Heart Failure (Treatment (Drug Therapy (Diuretics (Diuretics are used to…
Dietary education and weight management are essential to the patient's control of chronic HF. Sodium intake is restricted to 200-1000mg.
Angiotensin II receptors blockers
Renin-angiotensin-aldosterone system inhibitors
Diuretics are used to reside oedema, pulmonary venous pressure and preload. If excess extracellular fluid is removed, blood volume returning to the heart can be reduced and cardiac function improved. Diuretics act on the kidney by promoting excretion of sodium and water. Loop diuretics (Frusemide) act on the ascending loop of Henle to promote sodium, chloride, and water excretion.
Types of HF
Left-Sided heart failure occurs due to left ventricular dysfunction. Preventing normal forward blood flow and causes blood to back up into the left atrium and pulmonary veins. Increased pulmonary pressure causes fluid leakage from the pulmonary capillary bed into the interstitium and then the alveoli = pulmonary congestion and oedema.
Right-sided heart failure occurs when the right ventricle fails to contract effectively causing a backup of blood into the right atrium and venous circulation. When venous congestion occurs within the systemic circulation it results in; jugular venous distension, hepatomegaly, splenomegaly, vascular congestion of the GI tract and peripheral oedema.
May result from an acute condition such as right ventricular infarction or pulmonary embolism. Main cause is left-sided HF due to the pulmonary congestion and increased pressure in the blood vessels of the lung. This causes chronic pulmonary hypertension resulting in right-sided hypertrophy and HF.
Signs of HF
Left sided HF
LV heaves, alternating pulse, increase HR, LV hypertrophy, decrease PaO2, slight increase PaCO2 (poor O2 exchange), crackles, S3 & S4 heart sounds, pleural effusion, changes in mental status, restlessness & confusion.
Right Sided HF
Rv heaves, murmors, jugular venous distension, oedema, weight gain, increase HR, ascites, anasarca (body oedema) hepatomegaly (liver enlargement).
HF = inadequate pumping/filling of the heart. Resulting in the inability of the heart to provide sufficient blood to meet oxygen needs of the tissues.
In acute decompensated heart failure an increase in the pulmonary venous pressure is caused by failure of the LV. This results in engorgement of the pulmonary vascular system causing increased resistance. Due to this fluid is moved into interstitial space causing interstitial oedema.
Worsening of ventricular function and chronic neurohormonal activation that results in ventricular remodelling. Involving changed in the size, shape and mechanical performance of the ventricle.
Complications of HF
Pleural effusion, arrhythmias, left ventricular thrombus, hepatomegaly, renal failure.
Fatigue, dyspnoea, tachycardia, oedema, nocturia, skin changes behavioural changes, chest pain & weight changes.
Primary risk factors for HF - Hypertension and Coronary artery disease. Secondary factors include diabetes, advanced age, tobacco use, obesity and high serum cholesterol.