Introduction The heart is considered the most important central body for life, many people did not seem so serious a disease suffer or have gallbladder neck fractures, femur, and heart disease. Diagnosis of Heart Failure causes fear and anxiety in many people. It is clear that remarkable progress has been made in treating heart failure.
The diagnosis is based on the assessment Clinical manifestations of pulmonary congestion, nursing assessment focuses on the search for signs and symptoms of pulmonary and systemic overload of fluids as inferred from a wealth of knowledge and professional preparation. Due to the increase in the tendency to reduce hospitalization and increase the use of consultancy services, it is becoming much more the need to update the nursing staff in action with patients who have heart failure.
CONGESTIVE HEART FAILURE
is the heart's ability to push enough blood to meet the needs of oxygen and nutrients to the tissues, this includes the right heart failure and left, which cusa the signs and symptoms from the circulatory disorder.
Heart failure can define from 3 views.
report: syndrome accompanied by signs and symptoms secondary to failure of the heart as a pump. Hemodynamic
: pathophysiological state in which the heart is unable to maintain the volume / min appropriate to the needs of the tissues with the values \u200b\u200bof filling pressure of increased cavities, left atrial pressure above 12 mn hg, return venous blood volume also increased.
Biochemical metabolic: Impotence of the heart to transform chemical energy into mechanical.
PATHOPHYSIOLOGY
The mechanism involves reduction in the contractile properties of the heart which reduces the normal cost. The primary problem is the damage and inhibition of myocardial muscle fibers, stroke volume is poor and can not maintain a normal cardiac output. Stroke volume, which drives the heart with each contraction, depends on three factors: preload, contractility and poscarga.2
ETIOLOGY 1. Coronary atherosclerosis.
2. Systemic or pulmonary hypertension.
3. Rheumatic fever.
4. Cor lung.
5. Constrictive pericarditis.
6. Valve stenosis.
7. Hyperthyroidism.
Pathogenic Classification
1-Primary: correspond to myocardial failure.
a) Coronary artery disease.
b) IMA H
c) Ventricular remodeling after AMI
d) Hypertensive heart disease.
e) My heart.
f) metabolic disorders.
2. Secondary: correspond to overload.
a) Diastolic.
b) systole.
Clinical Manifestations.
The hallmark is the increased intravascular volume. By reducing spending on the heart increasingly inadequate arterial and venous pressures. Increased pulmonary venous pressure allows the passage of fluid from the capillaries into the alveoli (pulmonary edema) that occurs with coughing and dyspnea, most often systemic venous pressure and increased peripheral edema ponderal.1
Insufficient hemicardio left. Here
predominant visceral congestion and peripheral tissues. This is because the attack right can not properly push blood volume and thus does not accommodate all hematic fluid reaches the venous circulation.
The table includes lower extremity edema, weight gain, hepatomegaly, neck vein distention, ascites, anorexia, nausea, nocturia and weak.
Edema begins in feet and ankles, slowly climbs up the legs and thighs and external genitalia and final portion covers lower trunk. It suddenly. Sacral edema frequently in people who lie in bed.
Hepatomegaly is caused by venous engorgement and tenderness in the right upper quadrant abdomen of the patient complains of pain, this process reaches a level known as ascites.
Anorexia and nausea are the result of venous engorgement and stasis of abdominal organs.
Nocturia or wetting, because the rest appears to increase the risk prone venal blood, which occurs diuresis, which is more common at night because the physical rest improves cardiac output.
accompanying weakness of right heart failure depends on the lower cardiac output.
examinations.
We refer to these complementary studies that help us to confirm the diagnosis
IC 1. Chest X-ray: cardiomegaly were found in the absence of this does not rule out IC as in diastolic dysfunction.
2. Electrocardiogram is useful for information about the underlying heart disease such signs of LV hypertrophy, ischemic changes of ST segment or T wave, or the presence of the Q wave of necrosis with signs that speak of a hypertensive heart disease.
3. Laboratory analysis.
4. Echocardiogram: This test is a priority to evaluate the patient. TREATMENT
The main objectives of treatment of individuals with impaired are:
1. Improve sleep to lessen the workload of the heart.
2. Improve the strength and efficiency of myocardial contraction through drugs.
3. Remove the excess volume or diabetic, diet and rest. PHARMACOTHERAPY
1-Cardiac glycosides. Digitalis
: These drugs improve the force of myocardial contraction and slow the frequency of it. Exert various effects:
Increased cardiac output, decreased venous pressure and blood volume, increased diuresis, which relieves pain.
digitalis poisoning: Anorexia, nausea and vomiting. Heart rhythm disturbances, bradycardia, premature ventricular contractions, ventricular bigeminy, blurred vision, weakness, and others.
. Prior to administration should be measured heart rate in the area espical if you notice excessive deceleration or change in the rhythm, not given the drug and medical alerts.
. If the clinician ordering the use of digitalis, it is necessary to measure its concentration in serum before administration.
. Managing diabetes in the early hours of the morning so that does not interfere with sleep.
. Weigh the patient daily, at the same time and swelling of the leg examined.
2-Vasodilators:
Used to reduce the resistance to expulsion of blood from the left ventricle. Its action is accompanied by a more complete ventricular emptying and venous capacity improvement. Sodium nitroprusside
: via intravenous drip in perfectly calibrated and monitored. It monitors the patient mediation of the pulmonary artery pressure and cardiac output. Another vasodilator is nitroglycerin.
3-Dietoterapia: consists in providing nourishment to the heart to develop a minimum of effort and muscular work, while the nutritional status remains within satisfactory limits.
calorie diet is that overweight and increases the heart's workload increases, decrease alcohol consumption, and to reduce salt intake in patients with mild IC. In IC must strictly control the salt used diuretics but not exceed l0 grams daily.
4 - Delete the habit of smoking.
Nicotine increases heart rate and therefore the consumption of O2 and carbon monoxide causes tissue hypoxia and infarction.
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