Transcript: CAD and advancing age are primary risk factors for CHF, others include HTN, diabetes, cigarette smoking, obesity, and high cholesterol. ACE Inhibitors Diuretics Inotropic drugs Vasodilator drugs Antiarrhythmic drugs Beta-Adrenergic blockers Human B-type natriuretic peptide Goals Clinical Manifestations of lf sided heart failure MEDICATIONS Clinical Manifestations of rt. sided heart failure Risk Factors Nursing Diagnosis - Congestive heart failure (CHF) is an abnormal condition involving impaired cardiac pumping. - CHF is not a disease. - CHF is associated with numerous types of heart disease, particularly long-standing HTN and CAD. - CHF is characterized by ventricular dysfunction, reduced exercise tolerance, diminished quality of life and shortened life expectancy. CHRONIC - CAD, hypertensive heart disease, rheumatic heart disease, congential heart disease, cor pulmonale, cardiomyopathy, anemia, bacterial endocarditis, valvular disorders ACUTE - acute myocardial infarction, arrhythmias, pulmonary emboli, thyrotoxicosis, hypertensive crisis, rupture of papillary muscle, ventricular septal defect, myocarditis CHF - what is it? Activity intolerance related to fatigue secondary to cardiac insufficiency and pulmonary congestion. 1. Decrease peripheral edema. 2. Decrease shortness of breath. 3. Increase exercise intolerance. 4. Compliance with drug regimen. 5. No complications related to CHF. weight daily and monitor trends. diet education. monitor for serum elctrolyte levels to assess as a response to treatment. encourage alternating rest and activity periods to reduce cardiac workload, work w/ PT/OT to plan and monitor activity program. monitor respiratory pattern for symptoms of respiratory difficulty. administer O2 delivery as ordered. position to alleviate dyspnea. monitor hemodynamic status. monitor renal function and I&Os. adjust environment to promote sleep. use a calm, reassuring approach to reduce anxiety. - crackles (pulmonary edema) - Cheyne-Stokes respirations - pulsus alterans - descr. PaO2, incr. PaCO2 -S3 & S4 heart sounds - fatigue - dyspnea - orthopnea - dry hacking cough - nocturia Congestive Heart Failure Nursing Care Presented by Martin Mufich - fatigue - anorexia/GI bloating - nausea - murmurs -peripheral edema -weight gain -increased HR - edema of dependent body parts - ascites - JVD - hepatomegaly - rt side pleural effusion Common Causes of CHF Diagnostic Studies Determination of UnderLying Cause history and physical exam serum chemistries liver function tests chest x-ray electrocardiogram echocardiogram exercise-stress testing nuclear imaging studies hemodynamic monitoring cardiac catheterization ABGs (cc) photo by theaucitron on Flickr
Transcript: The anatomy of the heart is unbelievably dynamic. Despite the function of our lungs, without our heart we would constantly have oxygen debt. Its explanatory to say our heart is the ultimate syner- gist. In this particular case though, its antagonist potential is evident. Trailing back to blood pressure and weight ; salt (sodium) is the the main attribute for calcification within arteries. Exercise regularly If appropriate, surgery options should be discussed for patients who have had a heart attack M E D I T A T I O N Animation prevention ^ ^ Open heart surgery Signs/symptoms/effects (CHF), there is a loss of pumping efficiency by the heart. Tobacco field Stay Away From: Tobacco Alcohol Treatment There is up to 6 million Congestive heart failure cases in America. An estimated 670,000 people get Congestive Heart failure each year. After 65, you are prone to this hospitalization leader. It is recommended that these individuals look into extended medicare with their families so that precautionary measures are their in the long run but especially in case of an emergency. Unfortunately, it's one of those types that are a miracle to really overcome. One can only do so much within their own power to rid or alleviate the true factor behind its existence. The End Prognosis ^ Heart attack chest pain heart burn A lot of people commonly confuse Congestive heart failure with Heart Disease. Believe it