Abnormal Transport & Perfusion: Heart Failure, CVI, VTE, & Arterial vs Venous Ulcer (Week 3) Flashcards
Causes of Chronic Heart Failure
CAD & HTN Rheumatic Heart Disease Congenital Heart Disease Pulmonary Disease Cardiomyopathy Anemia Valvular Disorders Bacterial Endocarditis
Causes of Acute Heart Failure
Acute MI Dysrhythmias Pulmonary emboli Thyrotoxicosis HTN crisis Rupture of papillary muscle Ventricular septal defect Myocarditis
Heart Failure Etiology
Interference with Cardiac Output regulating mechanisms of: Preload Afterload Myocardial contractili Heart Rate Metabolic State Valve dysfunction
Major HF Contributing Factor
Hypertension - increases risk y threefold
Risk Factors
Hypertension Diabetes Cigarette Smoking Obesity High Serum Cholesterol
Types of Heart Failure
Systolic Heart Failure Diastolic Heart Failure Mixed Systolic and Diastolic Heart Failure Abnormal Transport and Perfusion Backwards and forwards flow dysfunctions
Systolic Heart Failure
Most Common type of HF
Inability of heart to pump blood
Caused by defect in ability of ventricles to contract or by increasing afterload or mechanical abnormalities - LV loses ability to generate enough pressure to eject blood through high pressure aorta
*** Decrease in the LV ejection fraction
Systolic Heart Failure Causes
impaired contractile function, (MI) increased afterload (hypertension) cardiomyopathy mechanical abnormalities (valvular heart disease)
Diastolic Heart Failure
Heart Failure with preserved systolic function
Impaired ability of ventricles to fill during diastole
Will result in decreased stroke volume
*high filling pressures and the resultant venous engorgement in both pulmonary and systemic vascular systems
Diagnosis made on presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy and a normal EF
Diastolic Heart Failure Causes
Left ventricular hypertrophy from chronic systemic hypertension, aortic stenosis, or hypertrophic cardiomyopathy
Myocardial fibrosis
Hypertension
L Sided Heart Failure Signs and Symptoms
LV Heaves, Cheyne-Stokes respirations, tachycardia, pulsus alternans, crackles, S3S4 sounds
Fatigue, dyspnea(shallow up to 32-40/min), orthopnea, dry hacking cough, pulmonary edema, nocturia
L Sided Heart Failure
Results from LV dysfunction, causing blood to back up through left atrium and into pulmonary veins
Increased pressure causes fluid extravasation from pulmonary capillary bed into interstitium and then the alveoli»_space; pulmonary congestion and edema
R Sided Heart Failure
Causes backward blood flow to R atrium and venous circulation. Venous congestion in systemic circulation results in peripheral edema, hepatomegaly, splenomegaly, vascular congestion of GI tract, jugular vein distension
Primary cause of R Sided Heart Failure
Left sided heart failure
L sided results in pulmonary congestion and increased pressure in the blood vessels of the lung - eventually leading to right-sided hypertrophy and failure
R Sided Heart Failure Signs and Symptoms
RV Heaves, murmurs, peripheral edema, weight gain, increased HR, ascites, jugular vein distension, fatigue, dependent edema, RUQ pain, anorexia and GI bloating, nausea
Clinical Symptoms of Heart Failure
Dilated Pupils Skin pale, gray, or cyanotic Dyspnea Orthopnea Crackles Cough Decreased BP Nausea and vomiting (peristalsis slows) Ascitis Dependent pitting edema Anxiety Falling )2 Sats Confusion Jugular Vein Distension Infarct Fatigue S2 gallop, tachycardia Enlarged spleen and liver Decreased Urine Output Weak Pulse Cool, moist skin
NYHA Heart Failure Class 1
No limitation on physical activity
Normal activity does not cause fatigue, dyspnea, palpitations, or anginal pain
NYHA Class 2 HF
Slight limitation of physical activity, no symptoms at rest
Ordinary physical activity results in fatigue, dyspnea, palpitations, or anginal pain
NYHA Class 3 HF
Marked limitation of physical activity. Usually comfortable at rest
Ordinary physical activity causes fatigue, dyspnea, palpitations, or anginal pain
NYHA Class 4 HF
Inability to carry on any physical activity without discomfort
Symptoms of cardiac insufficiency or of angina may be resent at rest
If any physical activity is undertaken, discomfort is increased
Non-Invasive Positive Pressure Ventilation
CPAP PEEP IPAP EPAP BiPap
NIPPV Inspiration
IPAP = Pressure Support = Pressure Boost
Increase Tidal Volume - decrease pCO2
Indications: COPD, Respiratory Failure, Pulmonary Edema, Sleep Apnea
NIPPV Expiration
CPAP = EPAP = PEEP
Alveoli remain slightly inflated during expiratory phase
Increase oxygenation to tissues
Increases pO2
Facilitates inspiratory phase
Indications: Sleep apnea, atelectasis, pulmonary edema, respiratory failure
Pharmacological Interventions
Correct Na and water imbalances (volume overload)
Reduce cardiac workload
Improve myocardial contractility
Chronic Venous Insufficiency
Venous stasis occurs when normal blood in venous system is disturbed by: Dysfunctional Vein Valves Inactivity in muscles of limb Change in unidirectional blood flow Blood then pools leading to edema
Chronic Venous Insufficiency
Often occurs as a result of previous episodes of DVT - can lead to venous leg ulcers
Hydrostatic pressure in veins increases and serous fluid and RBCs leak from capillaries into and venules into tissue, resulting in edema
CVI Causes
Vein incompetence Deep vein obstruction Congenital venous malformation Arteriovenous fistula Calf Muscle Failure **Incompetent valves of the deep veins
