symptoms
warning signs of worsening heart failure
- weight gain 1-2lbs overnight or 3+ lbs in a week
- decrease in exercise tolerance
- cough lasting >3-5 days
- excessive urination at night/ increased swelling
- development of dyspnea or angina at rest
what is ultrafiltration used for
- removes excess fluid for overload
- pulls saline (less work on kidneys than diuretics)
- pulls 6L/day
causes of heart failure in the peds population
- congenital (most common and at 8 weeks gestation)
- moms: alcohol use, virus (rubella), poor prenatal nutrition, diabetes, >40 y.o, chromosome abnormality
what is BNP and how does it correlate to heart failure
- is secreted by the ventricle in response to being stretched. increased bp can indicate ventricle dilation.
- BNP produces vasodilation
non-pharmacological treatment for managing heart failure
- taking medications
- reducing sodium (2-3g/day)
- daily physical activity
- keeping track of symptoms each day
signs/ symptoms of left sided heart failure
- decreased breath sounds
- crackles, rhonchi, wheezing, dyspnea, orthopnea
- dry hacking cough with pink frothy sputum
- PND, increased HR, s3, s4
why are medications given for heart failure
- decrease preload, afterload, anxiety
- oxygenation
- improve contractility
- control heart rate
what are the types of heart failure
- systolic (left) is the most common. occurs when the heart can't contract forcefully enough during systole to eject adequate blood into circulation
- diastolic (left) LV fails to relax adequately, known as a stiff ventricle
- right sided can be caused by LV, RV MI, or pulmonary HTN
what is the best diagnosis for heart failure
echocardiogram. it can be done at the bedside and it is an ultrasound that can identify structures, ventricle enlargement, valve problems, ejection fraction.
interventions for left sided heart failure symptoms
- C&DB, incentive spirometer, walking or up in chair depending on tolerance
- sleeping with HOB up due to orthopnea
-
symptoms of right sided heart failure
- JVD, tachycardia
- organ swelling
- peripheral edema
- ascites, weight gain
- GI symptoms
which medications are given for heart failure management
- oxygenation: airway support, bronchodilators
- decrease anxiety: morphine
- decrease preload: diuretics, NTG, morphine, high fowler's, fluid restriction, ultrafiltration
- decrease afterload: vasodilators, ACEs, ARBs
- improve contractility: positive inotropes (digoxin, dobutamine)
- heart rate: digoxin, diltiazem, BB, HCN
what causes heart failure?
- increase in workload (*HTN*), hr, valvular disease
- loss of heart muscle mass *MI CAD*
- poor contractility (cardiomyopathy)
- inadequate heart rate (bradycardia)
- abnormal anatomy (congenital), volume overload (iatrogenic)
what are other labs to diagnose heart failure?
- chest xray: cardiomegaly, pleural effusion
- ecg: hypertrophy (does not diagnose)
- labs: BNP, kidney function, ABGs
- cbc: in kidney failure, erythropoietin isn't produced which promotes rbc production in the bone marrow.
nursing interventions for peds with hf
- upright position
- promote rest
- maintain body temp
- fluids limits, sodium limits
- track I/Os
causes of HF in pediatrics
- rheumatic heart disease
- endocarditis, myocarditis
- drug toxicity, chronic anemia
- complications of heart surgery
- fluid overload
alternatives for heart failure management (surgery)
- cardiac transplant the only effective treatment for end stage failure
- bridge to transplant: LVAD (assistive device), IABP (intra aortic balloon pump)
- ICD to prevent sudden cardiac death
- surgery is done to decrease ventricle size to support it.
what's the difference between preload and afterload
preload: volume of blood in the ventricles at the end of diastole (EDP) increased in hypervolemia, regurgitation of valves, HF
afterload: resistance left ventricle must overcome to circulate blood. increased in HTN & vasoconstriction
diagnosis of hf in peds
- primarily based on clinical manifestations such as tachycardia, respiratory distress and crackles
- cardiac catheterization (cam detect pulmonary stenosis/ transposition of great arteries)
- ecg, chest xray, physical exam
what are some chemical responses from heart failure? (BNP, ADH, etc.)
- BNP: released in response to fluid overload
- pro-inflammatory cytokines are remodeling
- endothelin: released with stretch (vasoconstriction)
- ADH: vasopressin > fluid retention + vasoconstriction
symptoms of HF in pediatrics
- tachypnea, tachycardia, LOW BP
- intercostal retractions, nasal flaring, grunting
- crackles, coughing, wheezing, swelling of hands, feet, periorbital area
- difficulty feeding (diaphoresis from being tired), failure to thrive, slow wt. gain
- irritability, cool extremities, oliguria, pallor, pain/ tenderness in abdomen
treatment for hf in peds
- meds (digoxin, lasix, ACEs)
- oxygen therapy
- surgery (hf in peds can be fixed, but not in adults)
- managing condition until baby is strong enough and less risk involved (~1-2 years)
what is a biventricular pacemaker
- aks cardiac resynchronization is used to treat the delay in heart ventricle contractions. it keeps R and L ventricles pumping together by sending small electrical impulses through the leads
what is the normal range of EF in a normal heart vs HF
- normal: 50-70%
- heart failure: <40%
- risk for sudden cardiac death/ eligible for ICD: <30%
what occurs during each comp. mechanism?
#1: activation of SNS (catecholamine release) increased hr, bp, arterial & venous vasoconstriction, ventricular dilation
#2: myocardial hypertrophy increase in ventricular wall (muscle cells enlarge) chambers dilate and become o2 deprived, ventricular remodeling (decreased SV and contractile systolic function)
#3: renin-angiotensin activation: decreased perfusion to kidneys, RAA compensates and increases afterload. aldosterone hangs on to Na+h2o to increase volume