or not there is actually a significant difference between the two. Like most all major health altercations, the exact reasoning behind Congestive heart failure isn't totally evident. Cardiomyopathy is the common overlooked diagnosis. Generally of unknown cause, cardiomyopathy has been linked to infection, & alcohol /drug abuse. ^ edema System Congestive Heart Failure is a lingering four stage process. Typical treatments are taken as precautionary measures. Stage A: People at high risk of developing heart failure, Stage B: People diagnosed with systolic left ventricular dysfunction but who have never had symptoms of heart failure, Stage C: Patients with known systolic heart failure and current or prior symptoms, Stage D: Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care. ^ I didn't know my grandfather on my moms side as well as my dads because he died of Congestive heart failure when I was 10 months old. I think it is interesting to know whether your past family health issues are hereditary or not so you know the chance of carrying it too. Cardiovascular Congestive heart failure Blood pressure Salt (sodium) Weight Why you chose this and How it has/will affect you. Causes General Description Diagnosis- how is it made
Transcript: Congestive Heart Failure. What is it? Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to deliver oxygen rich blood to the body. Causes/Risk Factors? Coronary artery disease. High blood pressure. Longstanding alcohol abuse. Disorders of the heart valves. Symptoms? Fatigue. Swelling of the ankles, legs, or abdomen. Accumulated fluid in the lungs. Fluid in liver and intestines. Shortness of breath. Tests/Diagnosis? Physical exams; breath sounds, swelling in the legs or neck veins. Electrocardiogram (ECG). Chest x-ray. Echocardiogram. Blood tests. Treatment? Lifestyle modifications Aerobic excercises Angiotensin Converting Enzyme (ACE) Inhibitors Beta-blockers Digoxin Diuretics Heart transplant Prognosis? the nature of the underlying heart disease the response to medications the degree to which other organ systems are involved and the severity of other accompanying conditions the person's symptoms and degree of impairment other factors that remain poorly understood Personal Reflection? My uncle was diagnosed with CHF in February of 2010 and passed away because of it in early July of 2010.
Transcript: Congestive Heart Failure What is Congestive Heart Failure? The heart is somehow uncapable of pumping enough blood to throughout the body, resulting in an insufficient amount of oxygen and nurtients traveling to the vital the organs. Symptoms Symptoms of right-sided heart failure include: Swollen legs Liver and spleen enlargement Swollen neck veins Fluid buildup in the stomach Swollen abdomen Slow weight gain irregular heart rhythm Nausea Vomiting Appetite loss Weakness Fatigue Dizziness Fainting episodes Diagnosis The Doctor will take a physical exam, this entitles: Blood test Chest X-ray Echocardiogram Stress test for Coranary Heart Disease Treatments Take meds Get surgury Have a pacemaker Other treatments Eat less salt Exercise regularly Limit alcohol consumtion No smoking Take rest breaks during the day Lose weight if over-weight All of the types of heart failure can result in similar symptoms, including the following Possibly from IV drug use. Shows heart movement Check kidneys & thyroid function Thank you for your attention! Coranary Artery Disease Heart Attack High blood pressure Longstanding alcohol abuse Viral infections of stiffening the heart muscle Thyroid disorder Disorder of the heart rhythm Diabetes Damage to heart valves Angina Chest pain or dsicomfort occuring in an area where the heart mucsle does not receive enough oxygen rich blood Causes Any Questions? •Shortness of breath, especially with activity such as walking •Difficulty breathing when lying flat in the bed •Waking up at night short of breath •Fatigue •Weakness •Pale, blue or cool skin •Palpitations •Changes in blood pressure •Fainting for no apparent reason •Swelling in the abdomen •Swollen legs Check for fluid build up; size of heart http://www.webmd.com/heart-disease/heart-failure/tc/heart-failure-overview
