Heart Failure

Inability of the heart to maintain sufficient CO to optimally meet the metabolic demands of tissues and organs.

Normal Sinus Rhythm

60-100 bpm

Begins in the sinus node and follows normal conduction pathway.

Sinus Tachycardia

Rate ›100 bpm.

Many causes: dec. PSNS activity, fever, pain, inc. metabolism, dec BP, hypoxia.

Compensating for inc. CO or dec. SV.

Sinus Bradycardia

Rate ‹60 bpm.

Results from slowed impulse generation by the sinus node.

Causes: inc. PSNS activity, sleep, drugs, inc SV, acute HTN (baroreceptor reflex)

Sinus Arhythmia

Normal finding assoc. w/ fluctuations in autonomic influences and respiratory dynamics

Requires no Tx.

Sinus Arrest

The absence of impulse initiation in the heart results in electrical asystole.

Flat EKG.

Causes: MI, electrical shock, electrolyte disturbances, acidosis.

Tx: Cardiac pacemaker.

Acute Respiratory Distress Syndrome

(ARDS)

Damage to alveolar membrane.

Assoc. w/ decline in the PaO2 that does not respond to O2 therapy.

Sudden, progressive respiratory failure w/ severe dyspnea and diffuse bilateral infiltrates.

Pulmonary trauma → inflammatory response eventually causing pulmonary edema.

Va/Q right to left shunt

Infant Respiratory Distress Syndrome

(IRDS)

Respiratory distress from surfactant deficiency and immature thorax development.

Infant becomes tachypnic, breathes w/ accessory muscles, hypotension, dec breath sounds, frothy sputum, expiratory grunt.

Tx: Balance F+E, ventilatory with PEEP as low FiO2 as possible, minimal handling, controlled temp.

Pneumothorax

Presence of air in pleural space that inhibit lung expansion.

Primary spontaneous pneumothorax results from rupture of small subpleural blebs in the apices. When air enters pleural space, the lung collapses and the rib cage springs out.

S/S: tachycardia, dec breath sounds on affected side, sudden CP, dyspnea.

Tx: symptom control, chest tube.

Pleural Effusion

Pathological collection of fluid or pus in pleural cavity as a result of disease process.

Inc. hydrostatic pressure in plasma.

Causes: CHF, cirrhosis, renal failure, pancreatitis, pulmonary embolism, infection.

S/S: pleuritic pain, dry cough, dec breath sounds

Tx: thoracentesis, chest tube drainage, treat cause.

Pneumonia

Inflammation of alevoli and interstitium.

Causes: Aspiration of oropharyngeal secretions, inhalation of infectious agent, contam. from systemic circulation.

S/S: fever, crackles, chills, cough, purulent sputum, mental status change (older adult)

Tx: Antibiotics, F+E balance, O2, bronchodilators, pulmonary clearance.

Pulmonary Embolism

Undissolved material that occludes pulmonary vasculature.

Causes: DVT, labor, air, tumor, infection

S/S: restlessness, anxiety, apprehension, dyspnea, CP, inspiratory pain, hemoptysis

Tx: prevent DVT's, O2, anticoagulants, thrombolytics, filter in IVC, embolectomy

Pulmonary Edema

Abnormal accumulation of fluid in alveolar sacs and surrounding interstitium.

Hydrostatic pressure of pulmonary capillaries overwhelm lymphatic drainage of pulmonary interstitium.

Causes: LV failure, MV stenosis, fluid overload, high altitudes, cardiomyopathy.

S/S: thin, pink frothy sputum, severe dyspnea, tachypnea, crackles

Tx: correct hypoxemia, dec. preload/afterload, tx cause.

Tension Pneumothorax

\Develops when air is trapped in the pleural space during inspiration and cannot escape during expiration.

This causes mediastinal shift which causes death.

Causes: blunt traumatic injuries.

Mediastinal Flutter

Results from air rushing in and out of thoracic cavity on the affected side.

Fluttering back and forth of the heart, trachea, esophagus and lung produces severe cardiopulmonary compromise.

Fatal if untreated.

Ejection Fraction

SV/EDV

Systolic Dysfunction

Dec. myocardial contractility, low EF, dec SV and CO

Cause: infarction of tissue. Not enough O2, dec ATP.

Pt usually ‹65 yr.

Progressive dyspnea, S3 heart sound, pulmonary congestion

Cardiomegaly present.

Diastolic dysfunction

Impairs Ca removal from muscle.

Pt usually › 65 yrs.

S/S: Acute dyspnea, S4 heart sound, pulmonary congestion, LV hypertrophy, normal/small heart.

EF› 50%.

Medical Management

Dec. Preload

Diuretics

low sodium diet

Keep pt. upright.

Medical Management

Dec. Afterload

Venodilators/arteriodilators

beta blockers

Medical Management

Improve contractility

Give O2

Digoxin (positive inotrope)

Medical Management

Improve ventricular filling

beta blockers

Tx symptoms.

Cardiogenic Shock

Too much preload/afterload

Dec. CO.