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Chapter 24 - Drug Therapy for Heart Failure
Terms in this set (7)
Overview of Heart Failure
heart cannot pump enough blood to meet the body tissue's needs for oxygen & nutrients
result from impaired myocardial contraction during systole, impaired relaxation & filling of ventricles during diastole, or a combination
accumulation of fluid in the lungs & peripheral tissues
Etiology of Heart Failure
HTN, cardiomyopathy, acute MI, volume overload, renal failure, hypermetabolic states
Narrowing of lumen can lead to blood clot formation & vasoconstriction
CAD & HTN most common conditions
Hyperthyroidism is hypermetabolic condition that is a major causative factor in developing heart failure.
Fluid volume overload impairs the pumping ability of the heart. Can be caused by renal failure, excessive IV fluids, certain meds. (corticosteroids, estrogen, NSAIDS).
Pathophysiology of Heart Failure
Results in low cardiac output & inadequate filling of arteries
High levels of catecholamine & endothelin
Catecholamine: increase force of myocardial contractility, increase HR & constrict blood vessels.
Endothelin (increased in heart failure): potent vasoconstrictor
Activation of renin-angiotensin-aldosterone system
* renin is an enzyme produced in the kidneys in response to impaired blood flow & tissue perfusion. The release of renin stimulates the production of angiotensin II. Angiotensin II is a powerful vasoconstrictor.
* Impairs cardiac function by increasing resistance (afterload) against which the ventricle ejects blood. This increases the filling pressures inside the heart, which increases the stress on the heart.
Two types: right-sided & left-sided
Right-Sided Heart Failure
Results from accumulation of blood in systemic venous system
Failure results in an increase in the right atrial, right ventricular, end-diastolic, & systemic venous pressures
Causes: stenosis or regurgitation of the pulmonic or tricuspid valves, right-sided ventricular infarction, cardiomyopathy, or recurrent left-sided failure
Stenosis = the abnormal narrowing of a passage in the body
Regurgitation = the reflux of blood through defective heart valves
S/S Right-Sided Heart Failure
cor pulmonale - an alteration in the structure and function of the right ventricle (RV) of the heart caused by a primary disorder of the respiratory system. Can develop secondary to a wide variety of cardiopulmonary disease processes
SWELLING (fluid is backing up in the right side of the heart which causes fluid to back-up in the hepatic veins and peripheral veins)
S = Swelling of legs, hands, liver, abdomen
W = Weight gain
E = Edema (pitting)
L = Large neck veins (jugular venous distention)
L = Lethargic (weak and very tired)
I = Irregular heart rate (atrial fibrillation)
N = Nocturia (frequent urination at night) lying down elevates the legs and allows the extra fluid to enter into the vascular system which allows the kidneys to eliminate the extra fluid.
G = Girth/Circumference of abdomen increased (from swelling of the liver and building up fluid in the abdomen)...can't breathe well and this causes nausea and anorexia.
Left-Sided Heart Failure
Results in a decrease in cardiac output from increase in left atrial & left ventricular end-diastolic pressures & congestion in the pulmonary circulation
Most commonly caused by MI or cardiomyopathy
S/S Left-Sided Heart Failure
DROWNING (these patients are literally drowning in their own fluid from the heart's failure to pump efficiently)
D = Difficult breathing
R = Rales (Crackle)
O = Orthopnea (cannot tolerate lying down...must sit-up to breath, especially while sleeping)
W = Weakness (extremely tired and fatigued due to SOB and heart can't compensate for increased activity)
N = Nocturnal Paroxysmal dyspnea (awaking during sleep with extreme dyspnea)
I = Increased heart rate (due to fluid overload and the heart is trying to get the blood to organs but it can't because of muscle failure)
N = Nagging cough (can be frothy/Foamy or blood-tinged sputum from fluid overload in the lungs...very bad sign)
G = Gaining weight from the body retaining fluid...2 to 3 lb in a day or 5 lbs in a week
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