Congestive Cardiac Failure..presentation

-This presentation is about congestive cardiac failure for Nursing students

1. DEEPA A, MSc(N), BSc(Psychology) NURSING TUTOR, TIRUPPUR MEDICAL COLLEGE, TIRUPPUR. CONGESTIVE CARDIAC FAILURE

2. MASTER PLAN FOR CCF Introduction Definition Risk factors Types left and right HF backward and forward HF systolic and diastolic HF acute and chronic HF Classification of heart failure stage A stage B stage C stage D Pathophysiology Compensatory mechanism

3. Clinical manifestation Right heart failure Left heart failure Diagnostic evaluation Management Pharmacological management Non-pharmacological management -IABP -CPAP -Cardiac Resynchronization Therapy -Endo ventricular patch circulation - Acron cardiac support -Heart Transplantation Complication Nursing management Health education Conclusion

4. Heart failure is the inability of the heart to pump sufficient blood to meet the body’s metabolic needs. An estimate of the heart’s efficiency as a pump is its ejection fraction, the percentage of blood the left ventricle ejects when it contracts. Normally, a healthy heart ejects 55% or more of the blood that fills the left ventricle during diastole. As the heart fails, the amount of ejected blood decreases. The heart’s ejection fraction is measured using an echocardiogram or multiple gated acquisition scan. introduction

5. The heart’s inability to pump enough blood to meet the body’s oxygen and nutrient demands, formerly called as congestive heart failure. Heart failure is a term that describes as inability of the heart to keep up it’s work load of pumping blood to the lungs and to the rest of the body. definition

6. Hypertension Hyperlipidemia Diabetes CAD Family history Smoking Alcohol consumption Uses of cardio toxic drugs Risk factors

7. Pulmonary embolism, chronic lung disease Hemorrhage and anemia Anesthesia and surgery Transfusion or infusion Increased body demands (fever, infection, pregnancy,) Physical and emotional stress Excessive sodium intake Cont …

8. Systolic and diastolic heart failure Acute and Chronic Heart Failure Left-Sided and Right-Sided Heart Failure Forward and backward heart failure TYPES

9. SYSTOLIC FAILURE Inability of the heart to contract to provide enough blood flow forward . SYSTOLIC AND DIASTOLIC FAILURE PUMPING PROBLEM

10. DIASTOLIC FAILURE Inability of the left ventricle to relax normally, resulting in fluid back up into the lungs. FILLING PROBLEM

11. LEFT SIDED HEART DISEASE Inability of the left ventricle to pump enough blood causing fluid back up into the lungs LEFT SIDED AND RIGHT SIDED HEART DISEASE

12. RIGHT SIDED HEART DISEASE Inefficient pumping of the right side of the heart causing fluid build up in the abdomen, leg, and feet.

13. ACUTE HEART FAILURE An emergency situation in which a patient was completely asymptomatic before the onset of heart failure. CHRONIC HEART FAILURE Long term syndrome in which a patient exhibits symptoms over a long period of time, usually as a result of preexisting cardiac condition. ACUTE AND CHRONIC HEART FAILURE

14. FORWARD HEART FAILURE Decreased cardiac output results in inadequate perfusion BACKWARD HEART FAILURE Blood remain in ventricle after systole, increasing atrial and venous pressure and rise in venous fluid out of capillary membrane into extracellular space. FORWARD & BACKWARD HEART FAILURE

15. Class I (Mild) Ordinary physical activity does not cause undue fatigue, palpitations, or dyspnea. The client does not experience any limitation of activity. Class II (Mild ) The client is comfortable at rest, but ordinary physical activity results in fatigue, heart palpitations, or dyspnea . Class III (Moderate ) There is marked limitation of physical activity. The client is comfortable at rest, but less than ordinary activity causes fatigue, heart palpitations, or dyspnea. Class IV (Severe) The client is unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency occur at rest. Discomfort is increased if any physical activity is undertaken CLASSIFICATION OF HF The American Heart Association

16. Stage A Patients at high risk for developing left ventricular dysfunction but without structural heart disease or symptoms of heart failure Stage B Patients with left ventricular dysfunction or structural heart disease who have not developed symptoms of heart failure Stage C Patients with left ventricular dysfunction or structural heart disease with current or prior symptoms of heart failure Stage D Patients with refractory end-stage heart failure requiring specialized interventions AMERICAN COLLEGE OF CARDIOLOGY AND AMERICAN HEARTASSOCIATION ( ACC/AHA) CLASSIFICATION OF HEART FAILURE

17. pathophysiology

18. Decreased Cardiac output hypotension Medullary activation Of sympathetic Nervous system Stimulation of adrenal medulla Catecholamine release Vasoconstruction Tachycardia tachypnea Increased Venous return Transitory increase In blood pressure Blood shunted to brain and heart Decreased blood flow to kidney Stimulation of renin angiotensin aldosterone secretion Maintenance of level Of conseiousness and Dilation of Coronary arteries Compensatory mechanism

19. RIGHT SIDED HEART FAILURE Lower extremity edema Liver enlargement Ascites Weight gain JV distention Abdominal pain Nausea Weakness Anorexia Anxiety LEFT SIDED HEART FAILURE Dyspnea Unexplained cough Pulmonary cackles Low oxygen saturation Third heart sound Reduced urine output Altered digestion Dizziness and high-headache Confusion Restlessness Fatique and weakness Clinical manifestation

20. History collection Physical examination Echocardiography ECG Chest X-Ray Cardiac catheterization ABG studies Liver function studies Diagnostic evaluation

21. Human B-type natriuretic peptide As volume and pressure in the cardiac chambers rise, cardiac cells produce and released more BNP. This test aids in the diagnosis of heart failure. A level greater than 100/ml is diagnostic for heart failure. Inaddition the higher the BNP the more severe the heart failure. BNP is used in emergency department to quickly diagnose and start treatment. Radio nuclear ventriculogram.

