MANAGEMENT OF PATIENTS

WITH COMPLICATIONS FROM

HEART DISEASE
Heart Failure (HF)
• often referred to as
congestive heart
failure (CHF)
Heart Failure (HF)
• A clinical syndrome resulting from structural or functional
cardiac disorders that impair the ability of the ventricles to
fill or eject blood.
• is the inability of the heart to pump sufficient blood to meet
the needs of the tissues for oxygen and nutrients.
CHRONIC HEART FAILURE
Types of HF
1. diastolic heart failure
2. systolic heart failure

An assessment of the ejection fraction (EF) is performed to

assist in determining the type of HF.
Heart Failure (HF)
• Low EF is a hallmark of systolic HF
• New York Heart Association (NYHA) classification of
heart failure:
(NYHA) Classification of Heart Failure
Classification Signs and symptoms

I No limitation of physical activity

Ordinary activity does not cause undue fatigue; palpitation, or dyspnea

II Slight limitation of physical activity

Comfortable at rest, but no ordinary physical activity causes fatigue, palpitation, or
dyspnea

III Marked limitation of physical activity

Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or
dyspnea.

IV Unable to carry out any physical activity without discomfort

Symptoms of cardiac insufficiency at rest
If any physical activity is undertaken, discomfort is increased
Classification of Heart Failure (HF)
1. Left-sided heart failure
2. Right-sided heart failure
Classification of Heart Failure (HF)
1. Left-sided heart failure
occurs when the left ventricle fails and cardiac output
falls.
The blood backs up into the left atrium and lungs,
causing pulmonary congestion
Classification of Heart Failure (HF)
2. Right-sided heart failure
also known as cor pulmonale
occurs when the right ventricle does not contract
effectively
This causes blood to back up into the right atrium and
the peripheral circulation, which causes peripheral
edema and engorgement of the kidneys and other
organs
PATHOPHYSIOLOGY
Causes of Left-sided HF

