Congestive Heart Failure (CHF)

Question 1

Congestive Heart Failure (CHF)

Answer 1

• Fluid retention as a result of severe heart disease
• The pressure in the veins and capillaries draining into the diseased side of the heard increases to a point that fluid leaks into the corresponding body compartments (left or right sided heart disease)
• Causes impaired cardiac pumping (heart cannot deliver O2 requirements)
• Some breed predisposition (CKCS, sphynx)
• When treated appropriately up to 80% of acute patients may survive to discharge

Question 2

Left Sided Heart Disease

Answer 2

• Mitral valve disease
• Dilated cardiomyopathies
• Hypertrophic cardiomyopathy
• Congenital defects
• Fluid leaks into the lungs or pleural cavity (pulmonary oedema, pleural effusion)

Question 3

Right Sided Heart Disease

Answer 3

• Fluid leaks into the abdomen or pleural cavity (ascites, pleural effusion)

Question 4

Clinical Signs of CHF

Answer 4

• History of cardiac disease
• Dyspnoea
• Tachypnoea
• Mod to severe resp effort (but don’t rule out mild)
• Harsh breathing/lung sounds
• Congestive cough (coughing up pink serous fluid)
• Watery nasal discharge
• Cyanosis
• Orthopnoea (shortness of breath when lying flat)
• Restlessness and agitation
• Ascites (accumulation of fluid causing abdominal swelling)

Question 5

Initial Stabilisation

Answer 5

• Immediately bring to treatment and put on O2
• Never leave unsupervised
• Sedation should be administered in almost all patients due to stress
• If heart failure patient administer diuretic to draw fluid off lungs (often requires multiple rounds)
• IVC for repeat medications
• Diagnostics (biochem, rads, thoracic ultrasound, echocardiography) to assess level of disease (will need to stage diagnostics, may be able to get DV rad initially)

Question 6

Diagnostic Findings

Answer 6

• Azotemic (excess of urea in blood) due to diuretics reducing circulating volume and therefore loosing sodium, potassium and free water
• Hypokalaemic (due to above - give access to drinking water)
• Radiographs can show pleural effusion, cardiomegaly and pulmonary oedema
• Ultrasound can show pericardial effusion, B lines, left atrial enlargement and a dilated/hypertrophic myocardium

Question 7

Nursing Interventions

Answer 7

• Resolve pulmonary oedema (furosemide)
• Minimise stress (sedation, environment)
• O2 (reassess q4h, only wean or stop when normal respiratory rate/effort, SPO2 95-100% without therapy)
• TPR q1-6h (ECG if tolerates due to potential arrhythmias)
• Heart meds if indicated (pimobendan, fortekor, sildenafil)
• Recheck biochem (daily/bidaily) for renal parameters
• Repeat rads at least q24h
• Avoid IV fluids