heart failure
DESCRIPTION
Heart Failure. Hazel Phillips Cardiac Support Nurse Bedford Hospital NHS Trust. Heart Failure. “ Complex clinical syndrome that impairs the ability of the heart to respond to physiological demands for an increased output” ( Sign 2007) - PowerPoint PPT PresentationTRANSCRIPT
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Heart Failure
Hazel PhillipsCardiac Support Nurse
Bedford Hospital NHS Trust
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Heart Failure “Complex clinical syndrome that
impairs the ability of the heart to respond to physiological demands for an increased output” ( Sign 2007)
“ It is recognised to be a chronic disease with poor outcomes worse than many cancers” ( Cowie & Zaphirious, 2004)
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Causes of Heart Failure Coronary Heart
Disease (MI ) Hypertension Valvular heart
disease (Aortic and Mitral valve)
Cardiac arrhythmias
(heart block atrial fibrillation
Cardiomyopathy (dilated, hypertrophic alcoholic,& idiophatic
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Symptoms of Heart Failure Shortness of
breath Fatigue Proximal
Nocturnal Dyspnoea
Increase in weight Peripheral
oedema Anorexia
Orthopnoea
Nocturnal cough
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Diagnosis Full medical history and
examination ECG Blood screen & BNP(Brain natriuretic
peptide ) best taken off diuretic therapy If BNP positive request referral to H F
clinic
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Heart Failure Clinic Bloods for U&E, TFT, LFT, Glucose,
Lipid profile, Full blood count Chest X-ray ECG Echo (Gold standard) Full examination Diagnosis and Medical plan given
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Echocardiogram Developed 50 yrs ago Elder & Herz Ultrasonic waves are used to
investigate and display the action of the heart as it beats.
Non invasive test,painless, safe Examines size, function, and blood
flow through the heart
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LV Ejection Fraction
LV ejection fraction Qualitative assessment>75% Hyper-dynamic55-75% Normal40-54% Mildly 30-39% Moderate<30% Severe
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NYHA Classification Class I No Limitation on activity Annual Mortality
No fatigue, breathlessness, palpitations 3%-5% on ordinary physical activity
Class II Pt are comfortable at rest but physical activity such as climbing stairs results in 10% symptoms Class III Pt have marked limitations on physical activity, but comfortable at rest 12%-15%. Class IV Pt have symptoms at rest and any activity results in discomfort 15% - 20% worse prognosis than
some cancers
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Medication Loop Diuretic Furosemide, Bumetanide
Use lowest dose to reduce fluid overload
, Side effects hypotension (causing dizziness, light-headedness, or confusion) and hypokalemia.Regular checks of U&E
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Diuretics Metolazone Used for intractable oedema Use with close monitoring of renal
function Can cause hyponatraemia Profound diuresis when used with
loop diuretics
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Beta-blockers Increase life expectancy Contra indicated in Asthma and COPD Pt should be stable not fluid
overloaded Start low and increase slowly Licensed for HF Carvedilol 3.12mg-
25mg BD, Bisoprolol 1.25mg-10mg OD, or Nebivolol 1.25mg-10mg OD
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Beta-Blockers May worsen HF symptoms Monitor BP & pulse rate Side effects hypotension,
bradycardia, cold extremities (causing paraesthesia), sleep disturbances (including nightmares), and sexual dysfunction
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Angiotensin-Converting Enzyme
(ACE) inhibitor
Improves symptoms and life expectancy
Base line U&E’s Start low and increase slowly Lisinopril 2.5mg –30mg OD Ramipril 2.5mg – 10mg OD Enalapril 5mg –10mg OD Warn pt of first dose hypotension
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ACE Inhibitors Monitor Creatinne & Potassium
levels Side effects Hypotension, Cough,
rash, tiredness etc If cough troublesome can swap to
a angiotensin II receptor antagonists (ARB) ie. Losartan, candesartan
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Aldosterone Antagonist Moderate to severe HF NYHA Class III
– IV symptomatic on usual therapy Reduces mortality Spironolactone 25mg only drug
licensed Eplerenone only licensed for LVF post
MI Monitor U&E Potassium sparing
diuretics
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Aldosterone Antagonist Side effect: gastro-intestinal
disturbances impotence, gynaecomastia, lethargy, headache etc
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Digoxin Used if pt has an arrhythmia ie AF Can be used as last “resort” if all
other medication have not improved symptoms
Monitor for side effect and toxicity.
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Contraindicated Medication NSAID Calcium Channel Blocker(except
amlodipine & diltiazem) Metformin Glitazones Corticosteriods Tricylic antidepressants
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Non-Pharmacological Advice
Self management of condition Monitor weight daily Avoid salty food & “lo salt”replacement
products Influenza & Pneumococcoal vaccinations Lifestyle advice Exercise advice/ Cardiac rehabilitation Six monthly review
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Cardiac Cachexia Complication of end stage HF Loss of muscle mass & adipose
tissue Resulting in reduced exercise
tolerance,fatigue and dyspnoea Ensure adequate nutrition
supplements Advice from dieticians
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Other treatment options Dual chamber pacemakers + ICD Revascularisation (CABG PCI) Transplantation Left ventricular assist devices
(LVAD) Palliative care
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Further Information National Service Frame work (2000)
Chapter six Heart failure NICE Clinical Guideline 5 (2003)
Management of chronic heart failure in adults in primary and secondary care
Modernisation Agency (2004)Supportive and palliative care for advanced heart failure
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Further information Scottish Intercollegiate Guidelines
Network (Sign) 2007Management of Chronic Heart Failure
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Any Questions