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Heart Failure
Right Sided Heart Failure
Topics Discussed Here Are: 1. Heart Failure 2. Mitral Valve Prolapse 3. Mitral Regurgitation 4. Mitral Stenosis 5. Aortic Regurgitation 6. Aortic Stenosis
Manifestation: Distended neck veins ( pressure in superior vena cava) CVP Edema formation
ENLARGED RA TV RV PV LA
Lungs
Dyspnea (Orthopnea)
Manifestation: CO Easy fatigability Cyanosis (Peripheral) o Prolonged capillary refill o CO, O2 Restlessness (Syncope/fainting) o Sleepy, yawning, LOC Urine output ( Blood flow to kidneys)
AV
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Confirmation o TEE o Laboratory Tests BNP SUREST BUN For LSHF Serum electrolytes Edema o Na Hyponatremia!! o K - Hyperkalemia!!
Management:
Drugs:
Diuretics o Removes excess ECF, the rate of urine produced o Example: Furosemide (Lasix) K+ WASTING (Hypokalemia) Spironolactone (Aldactone) K+ SPARING (Hyperkalemia) Digitalis o Force of myocardium contractility Nursing Care for DIGITALIS o Example: Digoxin (Lanoxin) o Get HR
o o
REMEMBER for DIURETICS Monitor I&O Eat K+ Foods o Banana, citrus fruits, cantaloupe, watermelon, green leafy vegetables K+ Supplements (KCl) o Incorporate to IV o UO should be > 30ml/hr
ACTION of ACE Inhibitors Promotes vasodilation and diuresis the secretions of aldosterone o Na Retention Hyponatremia o K Excretion
Vasoconstriction
Angiotensin I
Angiotensin II
Angiotensin II Receptor Blocker (ARB) o Example: Valsartan o Action BP ( Systemic peripheral resistance) CO Beta Blockers Diet With HF o Example: > Na Diet (2 gm Na) Carvedilol (Coreg) Metoprolol (Topol) o Action Reduces adverse effects from constant stimulation of sympathetic nervous system Vasoconstriction Vasodilation (HYPOTENSION) Bradycardia Anti***** possibility of hypovolemia
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Valvular Disorders
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Mitral Regurgitation
Definition: Backflow of blood from LV to LA Causes: 1. 2. 3. 4.
Degenerative Changes Aging process Rheumatic Heart Disease Infective endocarditis Collagen Vascular disease SLE Butterfly Lesion (Skin Kidney Heart (Mitral Regurgitation)
Assessment and Diagnostic Findings Assessment 1. Systolic MURMUR 2. Pulse may be regular / irregular Normal: Volume, rhythm Diagnostic Findings 1. Doppler Echocardiography (TE) 2. TEE Management 1. ACE Inhibitors as Captopril (Capoten) 2. Restriction of activity 3. Antibiotic prophylactic therapy 4. Surgery a. Mitral valvuloplasty b. Valve replacement
Mitral Stenosis
Pulmonary Veins
RA TV RV PV Lungs
Pressure in LA
MV
Pressure in LV
AV Aorta
Assessment and Diagnostic Findings Assessment Findings 1. Weak and irregular pulse 2. Low pitched murmurs 3. Atrial dysrhytmias Diagnostic Findings 1. Doppler Echocardiography (TE) 2. Cardiac Catheterization Management: 1. No strenuous activity and competitive sports 2. Drugs: Anticoagulants Anti-anemic 3. Surgery 4. Valvuloplasty Mitral Commissurotomy To widen the narrowed MV
Definition: Obstruction of blood from LA to LV Cause: Rheumatic Endocarditis Clinical Signs and Symptoms: 1. DOE (Dyspnea On Exertion) 2. Progressive Fatigue 3. Hemoptysis, cough, wheezing 4. Paroxysmal nocturnal dyspnea
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Aortic Regurgitation
4.
Pulmonary Veins
Chest Trauma
RA TV RV PV Lungs
Clinical Manifestation: 1. Awareness of forceful heartbeat 2. Marked arterial Pulsations 3. Exertional Dyspnea and fatigue 4. Signs and Symptoms of Left Ventricular Failure Management: 1. Antibiotic prophylaxis 2. No physical exertion 3. Drugs a. Ca+ Channel Blockers, Nifedipine (Adalat, Procardia) b. ACE Inhibitors as Captopril (Capoten) 4. Surgery
Definition: - An obstruction within aortic valve - Blood Flow to LV from aorta Causes: 1. Inflammatory lesions 2. Infective endocarditis 3. Congenital abnormalities
Aortic Stenosis
Definition: Narrowing between LV and Aorta Cause: 1. Inflammatory changes 2. Congenital 3. Clinical Manifestation 1. Exertional Dyspnea, PND 2. Dyspnea and syncope 3. Angina Pectoris 4. Decrease pulse pressure Assessment Findings 1. Presence of MURMUR 2. Vibrations Diagnostic Findings 1. Doppler Echocardiography 2. ECG 3. Stress Test Management: 1. Antibiotic Prophylactic Therapy 2. Surgery Replacement of Valves
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