68WM6 10-07 Heart Failure and Pulmonary Edema

Cards

exertional dyspnea Dyspnea (difficulty breathing) especially upon exertion.
Orthopnea breathing while laying flat
Pulmonary crackles moist crackles and popping upon auscultation of lungs
Left Ventricular Failure 1) Describes inability of left ventricle to effectively pump enough blood to meet needs of body tissues. (a) The first sign is a decrease in cardiac output. (b) The second is pulmonary congestion. (c) The increased pressure in the left side of the heart backs up to the pulmonary system and the lungs become filled with fluid. (d) The increased permeability of the capillaries causes fluid to be pushed into the pulmonary capillary bed resulting in pulmonary edema and pleural effusions. (2) Left ventricular failure often occurs first because the left ventricle is most often affected by coronary atherosclerosis and hypertension. (3) If left untreated left ventricular failure progresses to right sided failure.
Right Ventricular Failure (1) Inability of right ventricle to effectively pump enough to meet the needs of body tissues because of increased pressure in the pulmonary circulation. (2) Right ventricular failure is most often caused by left-sided failure but chronic pulmonary disease and pulmonary hypertension also cause right-sided failure. (3) The inability of the right ventricle to pump blood forward into the lungs results in accumulation of fluid (edema) in extremities and various body organs (such as liver). (4) Patients with right-sided congestive heart failure retain excessive amount of sodium, contributing to existing edema.
Dependent edema edema of ankles when patient is standing or sitting. May shift to sacral region when in the prone position
Pitting edema when pressure is applied, pressure area becomes indented. After pressure is released, indentation disappears over time.
Nocturia excessive urination during night
hepatomegaly Liver enlargement related to right upper quadrant pain
ascites Abdominal edema related to flatulence, anorexia, nausea, abdominal distention
Digitalis preparations (cardiac glycosides): Improve cardiac output and increase contractile force of ventricles. Also slows heart rate.
inotropic relating to or influencing the force of muscular contractions -digitalis is a positive inotropic agent
Diuretics reducing excess fluid and sodium stored in tissues.
Nitrates peripheral vascular resistance, increase left ventricular output, increase left ventricular emptying, and increase cerebral and renal blood flow.
ACE Inhibitors decrease peripheral vascular resistance, improve cardiac output and studies have shown to extend and improve the lives of the patient with heart failure.
Pulmonary Edema Definition: The accumulation of extravascular fluid in the lungs and alveoli, caused primarily by heart failure. An acute, extensive, life threatening complication of left-sided heart failure
Inotropic agents dobutamine or amrinone to increase myocardial contractility without increasing myocardial oxygen consumption
Nitroprusside a potent vasodilator to improve myocardial contraction
Dobutamine (a) Inotropic support in CHF. (b) Cardiogenic shock.
Dopamine (a) Hypotension associated with shock. (b) Renal insufficiency.