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Heart Failure & Pulmonary Hypertension

Pathophysiology
by

Evangeline Sabado

on 11 August 2015

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Transcript of Heart Failure & Pulmonary Hypertension

RIGHT SIDED
HEART FAILURE
NORMAL FLOW
Through Superior vena cava,
Deoxygenated blood flows into
RIGHT ATRIUM then
Through tricuspid valve
into RIGHT VENTRICLE
THE HEART
Objectives
Overview of Patho and Core Defects
Signs and Symptoms
Diagnostics
Treatment Plans
Role of FNP

Heart Failure
Left sided heart failure
Right sided heart failure
Congestive heart failure
Class I, I, III, IV

Pulmonary Hypertension
Group I, II, III, IV, and V
Heart Blood Flow: www.kscience.co.uk
KNOWLEDGE RETENTION
Pathophysiology
Pathophysiology Presentation
Evangeline Sabado
HCS/510
October 31, 2014
Linda Alvarez

PULMONARY
HYPERTENSION
LEFT SIDED
HEART FAILURE
Pathophysiology
pulmonary vascular congestion and inadequate perfusion of systemic circulation
systolic vs. diastolic

Often, Left sided heart failure can progress to the right = CHF
Pathophysiology
inability of ventricle to provide blood flow into lungs
increased pulmonary circulation pressure
right ventricle dilates and fails due to increased workload
result is a rise in systemic venous circulation
Signs and Symptoms
Diagnostics
Treatment
UNDERTREATMENT &
MISDIAGNOSIS

HEART FAILURE is associated with HIGH mortality
20% die within 6 months of initial hospitalization
Median survival rate after first admission is 3.5 years

HEART FAILURE is associated with HIGH admission rates
In the U.S.: Most common cause of admission for people over 65
Up to 50% readmitted to hospital within 6 months of discharge
With aging population, rates to increase by 50% in coming decades


PULMONARY HYPERTENSION may not be detected until symptoms are severe, masked by primary pulmonary or cardiovascular disease
Resultant cor pulmonale is significant cause of morbidity and mortality in late stage chronic lung disease
Signs and Symptoms
Signs and Symptoms
Diagnostics
Diagnostics
Acute vs. Chronic
Treatment
Treatment
HEART FAILURE
Groups of Pulmonary Hypertension
CIRCULATION
NYHA Classification of Heart Failure
CORE DEFECTS
Cardiac
Class I

Class II

Class III

Class IV
No limitation on physical activity


Slight limitation on physical activity


Moderate limitation on physical activity


Symptoms even at rest
Dyspnea on activity
Fatigue
Angina
Tachycardic
Pain on upper right side abdomen
Decreased appetite
Lightheadedness
Syncopal episodes
Edema
Cyanotic lips and skin
To CONFIRM diagnosis:
Echocardiagram
EKG
Chest Xray
Right sided heart catheter

Underlying cause:
Chest CT / MRI
Lung Function Tests
VQ Scan
Polysomnogram


Group I

Group II

Group III

Group IV

Group V
Cause: drugs, medicine, unknown, inherited

Cause: left sided heart conditions (Mitral valve)

Cause: lung disease (COPD) or sleep apnea

Cause: blood clots or clotting disorders

Cause: thyroid disease or sarcoidosis
Oxygen
Diuretics
Anticoagulants
Digoxin
Physical Activity
Pathophysiology:
Increased pressure in pulmonary arteries due to artery walls tighten, artery walls stiff at birth or become stiff, or blood clots form in arteries

Difficult to push blood to the lungs

Right ventricle strains & weakens, leads to heart failure

Oxygenated blood is then
pushed out through the
aortic valve into the aorta
to the rest of the BODY
(Casey, 2013)
(National Heart, Lung, and Blood Institute, 2013)
(National Heart, Lung, and Blood Institute, 2013)
(National Heart, Lung, and Blood Institute, 2013)
(National Heart, Lung, and Blood Institute, 2013)
(National Heart, Lung, and Blood Institute, 2013)
(American Heart Association, 2014)
(American Heart Association, 2014)
Pulmonary
Renal
Therapies for HF are not curative
Management of symptoms and lifestyle modifications
Permanent diagnosis

Pharmacological treatment is blocking RAAS and SNS effects and removing excess extracellular fluid

Maintaining balance between maintaining cardiac function and not over straining the heart
SNS Tachycardia Beta Blockers
Dysrhythmias Positive Inotropes



Fluid in Dyspnea Diuretics
lungs



RAAS H20 & Na+ ACE Inhibitors
Retention Aldosterone
Antagonists
PATHOPHYSIOLOGY
Heart failure vs. Pulm HTN
Left-side vs. Right-side
Systolic vs. Diastolic
Acute vs. Chronic
Symptom severity
(Casey, 2013)
(Casey, 2013)
Differentiate
ROLE OF FNP
Compensatory mechanisms:
Sympathetic Nervous System
Renin Angiotensin Aldosterone System
Remodel heart & vasculature

Patient presentation:
High heart rate
Swelling in extremities
Trouble breathing (most common)
Heart Failure:
heart unable to pump effectively
unable to meet metabolic needs

