Congestion Heart Failure

Congestion Heart Failure

a condition in which the heart can't pump enough blood to the body's organs; can be one sided or both sided failure

Symptoms of CHF

Upright positionAnxiety or restlenessSkin cyanotic and clammyPersisitent cough Rapid BreathingFast heart rateEdema of lower limbs

Left ventricle is affected it results to (LVF)

Pulmonary edema

Pulmonary Edema

fluid leak into the pulmonary interstitial spaces (pulmonary congestion); Hypoxia and poor 02 exchange

Clinical Manifestations of LVF

Dyspnea Orthopnea Cough or wheezing Frothy pink sputum Crackles can be heard in the lungs Paroxysmal Nocturnal DyspneaCerebral hypoxia

Orthopnea

difficulty in breathing at rest or when lying flat in bed (supine position causes the fluid to back up in the lung)

Paroxysmal Nocturnal Dyspnea

waking up at night short of breath.

Cerebral hypoxia

result of decreased cardiac output

Causes of Cerebral hypoxia

Anxiety Irritability Restlessness Confusion Impaired memory Insomnia Nocturia

Right ventricle is affected it results to (RVF)

Edema of the leg, ankles, liver, and abdominal cavity

Clinical Manifestations of RVF

Shortness of breathSwelling of feet and anklesUrinating more frequently at nightPronounced neck veinsPalpitations (sensation of feelingthe heart beat)Irregular fast heartbeatFatigueWeaknessFaintingHepatomegalyAscites

Causes of Liver congestion

Hepatomegaly Ascites

RVF

peripheral fluid overload

LVF

pulmonary fluid overload

Medications for CHF

DiureticsBeta blockersDigitalisnotropesAngiotensin

Digitalis

Digoxin

Inotropes

Dopamine, Dobutamine

Angiotensin

converting enzyme inhibitors

Surgical Management of CHF

Heart TransplantationCardiomyoplasty

Heart Transplantation

removes a damaged or diseased heart and replaces it with a healthy one; healthy heart comes from a donor who has died. It is the last resort for people with heart failure when all other treatments have failed;

allograft

take a working heart from a recently deceased organ donor

orthotopic procedure

own heart may either be removed

heterotopic procedure

less commonly, left in to support the donor heart

CABG

coronary artery bypass graft

Cardiomyoplasty

a procedure in which skeletal muscles are taken from a patient's back or abdomen; wrapped around an ailing heart; added muscle, aided by ongoing stimulation from a device similar to a pacemaker, may boost the heart's pumping motion

Rheumatic Fever

diffuse inflammatory disease characterized by a delayed response to an infection by GABHS in the tonsillopharyngeal area; Considered a connective tissue disease; thought to result from an autoimmune response, but the exact pathogenesis remains unclear

Major Clinical of RHF

CarditisPolyarthritisChoreaErythema marginatumSubcutaneous nodules

Minor Clinical of RHF

Fever, malaiseArthralgia+ throat culture for GABHSElevated WBC & ESRECG - Prolonged PR interval

Jones' Criteria

2 Major or 1 Major and 2 minor; plus the evidence of recent strep infection

Medication of RH

Eradicate infection (Penicillin or Erythromycin for 10 days) Minimize cardiac output (Corticosteroids, Beta blockers, diuretics) Promote comfort (Salicylates and bed rest, Phenobarbital or haloperidol for chorea)

Pericarditis

an inflammation of the pericardium characterized by pericarditic chest pain, pericardial friction rub, and serial electrocardiographic (ECG) changeS; a condition in which the sac-like covering around the heart (pericardium) becomes inflamed

Clinical Manifestations of Pericarditis

chest pain that is usually precordial or retrosternal with referral to the trapezius ridge, neck, left shoulder, or arm; dyspnea or tachypnea; fever, chills, or sweating if the condition is caused by an infection

Medications of Pericarditis

NSAIDSColchicineAntibiotics or antifungalsCorticosteriodsDiuretics; Na restriction

Surgical Management

PericardiectomyPericardiocentesisPericardiotomy

Myocarditis

disease that causes inflammation of the heart muscle. This inflammation enlarges and weakens the heart, creates scar tissue and forces it to work harder to circulate blood and oxygen throughout the body

Clinical Manifestations of Myocarditis

Shortness of breath, especially afterexercise or when lying downFatigueHeart palpitationsChest pain or pressureLightheadednessSwelling in the hands, legs, anklesand feetA sudden loss of consciousness

Diagnosis of Myocarditis

ECGChest X-rayEchocardiogramMRI Biopsy

Medications of Myocarditis

ACE inhibitorsBeta blockersDiuretics

Endocarditis

n infection of the endocardial surfaces of the heart primarily of 1 or more heart valves, the mural endocardium, or a septal defect

Clinical Manifestations of Endocarditis

Low grade, intermittent fever (90% present)Murmur (85% present)PetechiaeSubungual (splinter) hemorrhagesOsler nodesJaneway lesionsRoth spots

Subungual (splinter) hemorrhages

Dark red, linear lesions in the nail beds

Osler nodes

Tender subcutaneous nodules usually found on the distal pads of the digits

Janeway lesions

Nontender maculae on the palms and soles

Roth spots

Retinal hemorrhages with small, clear centers (rare)

