CONGESTIVE HEART FAILURE
DEFINITION:-
Causes and Risk factors : =
-Coronary artery
-Hypertension
-Myocardial Infection ( MI)
-Coronary Artery disease ( CAD)
-kidney failure
. -Smokeing
Classifications:-
-Left Sided Heart failure
-Right Sided Heart failure .
-Acute and corchronic
-High out Put and Low out Put
Right sided heart failure :-
-Liver and spleen enlargement-Right upper quadrant abnormal Pain.
-Nausea , vomiting
-slow weight gain
-Irregular heart rhythm .
Left Side heart failure : =
-fatigue and shortness of breath .-Paroxysmal neetural dyspnea .
-orthothea
. -Pulmonary edema
-Astma- like wheezing or dry hacking cough .
-wheezing -Pale cor bluish skin .
-Palpitations, irregular heart rhythm
-weakness , Insumia and Restlessness
Clinical Manifestations =
-orthaPena -Hacking cough
-Nectural dyspnea
Diagnostic Evaluation : .
-chest x - xey
-MRI -Blood test Electro Physiology study
-ECG
Medical Management =
-Medications may Be Prescribed to dilate blood vessels , strengthen the heart's pumping reduce water and sodium in the body to lessen the heart's work load .
(1 ) Diuretics : Bumetanide ( Bumex and furosemide ( Lasix ) . )
(2)Angiotensin- converting enzyme ( ACE ) inhibitors : = Ace inhibitors (enalaPril , lisinopril.captopril) inhibit the adverse effects of angiotensian 2nd (Potent vasoconstriction / sodium retention ).
(3) Angiotensin II receptor blocking (ARBs):-Angiotensin II - receptor blockers ( Losartan , and valsartan ) similar to Ace inhibitors Used in client who can not tolerate Ace inhibitors due to cough or angioedema .
(4) Digitalis :-• Positive inotropic agents Digoxin ( Lanoxin ) ] increase the heart's ability to Pump more effectively by improving the contractile force of the muscle . (5) Bita Blockers:- Beta - adrenergic blockers [ cravedilo ! ( Coreg ) , metoProlol ( Low Pressor ) and bisoprolol zebeta ) ] decrease myocardial workload and Protect against fatal dysxhythmias by blocking morett .. nepfixine effects rayocardial workload of the syrthithetic nervous system .
(6) Aldosterone antagonists : Aldosterone antagonists ( spironolacto e and eplerenone ) decrease sodium setention , sympathetic nervous system activation and Cardiac remodeling .
(7 ) vasodilator Thearly : = vasodilator " theary decrease the workload of the heart by dilating . Peripheral vessels . Nitroglycerin , bydralazin = isosorbide , dinitrate and morphine sulphate.
Surgical Management:-
.
-Implantable cardiac defibrillator ( ICD )
. -Intra aortic balloonepump (IABP).
-Left ventrialar assist device (LVAD ).
-valve repair or value replacement surgery
- Heart transPlantation
. -Pace maker insertion .
. -Cardiac resynchronization thearly (CRT ) or biventricular Pacing.
Nursing Management:-
-The nurse explain sleep disturbances Perticulary sleep suddently interpted by
Shortness of breath .-The nurse also asks about the number of Pillows needed for sleep activitie of daily living and the activity that causes shortness of breath .
-Assess Peripheral arterial Pullies heart rhythum rate and B.P. -Assess Patient for Presence of peripheral edema .
-Assess externities for colour andtemperature .
→ Note result of serum electialytes level and other laboratory test
. -Assess abdomen for hepatomegally and ascites.