Transcript: Congestive Heart Failure causes High blood pressure Myocardial infarction Valvular heart disease Pulmonary disease diffuse myocardial disease Symptoms Dyspnea shortness of breath Orthopnea not being able to breath unless sitting up or standing Rales abnormal lung sounds Edema swelling in the body Definition The heart is not pumping blood properly and so the body is not getting the blood it needs The heart has to work harder and it eventually wears down the heart Specialists Cardiologist Blackwell Tower at huntsville hospital Risks diabetes Kidney disease heart enlargment passing down through family heart attack abnormal heart valves high blood pressure Body system/Organ affected Heart Lungs Kidneys Liver Treatment Lifestyle changes implantable heart device Heart surgery Heart medications Treatment for symptoms and complications Test physical examination heart catherization ECG nuclear heart scans CT scan cardiac stress test MRI chest x-ray Mortality Rate After diagnosis the survival rate past 5 years is 50% The survival rate longer than 8-12 years is 20% Occurences "5 mil Americans have it" "400,000 new cases a year" "1 out of 100 people older than 65" "20% heart attack patients will get it in 6 years" Anatomy and Physiological affects blood volume overload decreased pulmonary congestion edema kidney faliure increase blood pressure heart muscle wears down Sources Mosbys medical dictionary 5th adition Kenneth N Andersom Publisher Mosby St. Louis Missouri Pages 386&735 Heart Failure Medline plus 8600 Rockville Pike last updated: 02 May 2011, visited May 12, 2011 Avalible at: http://www.nlm.nih.gov/medlineplus/ency/article/000158.htm Congestive Heart Failure 1996-2011 MedicineNet, Inc visited May 11,2011 avalible at:http://www.medicinenet.com/congestive_heart_failure/article.htm Treatment options for heart failure 2011 Medtronic, Inc. Last updated: 22 Sep 2010; Visited May 11 2011.Avalible at: http://www.medtronic.com/health-consumers/heart-failure/treatment/index.htm Other websites visited: www. westsubcardiology.com/slides/gibbs_heart/sld003.htm http://www.wrongdiagnosis.com/c/congestive_heart_failure/prognosis.htm http://0giftarist.wordpress.com/category/science/ http://downeyubf.com/?p=1451 The End Heather Statum Block 4 due May 12 2011
Transcript: Congestive Heart Failure 5 million Americans each year have congestive heart failure. It's most common in people 65 years or older, African Americans, and males. As we age, the heart becomes a little weaker and the blood vessels become narrower, which causes the heart to fail or need more assistance. These are some ways the heart can develop congestive heart failure: Heart failure is not a disease but a condition that results when the heart is unable to pump enough oxygenated blood throughout the body. The lack of blood being pumped throughout the body, in addition to the buildup of fluid in the lungs causes congestive heart failure. Heart attacks- causes the heart to pump less effectively Infections/inflamed-causes the heart to weaken which is also known as cardiomyopathy Hypertension- causes the heart to work into overtime Diabetics Cancer treatment patients alcohol abuse cocaine or other illegal drugs
Transcript: Angiotensin Receptor Blockers (ARBs) ACE Inhibitor Doses Normal Heart vs. Heart Failure Monitoring for diuretics, thiazides, and loop diuretics Relieve symptoms Prevention of exacerbations Slow progression of disease Improve quality of life Daily weights Electrolytes (potassium, magnesium) Blood pressure Renal function (Serum creatinine, BUN) Drugs that worsen heart failure Lifestyle Modification Measurement of B-type natriuretic peptide (BNP) Echocardiogram for determining disease severity, left and right ventricular function Presence of medications known to worsen fluid retention, change left ventricular function and negative inotropic effects Symptoms of volume overload, low cardiac output or both Used in combination with loop diuretics to promote effective diuresis Preferred use in patients with mild fluid retention Not effective if CrCl < 30 mL/min