Heart Failure, Fluids, and Diet

Carolyn Scroggins, MSN, RN, GNP

Role of Potassium Disturbed K+ metabolism r/t majority of

clinical arrhythmias

Na+ & Ca++ reverse K+ -induced depression of conduction

K+ only electrolyte clinically significant

anti-arrhythmic properties.

Healthy Left Side Heart Left heart receives blood as it returns from

the lungs

Pumps blood into the aorta, main artery of the body.

Then-- blood delivered via arteries to all organs, muscles & tissues.

Left Side Does the Hardest Work

What happens in Lt. Heart Failure LHF?

Body holds extra fluid, blood backs up into the lungs: 1. because left heart pumps blood away from heart to body

organs.2. During LHF, kidneys do not get enough blood, & are

fooled into reacting as if body does not have enough blood.

3. Therefore, they hold on to salt & water to keep it in the blood rather than passing it out into the urine.Resulting: excess fluid builds up in the body, putting an additional strain on heart.

4. This strain makes pumping function of the left side of heart worse, causing less blood to get to the kidneys =vicious cycle.

Causes of Left-sided failure Heart Attack Chronic blockages of the heart arteries High Blood Pressure Leaking or narrow heart valves Heart muscle infections Acute MI & Cardiomyopathy

Blocked Cardiac Arteries

Leaky Valve

Cardiomyopathy

Myocardial Infarction

What is this artery called?

Lt. Sided Heart Failure Symptoms dyspnea, orthopnea, crackles, wheezing, hypoxia,

respiratory acidosis, cough (frothy sputum), cyanosis, palpitations, arrhythmias, elevated blood pressure

dyspnea on exertion appears to be earliest symptom

complaints of paroxysmal nocturnal dyspnea (awakening from sleep with shortness of breath), or new-onset dyspnea on exertion should undergo evaluation for heart failure

Shortness of Breath

Assessment for Fine Crackles

Left Heart Failure

Cyanosis R/T Lt. Sided Heart Failure

Difficulty Breathing R/T Lt. Sided Heart Failure

Medications for Lt. Sided Heart Failure

DIURETICS ACE INHIBITORS BETA BLOCKERS DIGOXIN

Why Meds are Used: Diuretics relieve pulmonary & peripheral edema.

May also treat hypertension since they dilate blood vessels.

Potential Side effects: dizziness, severe leg cramps, high blood sugar levels, high cholesterol levels (NURSES WATCH FOR THIS)

Examples: Furosemide(Lasix,) Bumetanide(Bumex), Hydrochlorthiazide(HCTZ)

ACE Inhibitors Angiotensin Converting Enzyme (ACE)

Inhibitors block Angiotensin II formation, causes constriction of blood vessels. reduce strain on heart; relax smaller arteries &

lower BP. SE: dizziness. ACE inhibitors can prevent

increases in heart size. Potential Side effects: cough, dizziness,

worsening of some types of kidney disease Examples: Lisinopril (Prinivil), Enalapril

(Vasotec), Captopril (Capoten)

Vasodilators Med group-- relax blood vessels & lower

resistance against which the heart has to pump. Like ACE inhibitors or ARBs (Angiotensin

Receptor Blockers) they can cause low blood pressure & dizziness.

Potential Side effects: hypotension, dizziness, tachycardia, headache (NOTE: THIS IS WHY NURSES TAKE BLOOD PRESSURE BEFORE ADMINISTRATION)

Examples: Hydralazine, Isosorbide Dinitrate, Nitroglycerin

Beta Blockers

Some sympathetic tone on the heart beta-blockers reduce sympathetic

influences that stimulate heart rate beta-blockers--decrease heart rate,

contractility, conduction velocity, & relaxation rate.

Beta Blockers Drugs block the heart cell response to catecholamines

(norepinephrine, epinephrine) –

1. Catecholamines- responsible for CNS "fight or flight" response. Beta-Blockers may reduce heart’s energy needs, & over a long time may reduce heart size & improve heart function.

