Congestive Heart Failure (CHF) is also called left-sided heart failure.
Common symptoms include:
Presence of fluid in the lungs: may be referred to as pulmonary edema, rails, or crackles.
Hypertension and dyspnea.
Increased heart rate, often atrial fibrillation (AFib) or atrial flutter.
Pink frothy sputum in severe cases.
Paroxysmal Nocturnal Dyspnea (PND): sudden shortness of breath at night.
Orthopnea: difficulty breathing unless upright.
Cool, pale, clammy skin.
Drug of Choice for CHF
Nitro (Nitroglycerin) is the primary drug used for CHF.
Pathophysiology of CHF
Normal cardiac output is approximately 6 liters per minute.
In CHF, the cardiac output decreases due to issues such as:
Lateral wall myocardial infarction (MI) or valve issues like mitral valve prolapse.
Reduced cardiac output leads to reduced blood filtration by the kidneys, resulting in perceived low blood volume (hypovolemia).
Epi release increases preload and heart rate but due to left ventricle damage, the heart struggles.
Increased pressure in the pulmonary veins leads to pulmonary hypertension.
Treatment Goals
Aim to increase cardiac output by dilating the blood vessels using nitroglycerin.
CPAP, nitro, morphine, and Lasix can be used, in that order of preference, with Lasix being last.
CPAP requirements: patient must be alert, able to follow commands, and have a blood pressure of at least 90 mmHg.
Characteristics of Different Heart Failures
Left-sided heart failure: Typically leads to pulmonary congestion.
No jugular venous distension (JVD), pedal edema, or abdominal ascites.
Right-sided heart failure: Leads to systemic congestion.
Clear breath sounds, but presence of peripheral edema and JVD.
Complete heart failure: Involves symptoms from both sides.
Management Approaches
Fluid management is crucial, especially distinguishing between right-sided MI and left-sided MI treatments.
Understanding the impacts of drugs like nitroglycerin and the need for careful monitoring with right-sided MIs due to their potential to bottom out blood pressure.
Stroke and Cardiovascular Events
Differentiates between cerebral artery aneurysm, hemorrhagic stroke, and ischemic stroke.
Hemorrhagic strokes often linked with chronic hypertension.
Ischemic strokes linked with blockages, often with onset over several hours.
Aneurysms can occur suddenly, often in individuals under 40.
Emergency Responses
Treatment of high blood pressure should avoid rapid drops to prevent rebound hypertension.
Recognize signs of Cushing's Triad in relation to brain injuries.
Proper management of acute hypertension involves gradual reduction and stabilization.
Summary
Understanding CHF involves recognizing symptoms, knowing the pathophysiology, and applying appropriate treatments systematically.
Stroke management requires differentiating between types based on symptoms and understanding when to transport to appropriate facilities.
Treating hypertensive crises involves cautious and gradual reduction of blood pressure to prevent complications.