Heart Failure
HF is the inability of the heart to pump sufficient blood to meet the need of the tissues for oxygen and nutrients
A clinical syndrome characterized by signs and symptoms
of fluid overload or of inadequate tissue perfusion
Congestive Heart Failure: Is usually an acute presentation of HF, some cases are reversible depending on the cause, most often; HF is a life-long diagnosis thats managed with 1) life styles changes and 2) medications; to prevent acute congestive episodes
Definition:
the term HF is preferred and indicates myocardial heart disease in which theres a problem with contraction of the heart (systolic dysfunction) or filling of the hear (diastolic dysfunction) and it may or may not cause pulmonary or systemic congestion
Types of HF:
Systolic heart failure: (alternation in ventricular contraction)
Diastolic heart failure (alternation in ventricular filling)
Classifications of heart failure according to NYHA:
I: No fatigue, no dyspnea, ordinary ADL and no limitation
II: dyspnea and fatigue. slight limitation ADL, no symptoms at rest, activity intolerance.
III: Marked limitation on ADL, comfortable at rest, less than ordinary activity will cause symptoms
IIII: symptoms of cardiac insufficiency at rest
Etiology of HF:
Coronary artery disease
Hypertension
Valvular disorder
Cardiomyopathy
Cardiac dysarrhithmias
Acidosis (Respiratory or Metabolic)
Electrolytes abnormalities
Antiarrhythmic medications
Clinical manifestations: Chronic HF produce signs and symptoms of failure to both ventricles.
Although, dysarrhythmia's (tachycardias, ventricular ectopic beat, atrioventricular and ventricular conduction defect) are common in HF
they may also be a result of treatment used in HF (digitalis)
Left-sided heart failure: manifestations of pulmonary venous congestion, dyspnea (all types) and cough (dry then moist), pulmonary bi-basilar crackles, lower than normal o2 saturation, an extra heart sound S3.
Inadequate tissue perfusion:
Decreased renal perfusion > oliguria and salt and water retention
Decreased cerebral perfusion (light headedness, dizziness, anxiety, confusion and restlessness
Decreased gastric tissue perfusion (altered digestion)
tachycardia, weak thready pulse, palpitations, fatigue, activity intolerance and insomnia.
Right-Sided heart failure: congestion of the viscera and peripheral tissue, JVD, dependent edema, hepatomegaly, ascites, weakness, anorexia, nausea.
Assessment and diagnostic findings: ECG, ECHO, Chest x-ray, radionculide ventriculoraphy, cardiac catheterization (ventriculogram)
Lab studies:
BUN, BNP, CBC, routine urinanalysis, serum electrolytes and creatinine and TSH