– Heart failure occurs when the heart can not pump enough blood to meet the body metabolic needs.
– Heart failure can occur as left side failure or right side failure.
(1) Left heart failure: inability of the left heart to pump volume of blood returned to it resulting in pulmonary congestion
• Caused by: hypertension, mitral and aortic valve disease, ischemic heart disease, and primary myocardial diseases
• Left side heart failure causes mostly pulmonary symptoms such as shortness of breath, dyspnea, and a moist cough
(2)Right heart failure: inability of right heart to meet demands of venous blood return resulting in systemic congestion
• Caused by: left heart failure (most common cause), primary vascular disease of the lungs, tricuspid and pulmonary valve disease, congenital or acquired left to right shunts
• Right side heart failure causes systemic symptoms such as edema and swelling, jugular vein distention, hepatomegaly and weight gain.
• Chest x-ray shows increase pulmonary congestion and lt ventricular (Lt H.F.), while Pulmonary congestion, cardiomegaly a and pleural effusion (Rt H.F.)
• ABGs, Blood chemistry, hypertrophy , ECG, Echocardiography, CVP increase.
• Analgesic (Morphine), Diuretics, angiotensin converting enzyme (captopril), dopmain, dobutamine, Nitrate (nitroglycerin), vasodilator
Definition: Syndromes causing an imbalance between myocardial oxygen demand and supply
Ischemia: insufficient tissue oxygenation.
Infarction: a zone of tissue deprived of blood supply.
– HTN, DM and Smoking
– Sedentary life-style, Family history
– Angina Pectoris
– Acute Myocardial Infarction
– Sudden Cardiac Death
– Chronic Ischemic Heart Disease
– Angina is chest pain caused by inadequate myocardial oxygen supply. Its usually caused by narrowing of the coronary arteries.
– Categories of Angina:
1- In Stable angina: symptoms are consistent and pain is relieved by rest.
2- In Unstable angina: pain is marked by increasing severity, duration, and frequency. Pain responds slowly to nitroglycerin.
3- In Prinzmetal (variant) angina: pain is unpredictable and may occur at rest.
– Clinical manifestation:
pain, feeling pressure or compression in the anterior chest, pain radiated to the neck, jaw, or back; usually lasts 3 to 5 minutes. It usually occurs after exertion, and emotional excitement. (Dyspnea, sweating, pallor)
– ECG shows ST segment depression and T wave inversion during angina pain.
Factors can produce anginal pain:
Physical exertion, Exposure to cold can cause vasoconstriction, Eating heavy meal and Stress → adrenalin → ↑ B.P.
• Signs + symptoms:-
• ECG shows ST segment depression and T wave inversion during angina pain.
• Bed rest and avoid activities .
• O2 5L/min, fowler position .
• Adminsiter medication as prescribed to increase oxygenation and to reduce cardiac workload.
• Nitroglycerin: 5mg, direct relaxation of blood vessels and smooth muscles of coronary arteries → lead to ↑ blood supply to myocardium. Pan should be relieved within 3 minutes.
• Reduce risk factors through diet, exercise, weight loss, smoking cessation, and stress reduction.
• Crushing chest pain radiate to the shoulder + down the arms [not after effort or emotional upset]
• Dyspnea, pallor, diaphoresis, nausea + vomiting, elevated temprature.
• Note : rate of MI greater in ♂ male than ♀ female .
• 1] A: History of present illness [duration, pain]
• B: History of previous illness [↑ BP., D.M]
• 2] ECG: enlarge Q wave, elevation or depressed ST segment and T wave inversion.
• 3] CPK most sensitive + reliable indicator in case of MI, p 6hrs → return to normal in the 3rd day.
• 4] WBC shows increase count.
• Bed rest to ↓ O2 demand.
• Relieving chest pain, analgesics [morphine sulfate].
• Vasodilators Nitroglycerine IV. [dilates both arteries + veins.
• Anticoagulant [ heparin].
• Thrombolytic [streptokinase] dissolving thrombus.
• O2 administration.
• ↓ anxiety
• Patient education.