HF 1
What is heart failure?
Impaired cardiac pumping/filling
The heart is unable to produce adequate cardiac output (CO) to meet metabolic needs
Unable to pump blood to the rest of the body, including brain and vital organs
Decreased cardiac output leads to decreased tissue perfusion
Causes of Heart failure?
HTN
Coronary Artery disease
What is cardiomyopathy
Disease of the heart, can be inherited
What is HTN?
Usually defined as a blood pressure above 140/90
Reasons for poor adherence with HTN management
Inadequate teaching
Low Health Literacy
Unpleasant side effects of drugs
Return to normal BP
High cost of drugs
Lack of insurance
Right Sided Heart Failure causes
Fluid to back up in the venous system
Fluid to move into the tissues
Left Sided Heart Failure causes
blood to back up into the left atrium
Increased pulmonary hydrstatic pressure which causes pulmonary congestion and edema
Cardiomyopathy treatment
medications
surgically implanted devices
heart surgery
heart transplant
What are the 3 different types of HTN
Primary HTN-Unknown cause of HTN (not related to another medical condition) also called essential HTN
Secondary HTN-Has a known cause (usually caused by another medical condition such as OSA)
Emergent HTN-Hypertensive crisis sudden and severe increase in BP usually >180/120
HTN Risk Factors (Name 5)
Family Hx
Excessive Na+ intake
Physical Inactivity
Alcohol
Smoking
African American
Stress
High Cholesterol
Signs/symptoms of Right Sided Heart Failure (Name 6)
Fatigue
Peripheral Venous Pressure
Ascites
Enlarged Liver and Spleen
Distended Jugular Veins
Anorexia/GI distress
Weight Gain
May be secondary to pulmonary problems
Signs/Symptoms of Left Sided Heart Failure (Name 6)
Paroxysmal Nocturnal Dyspnea
Elevated Pulmonary Capillary wedge pressure
Pulmonary Congestion-cough, crackles, wheezes, blood-tinged sputum, tachypnea
restlessness
confusion
orthopnea
tachycardia
exertional dyspnea
fatigue
cyanosis
Cardiomyopathy-Restrictive
Rigid Ventricular walls
diastolic dysfunction
least common type
What are some modifiable risk factors? (Name 5)
Na+ intake-<2000mg/day
Moderation of alcohol
Physical Activity-30 minutes/5day week Goal 150min/week
Decrease Weight
Decrease Stress
Decrease Depression
Avoid tobacco
DASH diet
What is the Silent Killer? (Name 3 symptoms of severe hypertension)
Asymptomatic until severe and target organ disease occurs.
Symptoms include:
Fatigue
Dizziness
Palpations
Angina
Dyspnea
What is Biventricular Failure?
Both right and left ventricular dysfunction
Inability of both ventricles to pump effectively
Causing venous engorgement and decreased perfusion to vital organs
Treatment for CHF
Nutritional Therapy-diet and weight reduction, DASH diet, Na+ reduction/restriction
Fluid restriction
Monitor I&O
Daily weights-gain of >2lbs in 1 day or 5lb in a week report
Quit smoking
Cardiomyopathy-Dilated
Enlargment of all cardiac chambers
Systolic Dysfunction
Most common type
Preferred first line therapy for geriatrics.
Thiazide diuretics
Calcium Channel Blockers
ACE Inhibitors or ARB
What tests/labs would you anticipate being ordered to help with a HTN diagnosis after ruling out secondary HTN?
Multiple elevated BP readings
Echo
LFT's
TSH
HDL
LDL
triglycerides
CHF medication class Treatment
Diuretics
Vasodialators-reduces bp, decrease stretch of the heart
Morphine-reduces preload/after load, decreases dyspnea, anxiety
Positive inotropes-increase cardiac contractility, example digoxin
beta blockers-decrease workload, decrease heart rate (lol's)
Daily Double
What is the 5 year survival rate for CHF?
50ish%
Cardiomyopathy-Hypertrophic
Diastolic Dysfunction
Risk of Sudden death in young atheletes
Thickened left ventricular wall
HTN medication classes
Ace Inhibitors-Relax blood vessels, lowers blood pressure and prevents diabetes-related kidney damage
Diuretics-Eliminates extra water from the body
Beta Blockers- Slow the heart rate and decreases blood pressure
Antihypertensive drugs-lower blood pressure
Calcium Channel Blockers-Relaxes blood vessels
Vasodilators-Widens blood vessells
Gerontologic considerations with HTN (name 4)
Loss of elasticity in arteries
Increased PVR
Decreased adrenergic receptor sensitivity
Blunted baroreceptor refluxes
decreased renal function
Decreased renin response to sodium and water depletion
Altered drug absorption, metabolism and excretion