Goals of therapy Types Drugs That May Worsen Heart Failure Nitrates/Hydralazine Doses Blood pressure Potassium Renal function: SCr/BUN Cough Angioedema Used to assist in fluid removal Block sodium reabsorption in the ascending loop of Henle Has not shown a mortality benefit but improves symptomatic relief of fluid overload, improves exercise tolerance, and prevents hospitalization Treatment Overview Drug Therapy Stage C Heart Failure Treatment Algorithm Prevent conversion of angiotensin I to angiotensin II Shown to reduce morbidity and mortality in heart failure and post-myocardial infarction patients Thiazide Source: ACC/AHA Beta Blockers Doses References Left Ventricular Dysfunction Heart Failure Life threatening condition in which the left side of the heart cannot pump enough blood to the body Right Ventricular Dysfunction Heart Failure Condition in which right side of heart loses its ability to pump blood effectively Goals: Reduce fluid retention Improve quality of life Reduce hospitalization Inhibits reabsorption sodium and chloride in renal tubules Beta Blockers Signs and Symptoms Heart Failure Treatment of Diastolic Heart Failure NYHA Functional Classification in Patients with Heart Failure Focus: Systolic Dysfunction Heart Failure Isosorbide Dinitrate and Hydralazine DiPiro, Joseph T. Pharmacotherapy: A Pathophysiologic Approach. New York: McGraw-Hill, 2005. Print. Hunt, HA, WT Abraham, and MH Chin. "Focused Update ACC/AHA 2005 Guidelines for Diagnosis and Managment of HF in Adults." Circulation 119 (2009): E391-479. Print. Lindenf, Eld J., NM Albert, JP Goehmer, and Et Al. "Exectutive Summary: HFSA 2010 Comprehensive HF Practice GUideline." J Card Fail 16 (2010): 475-539. Print. Rossamond, W. "Circulation." 117 (2008): E25-146. Print. Sutton, S. Scott. McGraw-Hill's NAPLEX Review Guide. New York: McGraw-Hill, 2011. Print. Lex-Drugs Online, Lexi-Comp Inc. Hudson, OH. http://www.crlonline.com/crlonline Journal of the American College of Cardiology 2003, 41:1519-1522. Journal of Cardiac Failure Vol 13 Nov 2007. Types of Heart Failure Stage A and Stage B Heart Failure Treatment Algorithm Diagnosis Work by blocking the mineralcorticosteroid receptor, the target site for aldosterone Spironolactone has been shown to reduce to reduce all-cause mortality in patients with moderate to moderately severe heart failure Eplerenone demonsatrated mortality benefit in patients with left ventricular dysfunction following MI Avoid if serum potassium is > 5 mmol/L or creatinine clearance is < 30 ml/min Negative Inotropic Effect Antiarrhythmics, beta blockers, calcium channel blockers, intraconazole, terbinafine Cardiotoxic Doxorubicin, daunomycin, cyclophosphamide, trastuzumab, imatinib, alcohol, amphetamines Sodium and water retention NSAIDs, Cyclooxygenase-2 inhibitors, rosiglitazone and pioglitazone, glucocortioids, androgens and estrogens, salicylate, sodium containing drugs ACE inhibitors Summary Patient Education and Lifestyle Modifications ACE Inhibitors ACC/AHA Stages of Heart Failure Signs and Symptoms Angiotensin Receptor Blockers Source: ACC/AHA, Dipiro Definition of Heart Failure 5 million heart failure patients 550,000 are diagnosed each year Mortality 30% - 40% per year after diagnosis What is heart failure Difference between systolic and diastolic dysfunction Causes Signs and symptoms Classification System ACC/AHA Stages of Heart Failure NYHA Functional Class Pharmacy Therapy Drug Therapy Options ACE Inhibitors ARBs Beta Blockers Diuretics/Thiazides/Loop Diuretics Nitrates/Hydralazine Other Agents Aldosterone Antagonists Digoxin Antiplatelet therapy Shown to reduce mortality in multiple large, randomized, placebo-controlled trials Block the sympathetic nervous system stimulation Reduce plasma norepinephrine References Inhibits Na/K ATPase pump causing increase in intracellular sodium and calcium concentration Has positive inotropic effects, such as increasing the contractility of heart Does not show mortality benefit but improves symptoms and reduce hospitalization Recommended in patients who remain symptomatic despite standard therapy with beta b lockers
