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Diseases Of The Heart

Diseases Of The Heart. dr shabeel pn. Heart Failure. Heart failure is a clinical syndrome Heart is unable to pump sufficient blood to meet the needs of the tissues Heart failure is the number 1 DRG for hospitalization in people over 65 years. Etiology of Heart Failure. CAD

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Diseases Of The Heart

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  1. Diseases Of The Heart dr shabeel pn

  2. Heart Failure • Heart failure is a clinical syndrome • Heart is unable to pump sufficient blood to meet the needs of the tissues • Heart failure is the number 1 DRG for hospitalization in people over 65 years

  3. Etiology of Heart Failure • CAD • Systemic or pulmonary hypertension • Cardiomyopathy • Valvular disease • Septal defects • Myocarditis

  4. Dysrhythmias • Hypervolemia • Metabolic disorders • Autoimmune disorders • Anemia in the elderly

  5. Pathophysiology Of Heart Failure • Decreased amount of blood ejected from ventricles • Stimulation of SNS - increases myocardial workload or O2 demand • Ventricular hypertrophy • Decreased renal perfusion

  6. Activation of Renin-Angiotensin-Aldosterone System • Renin interacts with Angiotensinogen to produce Angiotensin I • Angiotensin I converts to Angiotensin II • Angiotensin II stimulates release of Aldosterone

  7. Blood backs up in left atrium and pulmonary veins • Increased hydrostatic pressure forces fluid out of pulmonary capillaries into alveoli and interstitial spaces • Right ventricle dilates due to increased pulmonary pressures (pulmonary HTN) • Engorgement of venous system extends backwards into systemic veins and organs

  8. Right ventricular failure usually follows left ventricular failure • Right ventricular failure can occur solely without left ventricular failure – cor pulmonale • Heart failure can affect systolic function or diastolic function

  9. Clinical Manifestations Of Left Ventricular Failure (LVF) • Dyspnea • Dyspnea on exertion (DOE) • Orthopnea • Paroxysmal nocturnal dyspnea (PND) • Cough • Crackles • Hypoxia, cyanosis • Tachycardia, palpitations

  10. S3, S4, murmurs • Weak, thready pulses • Fatigue • Pale, cool, clammy skin • Restlessness, anxiety, confusion • Nocturia, oliguria • Decreased GFR, increased creatinine

  11. Clinical Manifestations of Right Ventricular Failure (RVF) • Elevated JVD • Positive HJR • Hepatomegaly, splenomegaly • Ascites • Anorexia, nausea, constipation

  12. Sacral edema • Peripheral edema • Anasarca • Weight gain • Decreased activity tolerance

  13. Acute Pulmonary Edema • Life threatening situation • Large accumulation of fluid in lungs • Manifestations • Severe dyspnea, sense of suffocation • Cough, large amounts of frothy, blood tinged sputum • Wheezing and coarse crackles • Cyanosis

  14. New York Heart Association’sFunctional Classification of Heart Disease • Class I – Ordinary activity does not cause symptoms • Class II – Slight limitation of ADLs • Class III – Comfortable at rest but any activity causes symptoms • Class IV – Symptoms at rest

  15. Diagnostic Findings With Heart Failure • Echocardiogram with Doppler flow studies • Chest x-ray • ECG • B-Type Natriuretic Peptide (BNP)

  16. BUN and creatinine • T4 and TSH • Liver function tests • Stress testing or cardiac cath

  17. Objectives In Treating Heart Failure • Identify and eliminate the precipitating cause • Reduce the workload on the heart • Enhance patient and family coping with lifestyle changes

  18. Medical Management of Heart Failure • Exercise • Bed rest in upright position in acute and refractory stages • Regular exercise program • Oxygen therapy • Dietary restrictions • Sodium restriction • Fluid restriction

  19. Cardiac resynchronization – biventricular pacing (Medtronic InSyn) • Mechanical assist devices • Transplantation

  20. Pharmacologic Management of Heart Failure • ACE inhibitors • Vasodilate • Promote diuresis • Drugs – Vasotec, Captopril, Zestril, • Angiotensin II Receptor Blockers (ARBs) • Prescribed when patient intolerant of ACE-I • Drugs – Diovan, Aticand

  21. Beta1 Blockers • Decrease cytotoxic effects of constant stimulation of SNS • Decrease workload by decreasing heart rate • Drugs - Coreg, Lopressor, Atenolol

  22. Vasodilators • Cause venous dilation • Cause arterial dilation • Drugs – Nitrates ie. Isordil (isosorbide) and other meds ie. Apresoline (hydralazine); BiDil ( isosorbide & hydralazine combination)