Causes:
MI - necrosis of ventricular wall
HTN, valve damage, dysrhythmias - inc. metabolic stress
Lung disease - affecting right side of heart
CAD - interrupting blood supply
Drugs & Alcohol - scarring/damage ventricle






Poor ventricular
function
Reduced
cardiac output
Compensatory
mechanisms
Increase Preload
Increase Afterload
Add more strain
to Ventricles
(Casey, 2013)
(Casey, 2013)
RAAS
Dyspnea
Orthopnea
Cough of
frothy sputum
Fatigue
Dec. urinary output
Edema
Echo - decreased
cardiac output &
cardiomegaly

Serum BNP -
causes arterial &
venous dilation,
suppresses RAAS
and SNS
Dyspnea on exertion
Pulmonary edema
Crackles on
auscultation
Possible S4 gallop
VS
SYSTOLIC
DIASTOLIC
SYSTOLIC
DIASTOLIC
Echo - left ventricular
hypertrophy, poor ventricular filling with normal Ejection fraction

Chest Xray - pulmonary congestion without cardiomegaly
VS.
Systolic vs. Diastolic
Treatment
ACUTE
CHRONIC
SYSTOLIC
DIASTOLIC
Cause is often MI
O2, Nitrates, Morphine
Diuretics
IV inotropes
ACE inhibitors
IV betablockers
IV nesiritide
Increase contractility and
reduce preload & afterload
Diuretics
Aldosterone antagonists
ACE inhibitors
Beta blockers
CONSIDER:
Inotropes for afib
Statins for hyperlip.
Anticoags for afib.
Amiodarone for
vent.tachycardia
Goal is to help increase perfusion to the system
Goal is to improve ventricular relaxation and prolong diastolic filling times to reduce diastolic pressure
Heart appears normal at rest
Cardiac output fails with exercise
Chest pain
Possible Murmurs
Pulmonary valve
Tricuspid valve
Peripheral edema
Hepatic congestion
Jugular venous distension
ECHO - Right ventricular hypertrophy

Causes:
Left heart failure (most common)
Lung disease (COPD, ARDS)
PAH (cor pulmonale)
Right ventricular MI
Cardiomyopathies
Pulmonic valve disease
Goal: decrease workload of right ventricle by lowering pulmonary artery pressure

*Same treatment as PAH
VS.
VS.
(Brashers, 2014)
(Casey, 2013)
(Brashers, 2014)
(Brashers, 2014)
(Brashers, 2014)
(Brashers, 2014)
1. FROM BODY TO HEART
2. FROM HEART TO LUNGS:
3. FROM LUNGS TO HEART:
4. FROM HEART TO BODY:
Blood from Right Ventricle
Flows through pulmonary valve
and pulmonary artery into
lungs for OXYGEN
Oxygenated blood flows from
pulmonary veins into
LEFT ATRIUM then
Through mitral valve
into LEFT VENTRICLE
(Nursing Education Consultants. (2007). Right sided heart failure. [jpeg]. Retrieved from http://dorasnursing.tumblr.com/post/16575871576/lalainern-right-sided-heart-failure)
(Guest. (2013). Left sided heart failure. [jpeg]. Retrieved from http://biology-forums.com/index.php?action=gallery;sa=view;id=11378)
(Brashers, 2014)
(Brashers, 2014)
(Brashers, 2014)
(Brashers, 2014)
(Brashers, 2014)
The Renin-Angiotensin-Aldosterone System [Photograph]. (2013). Retrieved October 19, 2014, from http://php.med.unsw.edu.au/medwiki/index.php?title=Neuronal_pathways_and_mechanisms_controlling_blood_pressure
REFERENCES
American Heart Association (2014). Classes of heart failure. Retrieved from
http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-
Heart-Failure_UCM_306328_Article.jsp
American Heart Association (2014). How the healthy heart works. Retrieved from
http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/
AboutCongenitalHeartDefects/How-the-Healthy-Heart-Works_UCM_307016_Article.jsp
Brashers, V. L. (2014). Alterations of cardiovascular function. In McCance, K. L. & Huether, S.
E. (Eds.) Introduction to pathophysiology(7th ed., pp. 1129-1193). St. Louis, Missouri:
Elsevier Mosby.
Chichin85. (2007, October 18). Circulation [Video File]. Retrieved from
http://www.youtube.com/watch?v=Pgi8ue-AMo
Casey, G. (2013). Heart failure. Kia Tiki: New Zealand, 19(2), 20-24. Retrieved from
http://www.nzno.org.nz/resources/library/online_journals.
Left sided heart failure. [Photograph]. (2014). Retrieved October 19, 2014, from
http://biology-forums.com/index.php?action=gallery;sa=view;id=11378
National Heart, Lung, and Blood Institute (2013). What are the signs and symptoms of
pulmonary hypertension? Retrieved from http://www.nhlbi.nih.gov/health/health-topics/
topics/pah/signs.html
The Renin-Angiotensin-Aldosterone System [Photograph]. (2013). Retrieved October 19,
2014, from http://php.med.unsw.edu.au/medwiki/index.php?
title=Neuronal_pathways_and_mechanisms_controlling_blood_pressure
Full transcript