• Coronary artery disease

• Myocardial infarction
• Myocarditis or endocarditis
• Heart valve disorders
• Arrhythmias
Causes of Left-sided HF
• Pulmonary hypertension
• Pulmonary embolism
• Hyperthyroidism
• Hypothyroidism
• Anemia
Clinical manifestations: Left-sided heart failure
• Crackles
• Dyspnea
• Nonproductive cough
• Blood tinged, frothy sputum
• Restlessness
• Tachycardia
• S3 and S4
• Orthopnea
• Nocturnal dyspnea
• Cool, pale skin
Causes of Right sided HF
• Left-sided heart failure
• Hypertension
• Age, infiltration, infections, that cause cardiac wall stiffness
• Heart valve disorders
• Lung disorders: COPD and Pulmonary Embolism
Clinical manifestations: Right-sided heart failure
• enlarged liver (hepatomegaly)
• enlarged spleen (splenomegaly)
• epigastric tenderness
• ascites
• edema
• anorexia, fullness, nausea
• Jugular venous distension (JVD)
• increased Weight
• nocturia
Diagnostic Exam
• Electrocardiography
• Chest x-ray
• BNP level: increased
• Echocardiogram
Treatments for HF
• Goal is to decrease workload on the heart.
• Diuretics
• ACE inhibitors: dilate blood vessels decreasing workload of
heart.
• Angiotensin II receptor blockers: can be used in place of ACE
inhibitors.
• Beta-blockers: slow the heart rate; prevent remodeling.
• Vasodilators: cause blood vessels to dilate.
Treatments for HF
• Positive inotropic drugs: makes the heart muscle contract more
forcefully.
• Anticoagulants: prevent clot formation.
• Opioids: relieve anxiety and decrease the workload on the
heart especially in pulmonary hypertension.
• Oxygen therapy: improves oxygenation.
• Lifestyle modification: exercise; weight loss; reduced
Treatments for HF
• Sodium, alcohol, and fat intake; smoking cessation; stress
reduction to reduce symptoms of heart failure.
• Coronary artery bypass surgery or angioplasty: for heart
failure due to coronary artery disease (CAD).
PULMONARY EDEMA
• abnormal accumulation of fluid in the lungs. The fluid may
accumulate in the interstitial spaces or in the alveoli.
• Pulmonary edema occurs when capillary fluid leaks into the
alveoli. Since the alveoli are filled with fluid, they do not
oxygenate the blood very well and the patient will be in
respiratory distress.
Pathophysiology
• Increased hydrostatic pressure that forces fluid out of the
pulmonary capillaries and to the interstitial spaces and
alveoli.
• The fluid within the alveoli mixes with air, producing the
classis sign of pulmonary edema---frothy pink (blood-
tinged sputum)
• The large amount of alveolar fluid creates a diffusion block
that severely impairs gas exchange
-Hypoxemia
Causes
• Left-sided heart failure
• Left-sided myocardial infarction (MI)
• Valvular heart disease
• Arrhythmias
• High blood pressure
Clinical Manifestations
• Scared expression on client’s face
• Shortness of breath
• Orthopnea
• Rapid, labored breathing
• Tachycardia
• Dependent crackles developing into diffuse crackles
• Signs and symptoms of shock: cold, clammy skin; low blood pressure
Clinical Manifestations
• Frothy, blood stained sputum with cough; looks like beaten egg-
whites (PINK FROTHY-SPUTUM)
• Cyanosis
• Jugular vein distension
• Respiratory acidosis
• Restlessness
• S3 gallop
• Cardiomegaly
Diagnostic Exam
• Arterial Blood Gas
• Chest x-ray
• Pulse oximetry
• Electrocardiography
Treatments
• Supplemental oxygen
• Elevate the head of the bed; lower foot of bed so
fluid will pool in lower extremities
• Weigh daily to monitor for fluid retention.
• Strict I & O
• Treatment of underlying cause of cardiac condition.
Treatments
• Consider mechanical ventilation.
• Diuretics
• Positive inotropic drugs
• Nitroglycerin
• Dobutamine IV
Cardiogenic shock
• called pump failure
• Condition of diminished cardiac output that severely impairs
tissue perfusion.
• can happen because of a damaged muscle, poor ventricular
filling, or poor outflow from the heart.
• As cardiogenic shock progresses, the vital organs begin to
lose perfusion until the heart is no longer able to perfuse
itself!
Cardiogenic shock
• Cardiogenic shock following acute MI means that the heart is
too damaged to effectively perfuse itself. When this
happens, the heart cannot eject blood forward, and the
ischemic heart muscle cannot continue to function
effectively. In the presence of ischemia, the heart begins to
beat erratically and cardiac output falls drastically.
Causes
• Myocardial infarction
• Lethal ventricular arrhythmias
• End-stage congestive heart failure
Signs and symptoms
• Tachycardia
• Hypotension
• Cool clammy skin
• Diaphoresis
• Cyanosis of lips and nail bed
Diagnostic Exam
• Serum enzymes
• ABGs: metabolic and respiratory acidosis and hypoxia.
• Cardiac catheterization and echocardiography: reveal other
conditions that can lead to pump dysfunction and failure like
cardiac tamponade, pulmonary emboli, and hypovolemia.
• Electrocardiography
Treatments
• Maintenance of patent airway; preparation for intubation
and mechanical ventilation: prevent or manage respiratory
distress.
• Supplemental oxygen
• IV fluids, crystalloids, colloids, or blood products: to maintain
vascular volume.
• Vasopressors: reduce left ventricle workload.
• Inotropics: increase heart contractility and cardiac output.
THROMBOEMBOLISM

• Causes (cardiac in origin)

Intracardiac thrombus
atrial fibrillation
Mural thrombi
Deep vein thrombosis (DVT)
PERICARDIAL EFFUSION AND
CARDIAC TAMPONADE
• Pericardial effusion refers to the accumulation of fluid
in the pericardial sac.
Diagnostic Exam
• Echocardiogram
• Chest x-ray
Management: Pericardiocentesis
Note:
*Biopsy

Complications:
Coronary artery puncture
Myocardial trauma
Dysrhythmias
Pleural laceration
Gastric puncture
Cardiac arrest
The heart is unable to pump and circulate blood to the body’s
organs and tissues

Pulseless Electrical Activity (PEA)

• Occurs when electrical activity is present on the ECG but
cardiac contractions are ineffective
Clinical Manifestations
• In cardiac arrest, consciousness, pulse and blood pressure are lost
IMMEDIATELY.
• Breathing usually ceases, but ineffective respiratory gasping may
occur.
• Dilated pupils
• Seizures
• Pallor
• Cyanosis
• Irreversible brain damage
Emergent Management

•CPR
•Defibrillator
High Quality Cardiopulmonary Resuscitation
Defibrillator
•END