Week 5- Heart Failure

Question 1

What is congestive heart failure?

Answer 1

• Occurs when the heart is unable to pump suffcient blood to meet the metabolic needs of the body
• As a result, blood backs up into either the pulmonary circuit, systemic circuit, or both
• Usually occurs secondary to another condition
• May present as an acute episode, but is chronic

Question 2

What causes left sided heart failure?

Answer 2

• Left ventricle is most commonly damaged during an MI
• Chronic HTN- long term effects of having to pump against the increased after load

Question 3

Left Sided Heart Failure

Answer 3

• In both cases, the right side of the heart continues to pump normally and deliver normal amounts of blood to the pulmonary circulation
• The left side of the heart is unable to pump the blood from the pulmonary vessels’
• As a result, blood backs up behind the left ventricle and the pressure in the left atrium and pulmonary veins increases
• As the pulmonary veins become engorged with blood, serum is forced out of the pulmonary capillaries and into the alveoli
• Acute cardiogenic pulmonary edema
• Resp symptom but is a cardiac issue

Question 4

What will the pt present with if they have Left sided failure?

Answer 4

• Pt. present with SOB, especially when lying supine
• Never lie pt supine (can make a stable patient go into cardiac arrest, can only breathe sitting up) NEVER LAY SUPINE
• Increased fluid in the vessels leaks into the interstitial spaces causing narrowing of the bronchioles= wheezing
• Air passing through the fluid filled alveoli= crackles
• Pt will present with tachypnea, cheyene- stokes respirations
• Pt may cough up the edema fluid in the form of foamy, blood tinged sputum

Question 5

S/S of the LHF

Answer 5

• Restlessness (impending doom)
• Agitation
• Confusion
• Severe SOB
• Tachypnea
• Abnormality high or low BP
• Crackles and possibly wheezes
• Frothy, pink sputum

Question 6

What is the management for LHF?

Answer 6

Aimed at:
- improving oxygenation
- Decreasing workload on the heart
- Reducing the preload so that the LV is less overburdened

• Vitals, cardiac monitor, SPO2, ETCO2 (35-45 mmHg)
• O2
• IV
  12 Lead ECG
• Position pt. upright unless BP or LOA precludes it (legs dangling if possible b/c keeps the fluid down and decreases the workload on the heart)
• Nitro- SL. 0.4-0.8mg, depending on BP
• Effects vasodilation
• Reduction in cardiac workload and improved cardiac output (lowers BP, making heart not have to work as hard)

Question 7

With wheezes, why should bronchodilators be avoided?

Answer 7

• B/c they caused increased tachycardia and this will increase the workload and worsen CHF
• If you give a pt with left side heart failure ventolin this is a bronchodilator and will open the bronchioles causing more fluid to move in causing them to drown

Question 8

What is CPAP used for?

Answer 8

• Lungs have a decreased ability to keep the alveoli open due to the fluid

Question 9

How does CPAP work?

Answer 9

• CPAP works to hold the alveoli open through the respiratory cycle so that O2 and CO2 can diffuse normality
• Mask can be removed for medication administration
• CPAP causes an increase in intrathoracic pressure- may cause a slight decrease in BP (need to have a slightly higher BP)

Question 10

When should you stop CPAP?

Answer 10

If the respiratory status is very poor, oxygen saturations levels are dropping ETCO2 is increasing or LOA is decreasing, stop CPAP and begin to ventilate via BVM
- Consider advanced airways if needed

Question 11

Paroxysmal Nocturnal Dyspnea

Answer 11

• Severe attacks of SOB and coughing that typically happen at night
• Usually wakes the person from sleep
• Often occurs with LHF where the cause is chronic
• Often occurs with LHF where the cause is chronic overload as opposed to MI
• These pt’s will often complain of 1-2 weeks of SOB at night

Question 12

Right Sided Heart Failure

Answer 12

• Most commonly occurs as a result of LHF
• As blood backs up from the left side of the heart and into the lungs, the right side has to work harder to pump blood into the engorged pulmonary arteries
• Eventually, the right side is unable to keep up to the increased workload, and it too fails
• Can result in pulmonary embolism or pulmonary HTN

Question 13

Pulmonary HTN

Answer 13

• Chronic increased resistance of blood through the lungs- backing blood into the right ventricles= increased workload= failure
• Pulmonary embolism- forward blood flow through the pulmonary system is blocked by a clot= increased workload on RV= failure

Question 14

S/S of right sided heart failure

Answer 14

• Presence or absence or pulmonary edema will assist you in determining if the RHF is secondary to LHF
• If pulmonary edema is present= secondary to LHF
• If non= lung or right sided heart problems
• When the right side of the heart fails- pressure backs up behind the right ventricle and increases pressure in the systemic veins causing them to become engorged
• Distention to external jugular veins
• Over time, serum is forced out of the veins into the surrounding tissues creating edma

Question 15

What is the management of RHF?

Answer 15

• RHF, by itself is seldom life threatening
• Usually develops gradually, over weeks (likewise it requires days to reverse)
• Prehospital treatment- make the pt. comfortable
• Monitor
• If pt. presents with signs of LHF as well, treat accordingly

Question 16

Cardiogenic Shock

Answer 16

• Occurs when the heart is so severely damaged that it can no longer pump sufficient blood to maintain tissue perfusion
• MI nearly always produces some impairment of the left ventricle
• Occurs when 40% or more of the left ventricle has been infarcted
• Can occur after resuscitation, ROSC

Question 17

S/S of Cardiogenic Shock

Answer 17

• Confusion/ comatose due to decreased cerebral perfusion (if awake, restless and anxious)
• Pale, cold skin- from massive peripheral vasoconstriction
• Poor SPO2 readings- fingers and hands are barely perfused
• Rapid, shallow respirations- often crackles
• Rapid, thread pulse
• As these compensatory mechanisms fail, the BP will drop
• Be aware of relative hypotension (happens inside the body)
• Absolute hypotension (happens outside the body and can see where it’s coming from)

Question 18

What is the management for cardiogenic shock?

Answer 18

• Focused on improving oxygenation and perfusion without increasing the workload on the heart
• 100% supplemental O2
• Place the pt. supine unless pulmonary edema is present
• IV- TKVO
• Cardiac monitor and 12 Lead
• Transport quickly