  23. Diuretics • Control Na and H2O retention • Three types • Potassium sparing –Aldactone (spironalactone), Inspra (eplerenone) • Loop diuretics – Lasix (furosemide) • Thiazide diuretics – Zaroxolyn (metolazone), HCTZ (hydrochlorazide) • Monitor for hypotension, lyte imbalances and dehydration, worsening renal failure

  24. Cardiac glycosides • Increase force of myocardial contraction and slow conduction through AV node • Drugs – Lanoxin (digoxin), Primacor, Inocor • Precautions with Lanoxin administration • Decreased renal function slows elimination • Will need to decrease dose with certain meds ie. amiodarone, erythromycin, quinidine • Usual dose – 0.125 mg to 0.5 mg (PO,IV,IM)

  25. Lanoxin toxicity – Therapeutic level 0.5-2.0 ng/mL • Symptoms – anorexia, N/V, fatigue, H/A, yellow or green halos, new dysrhythmias • Reversal – hold dose or administer Digibind (digoxin immune FAB) • Nursing considerations for Lanoxin administration • Assess heart rate for 1 min • Give after breakfast • Monitor for hypokalemia

  26. Calcium channel blockers • Contraindicated with severe systolic dysfunction • Drugs – Norvasc, Cardizem, Procardia

  27. Natrecor (nesiritide) • Indicated for the IV treatment of clients with acutely decompensated congestive heart failure with dyspnea at rest • Manufactured from E-coli • Effects - dilates veins and arteries, suppresses Aldosterone • Administration - IV bolus, then drip for 48 hrs • Contraindications - systolic pressure <90mm Hg, binds with Heparin • Side effects - hypotension, VT, HA, nausea • Incompatible with Heparin in same line

  28. Medical Management Of Pulmonary Edema • Sit patient in high Fowlers with legs and feet dependent • Oxygen • Morphine • Diuretics • Other meds as with heart failure

  29. Nursing Diagnoses For The Client With Heart Failure

  30. Nursing Interventions For The Client With Heart Failure • Monitor and manage potential complications • Assess cardiovascular status frequently • Vital signs • Heart sounds • Degree of JVD & HJR • All peripheral pulses

  31. Assess respiratory status frequently • Lung sounds • Assess degree of dyspnea • Assess O2 sats • Assess renal status • I&O • BUN & Cr • Assess for nocturia

  32. Assess GI system • HJR • Ascites • Appetite and constipation • Monitor fluid status closely • Daily weights • I&O • Peripheral and sacral edema

  33. Reduce fatigue • Promote activity tolerance • Control anxiety • Referrals • Teach client and family

  34. Client and Family Teaching Related to Heart Failure • Weigh daily • 2-3 gm Na diet • Fluid restrictions • Meds and side effects

  35. Signs and symptoms to report to physician • Weight gain • Loss of appetite • Syncopy or palpitations • Worsening SOB • Persistent cough

  36. Expected Outcomes • Maintains or improves cardiac function • Maintains or increases activity tolerance • Adheres to self-care program • Absence of complications

  37. Cardiomyopathy • Disease of the myocardium which affects its function • Three major types of cardiomyopathy • Dilated - DCM • Hypertropic - HCM • Restrictive

  38. Dilated Cardiomyopathy • Contractility decreases and ventricles dilate. Affects systolic function. • Etiology – viral myocarditis, toxins, alcohol, pregnancy, ischemia

  39. Clinical manifestations same as with LVF • Dx tests – ECHO, endomyocardial biopsy, ECG, chest x-ray, blood chemistries • Tx – same as with LVF; tx dysrhythmias; heart transplant

  40. Hypertropic Cardiomyopathy • Myocardium increases in size and mass • Reduces inner cavity of ventricles and ventricles take longer to relax and fill. Affects diastolic function • Etiology – genetic, HTN, and hypoparathyroidism

  41. Appears most often in young adults • Clinical manifestations – sudden cardiac death; dyspnea, palpitations, dizziness • Dx tests – radionuclide scans, ECHO, chest x-ray, ECG • Tx – Beta blockers and Ca channel blockers. Avoid meds that decrease preload or increase contractility (Lanoxin). Tx dysrhythmias - may insert ICD

  42. Restrictive Cardiomyopathy • Ventricle walls are rigid and do not stretch normally during filling. Cardiac output decreases. Affects diastolic function. • Etiology - Amylodiosis, Sarcoidosis

  43. Clinical manifestations – fatigue, activity intolerance, dyspnea and other symptoms of LVF • Dx tests – same as other cardiomyopathies • Tx – similar to hypertropic cardiomyopathy; tx dysrhythmias. Also tx underlying cause

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