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Etiology
Acute causes
Acute M.I
Dysrthymias
Pulmonary emboli
Thyrotoxicosis
Hypertensive crisis
Papillary muscle rupture
VSD
Chronic causes
CAD
Hypertension
RHD
Congenital heart disease
Cardiomyopathy
Pulmonary diseases
Bacterial endocarditis
Anaemia
Valvular disorders
Pathophysiology
Left heart failure
Hypertension
Increase force of LV contraction
Increase LV O demand
CM
Increase LV hypoxia
Decrease force of LV contraction Decrease
B.P
Increase LV preload
Pulmonary
Increase LA preload
oedema
Compensatory mechanisms
Increase in SNS activity
Ventricular hypertrophy
Ventricular dilation
Renin-angiotensin-aldosterone system
ADH
Endothelin
Proinflammatory cytokines
Counterregulatory mechanisms
Natriuretric peptides
Nitric oxide
Clinical features
Left heart failure- symptoms
Dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea, nocturia
Right-sided signs
1.
Peripheral edema
2.
Ascites
3.
Hepatomegaly
4.
Increased jugular venous pressure
5.
Hepatojugular reflux
6.
Anasarca
7.
Spleenomegaly
Investigations
Echocardiography
Chest roentogram
Electrophysiology
Angiography
Blood tests
Electrolytes (sodium, potassium), renal
Pharmacological management
Angiotensin-modulating agents
Diuretics
Beta blockers
Positive inotropes
Vasodilators
Vasopressin receptor antagonists
Human b type natriuretric peptide
Nursing management
High Fowlers position
Legs in dependent position
Oxygen
Activity restrictions
Emotional rest
Allay the anxiety
Monitor ECG,
S. electrolytes
Contd
Small meals than larger ones
Monitor weight daily
Maintain intake & output chart
Restrict sodium & fluid intake
Avoid activities that create valsalva response
Self care needs
Increase activity gradually & as tolerated
Medications
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