CHRONC

HEART
FALURE
NORMAL PHY8OLOGY
OF THE HEART
When stroke volume decreases, the heart sends signal telling
the brain to increase heart rate
Ah ganun ba sige
wait patataasin ko
HR mo.
Mababa po ang
stroke volume
ko! Pahelp!
Stroke voIume depends on three
factors:
W Preload the amount of bIood
presented to the ventricIe just
before systoIe.
W 19erload refers to the amount of
resistance to the ejection of bIood
from the ventricIe.
W Con9rac9l9 the force of
contraction in reIation to the status
of the myocardium.
LLU8TRATON OF
THE HEART
!reIoad
AfterIoad
ContractiIity
HEART FALURE
nabiIity of the heart to pump
sufficient bIood to meet the
needs of the tissues for oxygen
and nutrients.
Often referred to as congestive
heart failure or CHF because
patients experience puImonary
or peripheraI congestion.
%here are two types of Heart FaiIure:
A. SystoIic heart faiIure
B. DiastoIic heart faiIure
CIassification of Heart FaiIure
%abIe 1: American CoIIege of CardioIogyAmerican Heart Association CIassification of
Chronic Heart FaiIure
$tage Description
A: High risk for developing heart
failure
Hypertension, diabetes mellitus,
CAD, family history of
cardiomyopathy
B: Asymptomatic heart failure Previous M, LV dysfunction,
valvular heart disease
C: $ymptomatic heart failure $tructural heart disease, dyspnea
and fatigue, impaired exercise
tolerance
D: Refractory endstage heart
failure
Marked symptoms at rest despite
maximal medical therapy
%abIe 2: New York Heart Association (NYHA) Heart FaiIure Symptom CIassification
System
HA Class Level of mpairment
o symptom limitation with ordinary
physical activity
Ordinary physical activity
somewhat limited by dyspnea (e.g.,
longdistance walking, climbing two
flights of stairs)
Exercise limited by dyspnea with
moderate workload (e.g., short
distance walking, climbing one
flight of stairs)
V Dyspnea at rest or with very little
exertion
PATHOPHY8OLOGY
CLNCAL
MANFE8TATON8
eneraI:
W !aIe, cyanotic skin
W Dependent edema
W Decreased activity intoIerance
W UnexpIained confusion or aItered mentaI status
CardiovascuIar:
W ApicaI impuIse, enIarged and Ieft IateraI dispIacement.
W %hird heart sound (S3)
W Murmur
W %achycardia
W ncreased juguIar venous distention
CerebrovascuIar:
W Lightheadedness
W Dizziness
W Confusion
astrointestinaI:
W Nausea and anorexia
W EnIarged Iiver
W Ascites
W ncreased hepatojuguIar test
RenaI:
W Decreased urinary frequency during the day.
W Nocturia
Respiratory:
W Dyspnea
W Orthopnea
W BiIateraI crackIes
W Cough on exertion or when in supine position
W !aramyxaI nocturnaI dyspnea
AGNO8TC EXAMNATON8
W ECHOCARDORAM
W CHES% X-RAY
W ELEC%ROCARDORAM (EC)
W LAB. RESUL%S FOR SERUM ELEC%ROLY%E, BUN,
CREA%NNE, %HYROD S%MULA%N HORMONE, B-
%Y!E NA%RURE%C !E!%DE (BN!)
W CBC
W URNALYSS
MECAL - 8URGCAL
NTERVENTON8
SURCAL N%ERVEN%ONS:
W CARDAC %RANS!LAN%
W RESYNCHRONA%ON %HERA!Y
W M!LAN%ABLE CARDAC DEFBRLLA%OR
!HARMACOLOCAL %HERA!Y:
W ANO%ENSN-CONVER%N ENYME (ACE) NHB%ORS
W ANO%ENSN RECE!%OR BLOCKERS
W HYDRALANE AND SOSORBDE DN%RA%E
W BE%A-BLOCKERS
W DURE%CS
W D%ALS
W CALCUM CHANNEL BLOCKERS
W N%RAVENOUS NFUSONS
E$TRTDE
MLROE
DOBUTAME
OTHER MEDS:
W AN%COAULAN%S
W AN%ANNAL
NU%R%ONAL %HERA!Y:
W A LOW$ODUM (2 g/DA) DET
W DETAR RE$TRCTO OF $ODUM
ADD%ONAL %HERA!Y:
W $UPPLEMETAL OXE
NUR8NG MANAGEMENT8
W ADMNS%ER MEDCA%ONS AND ASSESSN %HE
!A%EN%S RES!ONSE %O %HE !HARMACOLOC REMEN.
W ASSESSN FLUD BALANCE, NCLUDN &O.
W EHN !A%EN% DALY A% %HE SAME %ME AND ON %HE
SAME SCALE, USUALLY MORNN AF%ER URNA%ON.
W AUSCUL%A%N LUN ROUNDS %O DE%EC% AN NCREASE
OR DECREASE N !ULMONARY CRACKLES.
W DE%ERMNE %HE DEREE OF JUULAR VEN DS%EN%ON
(JVD).
W DEN%FY AND EVALUA%E %HE SEVER%Y OF DE!ENDEN%
EDEMA.
W MON%OR !ULSE RA%E AND BLOOD !RESSURE.
W EXAMNE SKN %UROR AND MUCOUS MEMBRANES FOR
SNS OF DEHYDRA%ON.
W ASSESSN FOR SYM!%OMS OF FLUD OVERLOAD.
RECENT 8TUE8
- DES!%E OF %HE SNFCAN% ADVANCES N DRU
%HERA!Y FOR CONES%VE HEAR% FALURE OVER %HE
!AS% 20 YEARS, MANY DEVELO!MEN%S ARE UNDER
AC%VE S%UDY. NE CLASSES OF MEDCA%ONS ARE
BEN N CLNCAL %RALS NCLUDN %HE CALCUM
SENS%N AEN%S, VASO!E!%DASE AEN%S.