Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  35

STRUCTURAL DISORDERS

HEART FAILURE Heart failure (HF) is a common clinical syndrome caused by any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. HF may be caused by disease of the myocardium, pericardium, endocardium, heart valves, vessels, or by metabolic disorders. * The diagnosis of HF requires that two major or one major and two minor criteria be present concurrently. Minor criteria were acceptable only if they could not be attributed to another medical condition.

Major Criteria for Diagnosis of CHF

Minor Criteria for the Diagnosis of CHF

• Paroxysmal nocturnal dyspnea • Neck vein distension • Pulmonary rales • Cardiomegaly on chest x-ray • Acute pulmonary edema • Third sound gallop • Increased central venous pressure ( > I6 cm water at the right atrium) • Hepatojugular reflux • Pulmonary edema • Visceral congestion or cardiomegaly at autopsy • Weight loss ≥ 4.5 kg in 5 days in response to treatment of CHF

• Bilateral ankle edema nocturnal cough • Dyspnea on ordinary exertion

• Hepatomegaly • Pleural effusion • Decrease in vital capacity by 33% from maximal value recorded • Tachycardia (rate ≥ I20 beats/min)

Type of HF

Causes

Morphologic Changes

Symptoms

• Ischemic Heart Disease • Hypertension • Aortic and mitral valvular diseases • Myocardial diseases

• Congestion of the

• Cough • Dyspnea (initially with exertion and later at rest) • Orthopnea • Paroxysmal nocturnal dyspnea • Feeling of suffocation • Decreased cardiac output • Decreased renal perfusion (prerenal azotemia) • Hypoxic encephalopathy • Minimal pulmonary congestion • Systemic and portal venous system congestion

Left Sided Heart Failure

pulmonary circulation • Stasis of blood in the left- sided chambers • Hypoperfusion of tissues leading to organ dysfunction

• Left sided failure • Variety of disorders that affect the lung • Cor pulmonale • Primary pulmonary hypertension • Recurrent pulmonary thromboembolism • Chronic sleep apnea • Altitude sickness

• Hypertrophy and dilation of the right side of the heart

Right Sided Heart Failure