Heart Failure Flashcards
Compare and contrast right and left-sided heart failure.
Left-sided heart failure: The left ventricle of the heart no longer pumps enough blood around the body. As a result, blood builds up in the pulmonary veins (the blood vessels that carry blood away from the lungs). This causes shortness of breath, trouble breathing or coughing – especially during physical activity. Left-sided heart failure is the most common type.
Right-sided heart failure: Here the right ventricle of the heart is too weak to pump enough blood to the lungs. This causes blood to build up in the veins (the blood vessels that carry blood from the organs and tissue back to the heart). The increased pressure inside the veins can push fluid out of the veins into surrounding tissue. This leads to a build-up of fluid in the legs, or less commonly in the genital area, organs or the abdomen (belly).
Left-sided heart failure is usually caused by coronary artery disease (CAD), a heart attack or long-term high blood pressure. Right-sided heart failure generally develops as a result of advanced left-sided heart failure, and is then treated in the same way. It is sometimes caused by high blood pressure in the lungs, an embolism in the lungs (pulmonary embolism), or certain lung diseases such as COPD.
What role do you think you could play as the osteopath in the management of this patient with chronic venous insufficiency, and what advice would you give to the patient? Justify your answer.
Leg elevation causes venous flow to be augmented by gravity, lowering venous pressures and ameliorating edema. In a sitting position, the patient’s legs should be above the thighs; supine, they should be above the level of the heart
Therefore any treatment modalities should encourage and help this process.
And advice would be to adopt these positions where possible in Life.
Eflourage and drainage techniques. Calf pumping techniques that encourage venous return.
Treatment should be gentle so as to encourage the bodies system to work naturally.
MET to the lower extremity, keeping musculature strong and encouraging blood flow whilst still in an advantageous position
Advice on using a compression stocking.
The standard approach has been to use gradient compression stockings that provide 30-40 or 40-50 mm Hg of compression at the ankle, with gradually decreasing compression at more proximal levels of the leg. [25] This amount of graduated compression is sufficient to restore normal venous flow patterns in many or most patients with superficial venous reflux and to improve venous flow, even in patients with severe deep venous incompetence.
Gentle aerobic excercise that encourages venus return such as lower extremity calf raises.
Good diet to ensure healthy cardiovascular system.
What signs/ symptoms would you remain vigilant to identify given this patient’s history? Provide a brief explanation as to what these signs and symptoms may indicate.
Weight - Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The disease results from the buildup of fatty deposits (plaque) in your arteries, which reduce blood flow and can lead to heart attack.
Swelling in the lower legs and ankles, especially after extended periods of standing
Aching or tiredness in the legs
New varicose veins
Leathery-looking skin on the legs
Flaking or itching skin on the legs or feet
Stasis ulcers (or venous stasis ulcers)
If CVI is not treated,
the pressure and swelling increase until the tiniest blood vessels in the legs (capillaries) burst. When this happens, the overlying skin takes on a reddish-brown color and is very sensitive to being broken if bumped or scratched.
At the least, burst capillaries can cause local tissue inflammation and internal tissue damage. At worst, this leads to ulcers, open sores on the skin surface. These venous stasis ulcers can be difficult to heal and can become infected. When the infection is not controlled, it can spread to surrounding tissue, a condition known as cellulitis.
CVI is often associated with
varicose veins, which are twisted, enlarged veins close to the surface of the skin. They can occur almost anywhere, but most commonly occur in the legs.
Heart failure can develop suddenly, for instance after a heart attack or due to certain heart rhythm problems. This is known as acute heart failure.
But it usually develops gradually over time as a result of a different medical problem, such as permanently high blood pressure. This is known as chronic heart failure.
In heart failure due to left ventricular dysfunction,
CO decreases and pulmonary venous pressure increases. When pulmonary capillary pressure exceeds the oncotic pressure of plasma proteins (about 24 mm Hg), fluid extravasates from the capillaries into the interstitial space and alveoli, reducing pulmonary compliance and increasing the work of breathing. Lymphatic drainage increases but cannot compensate for the increase in pulmonary fluid
In heart failure due to right ventricular dysfunction,
systemic venous pressure increases, causing fluid extravasation and consequent edema, primarily in dependent tissues (feet and ankles of ambulatory patients) and abdominal viscera. The liver is most severely affected, but the stomach and intestine also become congested; fluid accumulation in the peritoneal cavity (ascites) can occur.
Chronic venous congestion in the viscera can cause
anorexia, malabsorption of nutrients and drugs, protein-losing enteropathy (characterized by diarrhea and marked hypoalbuminemia), chronic GI blood loss, and rarely ischemic bowel infarction.
