Page 59 - Critical Care Notes

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Heart Failure (HF)
HF, which is sometimes referred to as “pump failure,” is a general term for the
inadequacy of the heart to pump blood throughout the body. This deficit causes
insufficient perfusion to body tissues with vital nutrients and oxygen.
Pathophysiology
HF failure can be classified into left-sided failure and right-sided failure. Both
may be acute or chronic and mild to severe, caused by HTN, CAD, or valvular
disease, involving the mitral or aortic valve. HF can also be divided into two
subtypes: systolic heart failure and diastolic heart failure.
■ Systolic heart failure results when the heart is unable to contract forcefully
enough, during systole, to eject adequate amounts of blood into the circula-
tion. Preload increases with decreased contractility, and afterload increases
as a result of increased peripheral resistance.
■ Diastolic heart failure occurs when the left ventricle is unable to relax ade-
quately during diastole. Inadequate relaxation prevents the ventricle from
filling with sufficient blood to ensure adequate cardiac output.
Clinical Presentation
Left-sided HF manifests as:
■ Dyspnea, SOB, orthopnea, paroxysmal nocturnal dyspnea
■ Nonproductive cough
■ Diaphoresis
■ Chest pain, pressure or palpitations
■ Tachycardia, which may be weak and thready
■ S 3 gallop
■ Tachypnea
■ Pulmonary crackles or wheezes
■ JVD
■ Frothy, pink-tinged sputum; hemoptysis; pulmonary edema
■ Central or peripheral cyanosis or pallor
■ Fatigue, weakness
■ Confusion, restlessness
Right-sided HF manifests as:
■ Right upper quadrant pain
■ Peripheral edema, initially dependent then pitting. Weight gain.
■ JVD
■ Hepatomegaly, hepatojugular reflux
CV