Pathophysiology of Congestive Heart Failure

FIGURE 1. PATHOPHYSIOLOGY DIAGRAM OF 49 YR. OLD FEMALE CLIENT WITH CONGESTIVE HEART FAILURE FUNCTIONAL CAPACITY II SECONDARY TO VALVULAR HEART DISEASE SECONDARY TO RHEUMATIC HEART DISEASE

RISK FACTORS: · Lives in rural area · Lack of access to medical services due to low socioeconomic strata (unemployed) · Poor nutrition (inadequate food intake) · Environmental exposure to pathogens

Infiltration of Group A BetaHemolytic Streptococci

Activates antibodies that cause Acute Inflammation of the Heart

RHEUMATIC HEART DISEASE

Vegetative lesions occur in heart valves HOLOABDOMEN UTZ: Fatty Infiltration or streaks in pancreas

Risk Factors: · Rheumatic Heart Disease · Family history of VHD (mother) · Family history of Hypertension (father) · Female, 49 y/o · High sodium and cholesterol in diet

Sore throat

X-RAY: Prominent prosthetic valves, metal clicks on auscultation

PROSTHETIC VALVE REPLACEMENT

Tonsillitis (1980s)

BLOOD CULTURE: No growth of MO after 2 days of incubation

CEFTRIAXONE

PARACETAMOL

RISK FOR INFECTION

Fever

VALVULAR HEART DISEASE RISK FOR PULMONARY EMBOLISM

Triscupid, Mitral and Aortic Insufficiency

COUMADIN

2D ECHO: Mild Tricuspid regurgitation, good opening and closing of valves

Increased afterload, preload and increased pressure

2D ECHO: Concentric Left Ventricular Hypertrophy

Left Ventricular hypertrophy

Myocardial Dysfunction

Myocardial Failure

Heart Pump failure

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FIGURE 1. PATHOPHYSIOLOGY DIAGRAM OF 49 YR. OLD FEMALE CLIENT WITH CONGESTIVE HEART FAILURE FUNCTIONAL CAPACITY II SECONDARY TO VALVULAR HEART DISEASE SECONDARY TO RHEUMATIC HEART DISEASE (CONT.)

Systolic Dysfunction, Failure

2D ECHO: Ejection Fraction 53% Teicholtz’s, 47% Simpson’s ECG: 45 beats per min HR

2D ECHO: Mildly depressed overall systolic function

DECREASED CARDIAC OUTPUT

Decreased endsystolic volume

Decreased Perfusion of Tissues in the Body

Increased Aldosterone

Sodium and Water Retention

Increased Peripheral vascular Resistance

Increased Renin, Angiotensin

Vasoconstriction

Increased Sympathetic Activity

Increased Peripheral Vasoconstriction

Renal Vasoconstriction

METOPROLOL

Decreased Blood Pressure, Heart Rate

MYOCARDIUM: Increased Cardiac Workload

BRAIN: Decreased Oxygen Supply to Cerebral Tissues

Easy Fatigability, Walks only 3 flights of stairs

Increased Plasma Volume

ACTIVITY INTOLERANCE

Increased Venous Pressure to the Lungs

Pulmonary Edema

Pulmonary Congestion Risk factor: · Genetic predisposition

Capillary endothelial damage

HOLO-ABD UTZ:Bilateral Renal cysts

URINALYSIS: Hematuria (Taces of Blood in Urine)

2-Pillow Orthopnea

INEFFECTIVE BREATHING PATTERN

Decreased Oxygen Supply to Tissues

ACTIVITY INTOLERANCE

Decreased Blood Flow to Myocardium

Ischemia

Anaerobic Metabolism

Increased Lactic Acid Production

GASTROINTESTINAL TRACT: Decreased Oxygen Supply to GI Tract

URINALYSIS: Minimal Albumin in Urine

Dizziness

RISK FOR INEFFECTIVE CEREBRAL TISSUE PERFUSION

LIVER: Liver dysfunction

Increased Acid Production OMEPRAZOLE Superficial mucosal lesions of stomach and duodenum develop

Decreased Appetite, Weight loss

Chest pain IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS RISK FOR INEFFECTIVE MYOCARDIAL TISSUE PERFUSION

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