Congestive Heart Failure

9/1/08 9:01 AM

Situation when the heart is incapable of maintaining cardiac output adequate to accommodate metabolic requirements and venous return. Frontload prob for perfusion, Dec perfusion of the brain kidneys ect. Cont starving the critical organs. On the venous side there is venous engorgement, resulting in JVD pulm edema, liver acities, Pos jug venous reflex.

Systolic dysfunction- usually in the elderly, second to ischemia people usually remodel ventricles during this phase. Diastolic Dysfunction- Problems with filling Normal EF 65% -Efficiency Abnormal 40%-65% Sys EF, lethargy starting at 30%-45% SOB 20%-30% Incompatible with life <15%

Causes Ischemia and HTN are people are from diastolic dysfunction but more Er patients are from SYS dysfunction Younger pts not on ACE coumadin and Digoxin, consider diastolic dysfunction Pre-load ( like putting the gas in the vehicle; filling the tank) After-Load ( resistance to outflow; resistance above the aortic valve) Diagnosis, A brain natriuretic peptide (BNP) test measures the amount of the BNP hormone in your blood. BNP is made by your heart and indicates how well your heart is working. Normally, only a low amount of BNP is found in your blood. However, if your heart has to work harder than usual over a long period of time, such as from heart failure, the heart releases more BNP, increasing the blood level of BNP. The BNP level will drop when treatment for heart failure is working Echo for EF. H&P CX X-ray, Labs CBC, Chem 7, BNP, Cardiac Markers Pedal Edema, Rales, Pulm Congestion. Cardiology Consult. Renin angeotension aldosteron With Hypo perfusion of the kidneys cause HTN and hormonal release of aldosterone and adreanic prptide causing

vasoconstriction. Kidneys want more flow so release of hormones causes the vasoconstriction. Brain Natriuretic peptide (BNP)levels are very 600 plus no doubt range in CHF abnormal is greater than 100. 100-400 range can mean Cardiomyopathy, CHF,ACS, Pulm HTN, Pulm Embolus as well. But 600 range is diagnostic for CHF. Treatment Reduce Fluid Volume, decrease fluid pre-load & afterload and augment contractility. These have 0 references AHA has no data and recommendations on the treatment,

Data- 1.People who have pulmonary Capillary wedge pressures have higher mortaliy. Ask pt are they feeling better, If yes it is pos symptom improvement NTG vs. Lasix Lasix & NTG drops Pulm Capillary wedge pressure. Higher doses in NTG have high drops in Pulm Cap wedge pressure. NTG better than diuretics and high does are better than low doses, ( low doses are compared to like 0.4 mg SL > a couple of SL sprays. Increase NTG dosing at low dose until the veins dilate, reality is at a dose of 6,24,48 veins wanna have nothing to do with it anymore, They become resistance to titration. When straight higher doses are given then they open right open with no problem. Morphine is not that studied in CHF Patients. Someone circling the drain in Acute Resp failure; the only thing sustaining them is the catecholamine drive, Giving the morphine will take that all away and sedates them as well. Acute ACE therapy can be done as well.

9/1/08 9:01 AM

9/1/08 9:01 AM