Htn Heart Failure 2010
- 1. Hypertension
- 2. Objectives Describe the mechanisms of blood pressure elevation List risk factors for hypertension & CHF Describe the clinical manifestations of hypertension & CHF and their significance for therapeutic management and nursing care
- 3. Hypertension A systolic blood pressure greater than 140mm Hg and a diastolic pressure greater than 90mm Hg over a sustained period Heart is working harder putting heart & blood vessels under strain High BP can contribute to myocardial infarction, stroke, renal failure & atherosclerosis
- 4. Primary (Essential) Hypertension Elevated BP without an identified cause Accounts for 90 – 95% of all cases Exact cause unknown Contributing factors include increased SNS activity, overproduction of Na-retaining hormones & vasoconstrictors, ↑ Na intake, obesity, diabetes mellitus & excessive alcohol intake
- 5. Pathophysiology of Primary Hypertension For arterial pressure to rise there must be an increase in either CO or SVR Hallmark of hypertension is a persistent elevation in systemic vascular resistance (SVR)
- 6. Secondary Hypertension Elevated BP with a specific cause that often can be identified & corrected Causes include narrowing of aorta, renal diseases, endocrine disorders, neurological disorders, medications & pregnancy-induced hypertension
- 8. Risk Factors Increasing age Excessive alcohol intake Smoking Diabetes mellitus Elevated serum lipids Excessive dietary sodium Gender (men & post-menopausal women Family history Obesity Sedentary lifestyle Lower socio-economic groups Stress
- 9. Clinical Manifestations “ Silent killer” – frequently asymptomatic until severe & target organ diseases has occurred Severe hypertension may produce symptoms as result of effects on blood vessels & increased workload of heart Can include fatigue, reduced activity tolerance, dizziness, palpitations, angina & dyspnoea Headaches, nosebleeds & dizziness usually only occur with very high or very low BP
- 10. Risk factors for CV Problems in Hypertensive Pts Major Risk Factors Smoking Lipidemia Diabetes mellitus Over 60yrs Gender (men & postmenopausal women) Family history Complications -Target Organ Damage Heart diseases Stroke or TIA Nephropathy Peripheral arterial disease Retinopathy
- 11. Heart Failure
- 12. Heart Failure
- 13. Glossary Cardiac Output Stroke volume Syndrome Hypertrophy Cardiomyopathy Hepatomegaly Splenomegaly Tachypnoea Orthopnoea Rhonchi Crackle
- 14. Heart Failure Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients A clinical syndrome characterized by signs and symptoms of fluid overload or of inadequate tissue perfusion Signs & symptoms results when the heart is unable to generate a CO sufficient to meet the body’s demands
- 15. Heart Failure Most often this is a lif-long diagnosis that is managed with lifestyle changes and medications to prevent acute congestive episodes Congestive heart failure (CHF) is usually an acute presentation of heart failure (HF)
- 16. HF Incidence increases with age Incidence similar in men & women The most common reason for hospitalization in adults over 65 yrs Medical management is based on the type, severity and cause of HF
- 17. Types of HF Two types identified by assessment of left ventricular functioning Diastolic heart failure – alteration in ventricular filling Systolic heart failure – alteration in ventricular contraction
- 18. Pathophysiology of HF Results from a variety of CV diseases but leads to some common abnormalities that result in decreased contraction (systole), decreased filling (diastole) or both Significant myocardial dysfunction usually present before patient experiences signs & symptoms of HF
- 19. Systolic Failure Most common cause of HF Left ventricle loses ability to generate enough pressure to eject blood forward through the high pressure aorta Caused by impaired contractile function e.g.. MI, hypertension, cardiomyopathy & cardiac valvular disease
- 20. Diastolic HF Impaired ability of ventricles to fill during diastole resulting in decreased stroke volume Characterised by high filling pressures & resultant venous engorgement in both pulmonary and systemic vascular systems Usually the result of LV hypertrophy from hypertension
- 21. Diastolic & Systolic Heart Failure
- 22. Mixed Systolic and Diastolic Failure Seen in dilated cardiomyopathy Biventricular failure
- 23. Left-sided Failure Most common form Blood backs up through the left atrium into pulmonary veins ↑ pulmonary pressure causes fluid to escape from the pulmonary capillary bed into the alveoli Pulmonary congestion and oedema result
- 24. Right-sided Failure Primary cause is L) sided failure Causes backward flow to the right atrium and venous circulation Venous congestion in the systemic circulation results in peripheral oedema, hepatomegaly, splenomegaly, vascular congestion of GI tract & jugular vein distension
- 25. Risk Factors CAD ↑ age Hypertension Obesity Cigarette smoking Diabetes mellitus High cholesterol Maori descent
- 26. Acute Congestive Heart Failure Clinical Manifestations Typically presents as pulmonary oedema Most common cause is LVF secondary to CAD Agitation Pale or cyanotic, cold, clammy skin Severe dyspnoea, tachypnoea, orthopnoea Wheezing, coughing, production of frothy, blood-tinged sputum Crackles, wheezes & rhonchi throughout lungs
- 27. Heart Failure
- 28. Chronic Congestive Heart Failure Clinical Manifestations Depend on pt’s age, type & extent of heart disease & which ventricle is failing to pump effectively Fatigue Dyspnoea – Paroxysmal nocturnal dyspnoea Tachycardia Oedema Nocturia Skin changes Chest pain Weight changes Behavioural changes – restlessness, confusion, ↓ attention span
- 29. Pitting Oedema
- 30. Heart Failure
- 31. Signs & Symptoms
- 32. Glossary Cardiac Ouput = heart rate X stroke volume Stroke volume = amount of blood pumped by ventricle with each contraction Syndrome = collection of signs and symptoms Hypertrophy = increase in the size of an organ Cardiomyopathy = any disease that affects the structure and function of the heart Hepatomegaly = abnormal enlargement of the liver Splenomegaly = abnormal enlargement of the spleen Tachypnoea = abnormal rapid rate of breathing Orthopnoea = abnormal condition when a person must sit or stand to breathe deeply or comfortably Rhonchi = abnormal sounds heard on auscultation of an obstructed airway Crackle = abnormal respiratory sound heard on auscultation of the chest, characterized by discontinuous bubbling noises