Congestive Heart Failure Flashcards
CHF NYHA Functional Classifications
Class I: no limitation is experienced in any activities; there are no symptoms from ordinary activities.
Class II: slight, mild limitation of activity; the patient is comfortable at rest or with mild exertion.
Class III: marked limitation of any activity; the patient is comfortable only at rest.
Class IV: any physical activity brings on discomfort and symptoms occur at rest
Systolic Dysfunction
Contraction Problem
Can be Left or Right Sided
Heart contracts less forcefully and cannot pump out as much of the blood that is returned to it as it normally does.
The left heart cannot pump with enough force to push a sufficient amount of blood into the systemic circulation. This leads to fluid backing up into the lungs and pulmonary congestion.
LVEF less than 40%- Echocardiogram
Left Sided Heart Failure
Ineffective left ventricular contractile function
Systolic Dysfunction -Increased workload and end-diastolic volume enlarge the left ventricle -Pumping ability of the left ventricle fails, cardiac output falls -Right ventricle becomes stressed because it's pumping against greater pulmonary vascular resistance and left ventricle pressure -Blood backs up into left atrium and then into lungs LEFT=LUNGS -Left ventricle overloaded -Volume overload Regurgitant valve- MVR High output status -Pressure overload Output restriction- Aortic stenosis HTN -Left ventricle muscle weakened Post MI Poisoning -Restricted Filling Pericardial disease Restrictive cardiomyopathy Tachyarrhythmia
Signs/Symptoms of Left Sided Heart Failure
Signs and symptoms Dyspnea Orthopnea- sob when lying down Paroxysmal nocturnal dyspnea Pulmonary congestion Tachycardia S3 S4 Cool, pale skin Restlessness
Right Sided Heart Failure
RIGHT=REST OF BODY=Periphery Systolic Dysfunction Right ventricle primarily affected Pulmonic stenosis Pulmonary hypertension Ineffective right ventricular contractile function
Systolic Dysfunction
- Stressed right ventricle enlarges with the formation of stretched tissue
- Blood backs up into right atrium and peripheral circulation
- Blood pools in the right ventricle and right atrium
- Backed-up blood also distends the visceral veins, weight gain & peripheral edema
Signs and Symptoms of Right Sided Heart Failure
Jugular vein distention
Positive hepatojugular reflux
Hepatomegaly
Bi-Ventricular Failure
Late in course of Left sided Failure Problem initiates in Left ventricle Long standing aortic valve disease or systemic hypertension Have right sided heart failure Peripheral edema Congestive hepatomegaly Systemic venous distention
Diastolic Dysfunction
The contraction part of this cycle is called systole. The relaxation portion is called diastole.
Contraction function is normal but there’s impaired relaxation of the heart, affecting the ventricles
Left ventricular filling is abnormal and is accompanied by elevated filling pressures
Diastolic dysfunction may lead to fluid accumulation, especially in the feet, ankles, and legs, and some patients may also have pulmonary congestion
Causes of Diastolic Dysfunction
CAD Aging Stiff ventricles Uncontrolled or Chronic HTN Aortic Stenosis Hypertrophic cardiomyopathy Restrictive cardiomyopathy Amyloidosis, sarcoidosis & hemochromatosis
Diastolic Dysfunction Diagnostics
Plain echo may miss need to perform a doppler
Doppler scan assessment of trans mitral flow is the standard approach to detect diastolic dysfunction
Diuretics
Thiazide diuretics
HCTZ, metolazone
Loop diuretics
Bumex, Lasix, torsemide
Add potassium supplements, check creatinine
Potassium-sparing loop diuretics
spironolactone
CHF Meds
Prognosis ACE, ARB, BB Start on lowest dose ACE 50% dead in 5 months after diagnosis Symptoms Diuretics, Digoxin not used as much NSAIDS –hold onto sodium Imdur/hydralazine combination if Renal insuff aldosterone blocker – Ex. Inspra Spironolactone vs. Lasix vs. HCTZ Some patients need pacemaker or implantable cardiac defibrillator