Potential Side Effects: decreased ventricular function, slow heart rate, worsening of asthma symptoms. (NOTE: NURSES MUST TAKE APICAL PULSE)

Examples: Carvedilol (Coreg,), Metoprolol (Toprol XL)

side effects of beta blockers  SE--beta-blockers r/t cardiac mechanisms &

include: bradycardia reduced exercise capacity heart failure Hypotension atrioventicular (AV) nodal conduction block.NOTE: (These side effects result from excessive

blockade of normal sympathetic influences on the heart)

Beta Blockers/CCB When beta-blocker is given in conjunction

with calcium-channel blockers (e.g., verapamil) = additive effects in producing electrical & mechanical depression.

beta-blockers--contraindicated in heart failure patients.

beta-blockers--contraindicated in pts. with bradycardia & partial AV block.

Digitalis Increases strength of heart's contractions,

reducing resistance in blood vessels. Decreases heart rate in heart failure

patients & may decrease edema. Potential Side effects: nausea & slow or

fast heart beating Examples: Digoxin (Lanoxin)

Aldosterone Blockers Aldosterone-- adrenal hormone responds to

decrease in renal blood flow & other factors in heart failure.

May contribute to cardiac fibrosis. Blockade of aldosterone effects may improve

outcomes in advanced heart failure. Potential Side effects: fatigue, headache, low

blood pressure, nausea Examples: Spironolactone( Aldactone )

Healthy Right Side Heart Right heart receives blood from veins. Blood is returning from organs & low in oxygen. Right side heart pumps blood to the lungs,

where it picks up oxygen & delivers throughout the body.

Right heart begins to fail, blood & fluid back up into abdomen, legs & ankles.

Tenderness in upper right abdomen. Loss of appetite, bloating, tired feeling.

Cause of Right Sided Heart Failure

Left ventricle does not pump blood efficiently,

Leads to pressure buildup behind the left side of the heart

Eventually causes the right side of the heart to fail.

Symptoms Rt. Heart Failure (cor pulmonale: rt.ventricle hypertrophy)

dependent peripheral edema hepatomegaly splenomegaly jugular vein distention ascites & kidney congested=decrease filtering weight gain arrhythmias, nausea, vomiting, anorexia, fatigue, dizziness, syncope, weakness

Dependent Edema

Dependent Edema

Pitting EdemaEdema of ankles & feet-- common manifestation of right-sided heart failure.

"Pitting" edema refers to the failure of the skin & soft tissue to immediately resume its normal contour upon release of pressure.

                                                             

Ascites R/T Rt. Sided Heart Failure

Medications for Right-Sided Heart Failure

Diuretics: Furosemide or bumetanide help moderate to severe symptoms.

Hydrochlorothiazide, chlorthalidone, and chlorothiazide used for mild symptoms.

Spironolactone, prevents salt retention & helps with severe heart failure.

ACE inhibitors, Angiotensin Receptor Blockers Beta-blockers (such as metoprolol or carvedilol) can help prevent death

DigitalisNURSES NOTE: MEDICATIONS OFTEN INDICATE

DEGREE OF HEART FAILURE

Anti-Anginal Medications

Procardia (nifedipine)--Treats high blood pressure. migraine headaches, Raynaud's syndrome, cardiomyopathy, & congestive heart failure.

calcium channel-blocker—relaxes blood vessels of the heart

Calcium Channel Blockers

Calcium channel blockers-- class of drugs that block entry of calcium into the muscle cells of heart & arteries.

The entry of calcium into these cells that causes heart to contract & arteries to narrow. By blocking the entry of calcium, CCBs decrease contraction of heart & dilate (widen) the arteries.

CALCIUM CHANNEL BOCKERS (CCB)

By dilating arteries, CCBs reduce pressure in the arteries, making it easier for heart to pump blood, resulting in heart needing less oxygen.

By reducing heart's need for oxygen, CCBs relieve or prevent angina.

For what conditions are CCBs used?

high blood pressure angina abnormal heart rhythms (e.g.,

atrial fibrillation). used after a heart attack, among pts who

cannot tolerate beta-blocking drugs (high-risk for hypotension or bradycardia) , have atrial fibrillation, or require treatment for angina.

HEALTH HEART DIETS CALORIE CONTROLLED LOW-CHOLESTEROL FAT-RESTRICTED SODIUM-RESTRICTED

Note pg. 311 DHO Book FOR DIETS FLUID RESTRICTIONS ACCORDING

TO DAILY WEIGHT

Enlarged Liver

Enlarged Spleen

Enlarged Spleen