Duke diagnostic criteria

Two major criteria One major criterion and 3 minor criteriaFive minor criteria

Major Blood culture criteria for IE

Two blood cultures positive for organisms typically found in patients with IE Blood cultures persistently positive for 1 of these organisms, from cultures drawn more than 12 hours apart Three or more separate blood cultures drawn at least 1 hour apart

Major echocardiogram criteria for IE

Echocardiogram positive for IE, documented by an oscillating intracardiac mass on a valve or on supporting structures, in the path of regurgitant jets, or on implanted material, in the absence of an alternative anatomic explanation Myocardial abscess Development of partial dehiscence of a prosthetic valve New-onset valvular regurgitation

Minor criteria for IE

Predisposing heart condition or intravenous drug use (IVDA)Fever of 38°C (100.4°F) or higherVascular phenomenonIImmunologic phenomenon such as glomerulonephritis, Osler nodes, Roth spots, or rheumatoid factor Positive blood culture results not meeting major criteria or serologic evidence of active infection with an organism consistent with IEEchocardiogram results consistent with IE but not meeting major echocardiographic criteria

Medication of Endocarditis

Penicillin + Gentamycin (4-6 weeks)Ampicillin + Gentamycin (4-6 wks)Vancomycin (6wks)

Cardiomyopathy

is purely descriptive, meaning disease of the heart muscle; a general term for diseases of the heart muscle, where the walls of the heart chambers have become stretched, thickened or stiff

Types of Cardiomyopathy

Hypertrophic CardiomyopathyDilated Cardiomyopathy

Causes of Hypertrophic Cardiomyopathy

usually is inherited.caused by a mutation or change in some of the genes in heart muscle proteins.can develop over time because of high blood pressure, aging, or other diseases, such as diabetes or thyroid disease.cause of the disease isn't known

Causes of Dilated Cardiomyopathy

Often unknown 1/3 of people inherited the disease. Ischemic heart disease, heart attack, high blood pressure, diabetes, thyroid disease, viral hepatitis, and HIV Illegal drugs, such as cocaine and amphetamines, and some medicines used to treat cancerInfections, especially viral infections that inflame the heart muscle Complications during the last months of pregnancyAmyloidosis Connective tissue disorders Hemochromatosis Sarcoidosis Some cancer treatments, such as radiation and chemotherapy

Clinical Manifestations of Cardiomyopathy

Pulmonary congestion (left heart failure) dyspnea (rest, exertional, nocturnal), orthopnea Systemic congestion (right heart failure) edema, nausea, abdominal pain, nocturia Low cardiac output Hypotension, tachycardia, tachypnea Fatigue and weakness

Medications Of Cardiomypathy

ACE inhibitorsBeta-blockersAldosterone antagonistsCardiac glycosidesDiureticsNitratesVasodilatorsAntiarrhythmicsHuman B-type natriuretic peptide

Surgical Management of Cardiomyopathy

Left ventricular assist devicesCardiac resynchronization therapy(biventricular pacing)Automatic implantable cardioverterdefibrillatorsVentricular restoration surgery

Cardiac Tamponade

a pressure on the heart that occurs when blood or fluid builds up in the space between the heart muscle and the outer covering sac of the heart

Manifestations of Cardiac Tamponade

Anxiety, restlessnessSharp chest pain that is felt in the neck, shoulder, back, or abdomenChest pain that gets worse with deep breathing or coughingProblems breathingDiscomfort, sometimes relieved by sitting upright or leaning forwardFainting, lightheadedness Pale, gray, or blue skin Palpitations Rapid breathing Swelling of the legs or abdomen

Physical Examination of Cardiac Tamponade

Beck´s triad and pulsus paradoxusRapid breathing Heart sounds are only faintly heard through a stethoscope Weak or absent peripheral pulses

Beck´s triad

sinus tachycardia, elevated jugular venous pressure, low blood pressure

Management of Cardiac Tamponade

Pericardiocentesis Pericardiectomy

Peripheral Vascular Disease (PVD)

a slow and progressive circulation disorder that causes narrowing, blockage, or spasms in a blood vessel; a blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm

Raynaud's Disease

a rare disorder that affects the arteries; a disease, syndrome, or phenomenon; marked by brief episodes of vasospasm

Classification of Raynaud's Disease

VasospasticObstructive

Vasospastic RD

induced by cold, caffeine, stress

Obstructive RD

associated with autoimmune disorders such as SLE, rheumatoid arthritis

Clinical Manifestations of Raynaud's Disease

Spasm of digital arteriesPallorCyanosisRubor

Medication of Raynaud's Disease

Calcium Antagonist - Nifedipine

Buerger's Disease

known as Thromboangiitis obliterans (TAO), an inflammatory vasculopathy; characterized by an inflammatory endarteritis that causes a prothrombotic state and subsequent vaso-occlusive phenomena; strongly associated with heavy tobacco use, and disease progression is closely linked to continued use

Clinical Manifestations of Buerger's Disease

Tingling or numbness in the hands or feetPlae, reddish, or blue tinted hands or feetPain claudication that may come and go in legs feet or arms and handsInflmmation along vein blow skin surfcae

Treartment of Buerger's Disease

NONE