Transcript: Congestive Heart Failure History/ Definition Congestive Heart Failure or CHF, is generally defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body. It doesn't mean your heart stopped working, it just means its not working as hard as it should. -Two types. Heart failure can be chronic meaning your condition is ongoing, or acute, meaning your condition has started suddenly. - It has been around for as long as humans have existed. Symptoms Chronic -Swelling (edema) in your legs, ankles and feet -Shortness of breath (dyspnea) when you exert yourself or when you lie down -Fatigue and weakness -Rapid or irregular heartbeat Acute -Symptoms similar to those of chronic heart failure, but more severe and start or worsen suddenly -Sudden fluid buildup -Sudden, severe shortness of breath and coughing up pink, foamy mucus Test and Diagnosis -To diagnose heart failure, your doctor will take a careful medical history and perform a physical examination. -High blood pressure -Blood tests -Chest X-ray -Electrocardiogram or ECG. This test records the electrical activity of your heart through electrodes attached to your skin. (little white stickers attached to electricity) -Stress test or physical activity like walking or running on a treadmill. -Angiogram which is a catheter inserted into a blood vessel at your groin or in your arm and guided through the aorta into your coronary arteries. (Groin is VERY painful) Causes Heart failure often develops after other conditions have damaged or weakened your heart. (Like fluid build up around your heart, which stresses your heart and makes it work harder.) -Over time the heart cant keep up with blood flow. -Pumping chambers in your heart become stiff and not fill properly between beats. - Risk Factors A single risk factor may be enough to cause heart failure, but a combination of factors increases your risk. -High blood pressure -Coronary artery disease -Heart attack -Irregular heartbeats -Diabetes -Viruses (Common cold, flue, fever...) -Alcohol use -Tobacco products/smoking Treatments, Drugs, and Technology Heart failure is a chronic disease needing lifelong management, but with treatments and drugs like these you can live longer and make your heart stronger -Digoxin, This drug increases the strength of your heart muscle contractions. -Beta blockers, This drug not only slows your heart rate and reduces blood pressure but also limits or reverses some of the damage to your heart. -Diuretics, Often called water pills, make you urinate more and keep fluid from collecting in your body. -Coronary bypass surgery. -Heart valve repair or replacement. -Implantable cardioverter-defibrillators or ICDs. (Like Pacemaker) -Heart pumps (left ventricular assist devices, or LVADs) -Heart transplant Lifestyle Making lifestyle changes can often help relieve signs and symptoms of heart failure and prevent the disease from getting worse. -Stop smoking -Weigh yourself daily/ checking for fluid build up in body. -Restrict salt in your diet. -Limit fats and cholesterol. -Limit alcohol and fluids. (can interact to medications) -Reduce stress/ and get good sleep Prevention The key to preventing heart failure is to reduce your risk factors(Talked about, no smoking, eating healthy, good shape) Cure With all of the medicines and heart pumps out their, you can extend your life, but not save it. The only real way is to get a transplant and if it is successful you still have to take care of the new heart. Age You can be born with CHF, however older people or people that dont take care of their heart are at a higher rate of getting it. Males tend to get it more than females because of work conditions/ iron workers, coal mines etc. Charts and Pictures Celebs with CHF Bill Clinton - quadruple bypass surgery in 2004 David Letterman - quadruple bypass surgery in 2000 Larry King - heart attack and bypass surgery in 1987 Dick Cheney - at least 4 heart attacks Sources www.mayoclinic.com http://ezinearticles.com/?Heart-Disease-Hits-the-Famous www.ncbi.nlm.nih.gov www.medicinenet.com/congestive_heart_failure/article.htm
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