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Chapter 22.docx

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NURS 203
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Chapter 22 Heart Failure: Left or Right Heart Failure Left HF = lungs and Paroxysmal nocturnal dyspnea/pillow orthopnea Right = Liver Left heart failure=forward failure, cant get blood out of the heart b/c the LV fails Therefore your left ventricle has to push against an afterload and fails; or it has to deal with excess volume and fails; or you’ve had so many infarcts that the left ventricle is no longer muscle but now fibrous tissue and this reduces contractility and it fails. It’s a forward failure b/c you are having problems getting blood outside of the heart. This means that EDV will increase b/c you cannot get all the blood out b/c you cannot push it out. The pressure and volume will go back in to the left atrium, back into the pulmonary vessels, increase the hydrostatic pressure, and then pulmonary edema. With chronic left heart failure, this will lead to hemorrhage and alveolar macrophages will phagocytose RBC’s, leading to rusty colored sputum. On cytology, you will see heart failure cells, which are alveolar macrophages that has phagocytosed RBC’s and is broken down to hemosiderin. Pulmonary edema is always left heart failure. Left heart failure is a diagnosis of symptoms, b/c the main symptom in LHF is dyspnea (SOB), have trouble breathing b/c fluid in there. Right Heart Failure: Diagnosis of signs: Backward Failure; cant get blood into the heart. RHF is a problem of the right heart getting blood through the pulmonary vessels to the left heart. So, if it fails, blood builds up behind it, and it is a backward failure. B/c if it cannot get blood through pulmonary vessels into the heart, blood will build up behind it, and hydrostatic pressures will build in the venous circuit. This leads to neck vein distension; also, will get hepatomegaly (which is painful), and a nutmeg liver b/c of the increased pressures in the vena cava are transmitted to the hepatic vein, which empties into it, then back into the liver and the central vein, then will get red dots all over liver, which looks like a nutmeg. MCC congested hepatomegaly = RHF. What caused the increased in hydrostatic pressure also going to produce pitting edema and possibly ascites – therefore its more signs than it is symptoms. So, neck vein distension, pitting edema, hepatomegaly, nut meg liver, ascites. Examples of LHF: When you lie down to go to sleep, you can reabsorb up to 1 liter of fluid b/c it will go from the interstium to the venous side b/c there’s no effective gravity. Therefore, there is extra blood going back to the right heart and into the left heart. However, what if you had left HF? There will be excess blood coming back (that wasn’t there when you were standing up) and the left heart is having trouble getting blood out, with even more blood coming back in. Then the heart cannot handle it and goes back to the lungs, leading to dyspnea and continues for the next 30 minutes– this is paroxysmal nocturnal dyspnea. Eventually it settles down, you go back to sleep, wake up again, and it occurs again. Pt realizes that after you stand up, then it eventually goes away – therefore they put a pillow under
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