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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

Pathophysiology
Left heart failure
Hypertension
Increase force of LV contraction
Increase LV O demand

CM

Increase LV hypoxia
Decrease force of LV contraction Decrease
B.P
Increase LV preload
Pulmonary
Increase LA preload
oedema

Right heart failure


pulmonary 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