22. PHARMACOLOGICAL MANAGEMENT GOAL Aimed at diminishing the compensatory mechanism of low cardiac output and also improving contractility. management

23. Eliminate excess body water and decrease ventricular pressures. A low-sodium diet and fluid restriction complement this therapy Some diuretics may have slight vasodilator properties. Lasix Hydrochlorothiazide spironolactone 1.DIURETICS

24. Increase the heart’s ability to pup more effectively by improving the contractile force of the muscle. Digoxin Dopamine Dobutamine 2.POSITIVE INOTROPIC AGENT

25. Increases the workload of the heart by dilating peripheral vessels. By relaxing capacitance vessels, vasodilators reduce ventricular filling pressures and volumes. By relaxing resistance vessels vasodilators can reduce impedance to left ventricular ejection and improve stroke volume. 3.VASODIALATOR THERAPY

26. Nitrates – nitroglycerin isosorbide, nitroglycerin ointment predominantly dilate systemic veins Hydralazine predominantly affects arterioles, reduces arteriolar tone. Prazosin balanced effects on both arterial and venous circulation Sodium nitroprusside predominantly affects arterioles Morphine decreases and thus cardiac work.

27. Inhibits the adverse effects of angiotensin II Decreases left ventricular after with a subsequent decreases in heart rate associated with heart failure, thereby reducing the work load of the heart and increasing corbondioxcide, may decrease remodeling of the ventricle. Captopril 4.ANGIOTENSIN-CONVERTING ENZYME

28. Decrease myocardial workload and protect against fatal dysrhythmias by blocking norepinephrine effects of the symptomatic nervous system. Metoprolol Carvedilol 5.BETA-ADRENERGIC BLOCKERS

29. Similar to ACE inhibitors. Used in patients who cannot tolerate ACE inhibitors due to cough or angioedema. Decrease sodium retention, sympathetic nervous system activation and cardiac remodeling. 6.ANGIOTENSIN II RECEPTOR BLOCKERS 7.ALDOSTERONE ANTAGONISTS

30. Used patient with decompensated heart failure. It produces smooth muscle cell relaxation, diuretics and a reduction in afterload. 8.HUMAN B-TYPE NATRIURETIC PEPTIDE

31. Diet therapy Restricted sodium Restricted fluid Promotion of rest Do not make these patients walk Could start a fluid ‘rush’ into the alveoli Try to get them to sit still if they appear agitated an hypoxic NON PHARMACOLOGICAL MANAGEMENT

32. Relief Anxiety It may leads to increase in O2 demand and cardiac workload. Explain what you are doing Anti anxiety drugs and for decreasing preload.

33. INTRA-AORTIC BALLOON PUMP MECHANICAL CIRCULATORY SUPPORT

34. CONTINUOUS POSITIVE AIRWAY PRESSURE

35. CARDIAC RESYNCHRONIZATION THERAPY

36. ENDOVENTRICULAR CIRCULAR PATCH PLASTY

37. ACRON CARDIAC SUPPORT

38. HEART TRANSPLANT HUMAN HEART TRANSPLANTATION

39. ARTIFICIAL HEART TRANSPLANT

40. ARTIFICIAL HEART TRANSPLANT

41. complication

42. NURSING ASSESSMENT Obtain history of symptoms, limits of activity, response to rest and H/O response to drug therapy. Assess the arterial pulse (quality & character) Assess the heart rhythm and rate, BP, assess edema. Obtain hemodynamic measurements Assess weight Identify sleep patterns. Note the results of serum electrolytes NURSING MANAGEMENT

43. NURSING DIAGNOSIS Decreased cardiac output related to impaired contractility and increased preload and afterload. Impaired gas exchange related to alveolar edema due to elevated ventricular pressures Excess fluid volume related to sodium and water retention. Activity intolerance related to oxygen supply and demand imbalance.

44. NURSING INTERVENTIONS a) Maintaining adequate cardiac output Place patient at physical and emotional rest to reduce work of the heart. Evaluate frequently for progression of left sided heart failure. Take frequent BP reading. Auscultate heart sounds frequently and monitor cardiac rhythm Observe for signs and symptoms of reduced peripheral tissue perfusion, cool temperature of skin, facial pallor, poor capillary refill of nail buds. Administered pharmacotherapy as directed. Monitor clinical response of patient with respect to relief of symptoms.

45. b)Restoring fluid balance Assess for signs of hypovolemia caused by diuretic therapy thirst, decreased urine output, orthostatic hypotension, weak, thready pulse, increased urine specific gravity. Be alert for hypokalemia Monitor for pitting edema of lowering extremities and sacral area check daily weight Administered prescribed diuretics potassium supplements as ordered. Maintain I/O chart Administered I.V. fluids

46. c)Improving Activity tolerance Increase patient’s activities gradually. Observe the pulse, symptoms, behavioral response to increased activity. Relieve night time anxiety and provide rest and sleep. Give appropriate sedation to relieve insomnia and restlessness

47. Explain the disease process to the patient Teach the signs and symptoms of recurrence. Review medication, regimen. Review activity program. Restrict sodium as directed. HEALTH EDUCATION