Heart Failure

Heart Failure

Definition/Etiology:

Left ventricular ejection fraction (EF) is typically below 40%

• Systolic heart failure: inability to pump effectively
• Diastolic heart failure: inability to adequately fill

Can be a complication of any type of cardiac disease

Most commonly caused by CAD, chronic HTN, and diabetes

Pathophysiology:

Inadequate cardiac output and oxygen delivery to tissues

LV failure -> pulmonary HTN -> RV failure -> venous congestion

Rt sided HF most often caused by Lt sided

Clinical Presentation:

Collaborative Management:

Assessment:

• Chest X-ray (fluid), 12-lead EKG, labs, BNP (>100), echo

Interventions:

• Support ABCs
• continuous cardiac monitoring
• O2 (SpO2 >90%), may need BiPAP
• Initiate IV access
• Caution with fluids! Watch out for Sepsis Pts

Medication Management:

• Administer loop diuretics (get fluid off!)
• vasodilators (morphine, nitroprusside, nesiritide, ACE inhibitors) as needed (less stress on heart to push against BP)
• cardiogenic shock = positive inotropes

Evaluation | Patient Monitoring | Education:

• Level of consciousness
• Hemodynamic status
• Breath sounds and pulse ox
• Cardiac rate and rhythm
• Respiratory effort
• Intake and output

Linchpins: (Key Points)

• The pump is not pumping effectively
• Think fluid back up
• RV failure = back up right atrium to vena cava
• LV failure = back up left atrium to lungs