PathophysiologyLeft heart failure

Hypertension

Increase force of LV contraction

Increase LV O₂ demand

Increase LV hypoxia

Decrease force of LV contraction

Increase LV preload

Increase LA preload Pulmonary oedema

Decrease B.P

CM

Right heart failurepulmonary pathology

Increase pulmonary vascular resistance

Increase force of RV contraction

RV hypoxia

Decrease force of RV contraction

Increase RV preload

Increase RA preload

Peripheral oedema

Compensatory mechanisms

Increase in SNS activity

Ventricular hypertrophy

Ventricular dilation

Renin-angiotensin-aldosterone system

ADH

Endothelin

Proinflammatory cytokines

Counterregulatory mechanisms

Natriuretric peptides

Nitric oxide

Clinical features

Left heart failure- symptoms

Dyspnoea

Orthopnoea

Paroxysmal nocturnal dyspnoea, nocturia

dizziness, confusion, diaphoresis and cool

extremities at rest

Right ventricular failure - symptoms

Weakness

Anorexia

Indigestion

Weight gain

Mental changes

Left heart failure - signs Displaced apex beat Heart murmurs Tachypnea, tachycardia Crackles Dullness - lung fields to percussion and

diminished breath sounds at the lung bases (pleural effusion)

cyanosis, cough, hemoptysis Increased PAP

Right-sided signs

1. Peripheral edema

2. Ascites

3. Hepatomegaly

4. Increased jugular venous pressure

5. Hepatojugular reflux

6. Anasarca

7. Spleenomegaly

Investigations

Echocardiography

Chest roentogram

Electrophysiology

Angiography

Blood tests

Electrolytes (sodium, potassium), renal

function, liver function tests, thyroid function

tests, complete blood count, C-reactive protein

B-type natriuretic peptide (BNP)

Cardiac markers- M.I

Pharmacological management

Angiotensin-modulating agents

Diuretics

Beta blockers

Positive inotropes

Vasodilators

Vasopressin receptor antagonists

Human b – type natriuretric peptide

Devices and surgery

Bi-ventricular pacemaker

Implantable cardioverter-defibrillator

Ventricular assist devices

Cardiac transplantation

Nursing management

High Fowlers position

Legs in dependent position

Oxygen

Activity restrictions

Emotional rest

Allay the anxiety

Monitor ECG, S. electrolytes

Contd…

Small meals than larger ones

Monitor weight daily

Maintain intake & output chart

Restrict sodium & fluid intake

Avoid activities that create valsalva response

Self care needs

Increase activity gradually & as tolerated

Medications

Thank you