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Congestive Cardiac Failure
Congestive Cardiac Failure
Rubani . T
M.Sc nursing
Content
• Definition
• Etiology
• Pathophysiology
• Clinical Features
• Bedside Examination
• Investigation
• Management
Congestive Cardiac Failure
Definition:
CCF or Heart Failure in a clinical syndrome that
develops when the heart muscle is weakened
and cannot maintain the adequate cardiac
output or can do so only at an expence of
elevated ventricular filling pressure.
Pathophysiology
Cardiac output is determined by :
• Preload (the volume and pressure of blood in
the ventricles at the end of diastole)
• Afterload (the volume and pressure of blood
in the ventricle during systole)
•Myocardial contractility
Basis of starling law.
Frank-Starling mechanism
• Cardiac examination
S3(gallop rhythm) is audible and palpable at apex
Murmurs of mitral and tricuspid regurgitation are
frequently
present in patients with advanced HF
• Abdomen and extrimities
Hepatomegaly is seen (frequently tender
and pulsating)
Ascities and jaundice are late signs of HF
Peripheral edema is cardinal
manifestation of HF
(Usually symmetric) but is also
nonspecific
• Jugular Veins
JVP-Usually elevated
• Cardiac Cachexia
With severe chronic HF there is marked
weight loss and cachexia
Investigations
• BNP>100pg/mL
• Electrocardiogram may be normal or it could show numerous
abnormalities including acute ST-T–wave changes from
myocardial ischemia, atrial fibrillation, bradycardia, left
ventricular hypertrophy
• Serum creatinine may be increased because of hypoperfusion.
Pre existing renal dysfunction can contribute to volume
overload.
• Complete blood count useful to determine if heart failure is a
result of reduced oxygen-carrying capacity
• Chest radiography is useful for detection of cardiac
enlargement, pulmonary edema, and pleural
effusions
• Echocardiogram assesses left ventricle size, valve
function, pericardial effusion, and ejection fraction
• Hyponatremia, serum sodium <130mEq/L, is
associated with reduced survival and may indicate
worsening volume overload and/or disease
progression
Thiazides are ineffective with
GFR<30--/min.
Side Effects –
-Pre renal azotemia
-Skin rashes
-Neutropenia
-Thrombocytopenia
-Hyperglycemia
-Increased uric acid