inability to pump enough blood for metabolic needs

-early stages can be asympamatic 

Causes of

Heart Failure

CAD and HTN

-physiologic alteration involving cardiac remodeling

--increase sympathetic imput (epi and nor epi)

-- RAAS 

Heart Failure

Pathophysiology

hypertrophy and dilation

--increased pressure and decreased contractile force

-compensatory actions are short lived and eventually cause more harm than good

CHF 

symptoms

-decreased excercise tolerance, fatigue

-tachycardia, SOB, tachypnea, otrhopnea, Dyspnea On Excertion

-peripherial edema, weight gain, hepato spleen enlargement and jugular venis distension

Diruetics

ACE inhibitors

Beta Blockers

Inotropic Agents

HF Rx

diuretics

mechanism of action

most commonly used -thiazide or loop

-reduce blood volume

-decrease BP

-decrease peripheral and pulmonary edema

-decrease cardiac dilation

DOC: spironolactone

HF Rx

Diurectics

sprionolactone

potassium sparing diuretic

-opposes remodeling of heart

--inhibition of aldosterone effect on heart

----eplerenone has fewer ADRS

-block angiotenson II and its effect on remodeling

-dilation of veins and arteries

-decrease release of aldosterone

--inhibits Na and water retension (decreases vascular volume)

-past though it was contradicted in HF treatment

-action not fully understood

--moderation of sympathetic compensation

carvedilol

bisoprolol

metaprolol

in increased dosages

-bradycardia

-heart block

-decrease in BP

-fluid retension

-fatigue

-effect force of contraction 

digoxin

-positive inotropic action

(inhibition of Na/k pump cauing increase in intracellular Ca+ -> inc contraction)

--increased contractility

--increased Cardiac Output

--decreased sypathetic tone

--increased urine production

widely distributed ie crosses BBB

-hypokalemia (predisposes to cardiac tox)

--dec K= dec inhibition of pump= inc action of digoxin=tox/ heart disease

Monitor [K ser] and pulse

Digoxin

ADR's

-cardiac

--dysrhythmia causing

--- monitor pulse < 55-60 with different rhythum

-Non Cardiac

--GI (ANV)

--CNS (Dizzy, fatigue, mental disturbances)

--visual disturbances

-verapamil, diltiazem

-sympathomiometics

-diuretics, corticosteriods (dec [k])

-ACEIs, ARBs, k sparing diurectis (inc [k])

Heart Failure Stage

Classifications

Stage A: high risk no structural problems

Stage B: structural change, no symptoms

Stage C: structural change, symptoms with exertion

Stage D: structural change and symptomatic at rest

HF treatment 

by stage