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Heart Failure

519 Advanced Pathophysiology
by

Toufic Khairallah

on 15 October 2012

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Transcript of Heart Failure

Heart Failure 519 Advanced Physiology
Saint Francis Medical Center College of Nursing
Toufic S. Khairallah Definition Conditions/Risk Factors That May Lead To Heart Failure: Types of Heart Failure Tests & Dignostics Preventitive and Long Term Medications: Long Term Complications of Heart Failure: Long Term Treatment Options: Heart Failure (HF), formally known as Congestive Heart Failure (CHF) is caused by many conditions over the years that can weaken the cardiac muscle (Mayo Clinic, 2011). Coronary Artery Disease (CAD)
Myocardial Infarction
Hypertension
Murmurs
Cardiomyopathy
Myocarditis
Arrhythmias
Diabetes
Thyroid disease
Sleep Apnea
Chronic Obstructive Pulmonary Disease
Smoking & Alcohol
Medications (i.e. Avandia, Actos)
Viruses Brain Natriuretic Peptide (BNP)
Chest X-Ray
Cardiac Computerized Tomography (CT)
Magnetic Resonance Imaging (MRI)
Electrocardiogram (Echo)
Electrocardiogram (ECG)
Stress Test
Cardiac Catheterization Positive Inotropic Agents
Digoxin
Milrinone
Epinephrine
Dobutamine
Negative Inotropic Agents
Calcium Channel Blockers
Beta Blockers
Angiotensin-Converting Enzyme (ACE) Inhibitors
Angiotensin II Receptor Blockers (ARBs)
Diuretics
Aldosterone Antagonists
Anti-clotting Medications Implantable Cardioverter-Defibrillator (ICD)
Heart Valve Replacement or Repair
Cardiac Resynchronization Therapy (CRT) or Bi-Ventricular Pacing
Coronary Artery Bypass Grafting (CABG)
Ventricular Assist Device (VADs)
Heart Transplantation Renal Failure
Liver damage
Heart Attack
Stroke
Pulmonary Emboli Click on the following YouTube Videos on VADs New York Heart Association scale
American College of Cardiology (ACC) / American Heart Association (AHA) Classification System Staging Heart Failure With a stance on reimbursements with patients diagnosed with Heart Failure within 30 days it is important for the APN to educate the patient and empower the patient and their family to be compliant with their medications, treatments, and lifestyle changes.

The APN should also know the following Joint Commission Core Measures for Patients with Heart Failure: http://www.jointcommission.org/core_measure_sets.aspx CPM Resource Center. (2010). Heart Failure. Elsevier. Philadelphia, PA.
Heart Hope. (2012). Stages of Heart Failure. Retrieved from http://www.hearthope.com/about-heart-failure/stages-heart-failure.asp
Joint Commission. (2012). Heart Failure: Measure set. Retrieved from http://www.jointcommission.org/core_measure_sets.aspx
Mayo Clinic. (2011). Heart Failure. Retrieved from http://www.mayoclinic.com/health/heart-failure/DS00061Texas Heart Institute. (2012). Heart Information Center. Retrieved from http://www.texasheartinstitute.org/HIC/Topics/Meds/inotropic.cfm Reference: Smoking Cessation
Daily Weighing
Sodium Restriction
Daily Activity
Reduce Stress
Medication Compliance
Control blood glucose, hypertension, hyperlipidemia
Notify Physician or Advanced Practice Nurse of weight gain of 5 pounds or more within 3 days and/or change of Shortness of Breath Education: New York Heart Association (NYHA) Classification Scale
Early-Stage Heart Failure
Stage A
At risk for developing heart failure without evidence of heart dysfunction.
Stage B
Evidence of heart dysfunction without symptoms.

Advanced-Stage Heart Failure
Stage C
Evidence of heart dysfunction with symptoms.
Stage D
Symptoms of heart failure despite maximal therapy. American College of Cardiology (ACC) /
American Heart Association (AHA) Classification System Early-Stage Heart Failure
NYHA Class I
No symptoms at any level of exertion
and no limitation in ordinary physical activity.
NYHA Class 2
Mild symptoms and slight limitation during regular activity. Comfortable at rest.

Advanced-Stage Heart Failure
NYHA Class 3
Noticeable limitation due to symptoms, even during minimal activity. Comfortable only at rest.
NYHA Class 4
Severe limitations. Experience symptoms even while at rest (sitting in a recliner or watching TV). With a stance on reimbursements with patients diagnosed with Heart Failure within 30 days it is important for the APN to educate the patient and empower the patient and their family to be compliant with their medications, treatments, and lifestyle changes.

The APN should also know the following Joint Commission Core Measures for Patients with Heart Failure: Initiatives that affect the APN: Heart Hope, (2012) Heart Hope, (2012) Mayo Clinic, (2011); CPM Resource Center, (2010) Please take the time to download the articles and CPM document to help you with this weeks discussion on Heart Failure! Case Study: Patient’s Initials: H.J.
Patient’s DOB: 12/12/43
Gender/Ethnicity: Female/African American

SUBJECTIVE:
CC: Shortness of Breath and a Rapid Heartbeat

History of Present Illness: H.J. is a 69-year-old African American female that presented to the office complaining of a "racing heartbeat" and complaints of inability to “catch my breath.” She has been experiencing an increase in shortness of breath during the past week after visiting her relatives in Alabama. She complains that it is “hard to breathe at night while sleeping” and has to use 4-5 pillows to prop her head up at night. Case Study continued on next slide Vital Signs: B/P: 102/43 (sitting)Pulse: 125 (irregular)Resp: 30Oral Temperature: 98.2°F (36.7°C)SaO2%: 92% on Room AirHeight: 5’8”Weight: 215lbs BMI: 32.7Allergies: NKDASocial History: Drinks occasionally and smoke 2 packs per day for 30 years.Medications: metoprolol 50mg PO BID, ASA 81mg PO daily, MVI 1 tab PO daily, Lasix 80 mg PO BID (but needs refill and has been out for 3 weeks).Physical Exam:INTEGUMENTARY: No lumps, bumps, lesions, dryness, color changes, changes in size/shape of moles/birthmarks, nail changes noted.HEAD: No deformitiesEYES: PERRLA. Normal conjunctiva.EARS: TM’s pearly gray, Cone of light (COL) visible and landmarks (LM) noted, not abnormalitiesNOSE/SINUSES/ THROAT: Mucous membranes are pink and moist with no excessive/abnormal drainage. No tenderness of the sinuses and transillumination of the sinuses are unremarkable. Tonsils intact and normal size and shape with no purulent discharge.NECK: Cervical lymph nodes and thyroid gland unremarkable. No Carotid bruits noted. Hepato-Jugular Vein Distention & Jugular Vein distension noted.RESPIRATORY: Bilateral crackles auscultated with exhalation and inhalation. Symmetrical thoracic. Accessory muscles used. Percussion hypo-resonant and hyper-tactile fremitus throughout the thoracic cavity.CARDIOVASCULAR: No murmurs heard. S1 & S2 heard. No muffled heart tones. No peripheral edema noted. No pain when leaning forward or backwards. No chest pain with inhalation and exhalation.GASTROINTESTINAL: Soft to touch, non-tender. Bowel sounds heard <15 seconds in all 4 quadrants. No bruits noted. Positive Hepato-Jugular Vein DistentionMSCULOSKELETAL: No pain during palpation of the chest noted.PERIPHERAL VASCULAR: Extremities cool, clammy, pale. Capillary refill >3 seconds. Equal thready pulses (+1) in all extremities. Peripheral edema (+3). Positive Jugular Vein DistentionNEUROLOGICAL: Alert and oriented to person, time, and place. Mayo Clinic, 2011; CPM Resource Center, (2010) Mayo Clinic, (2011) Mayo Clinic, 2011; CPM Resource Center, (2010) Mayo Clinic, 2011; CPM Resource Center, (2010) Khairallah, (2012) Mayo Clinic, 2011; CPM Resource Center, (2010) Joint Commission, (2012)
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