Heart Failure: Review (Nursing)

00:01 Okay, let's bring this all together.

00:04 Now we have what looks like a really big flowchart.

00:08 But I promise you, it makes sense just walk through it with me.

00:10 It will be very clear to you and a great study guide.

00:14 At the very top here's what you're familiar with cardiac insult.

00:18 Now, we just listed some examples for you there.

00:20 Coronary artery disease, hypertension, MI, valvular heart disease, all things that we've talked about.

00:27 But each one of these can cause the heart to begin to lose its efficiency.

00:32 It doesn't function like it used to, and you have lower cardiac output.

00:37 Remember, that's a problem, because you need just the right amount of blood being pumped through your body in order to meet your metabolic needs.

00:45 Now, it's going to go one of two ways.

00:47 It's going to be impaired diastolic function, impaired ventricular function.

00:50 But here's where I want you to focus.

00:53 Remember, this is HF. You see in both of those boxes? And you see EF in both of those boxes? Well, the HF stands for heart failure.

01:03 The EF stands for ejection fraction.

01:06 Now, in this case, we're talking about the left ventricle.

01:10 So heart failure is kind of a progressive thing.

01:13 It tends to get worse and worse and worse over times, particularly if it's not treated.

01:18 So, keep in mind if we're talking about HF, heart failure, reduced ejection fraction, that means the ejection fraction is less than 40%.

01:29 The left ventricular ejection fraction is less than 40%.

01:33 Now this is present progressive, the left ventricle becomes dilated.

01:37 You have that cardiac remodeling becomes really stiff.

01:40 But heart failure, reduced ejection fraction is a left ventricular ejection fraction that is less than 40%.

01:48 Ever wonder where we get those? You can see that on an echo, you can have that information on an echo report.

01:55 Now on the right hand side, we're talking about heart failure, preserved ejection fraction.

02:00 Now preserved LEVF is greater than 50%, reduced less than 40, preserved greater than 50.

02:10 This also has progressive left sided ventured dilation.

02:13 you got the cardiac remodelling all that nasty stuff.

02:15 But what's the difference? You have preserved ejection fraction.

02:19 And we define that by saying a left ventricular ejection fraction that is greater than 50%.

02:26 All of this leads to that reduced cardiac output that you've heard us talk about all throughout this video series.

02:32 They want to have less cardiac output, follow that arrow to the right.

02:36 My organs are not perfused very well.

02:39 Let's take example of the kidneys.

02:41 Now when the kidneys aren't perfused very well, you know, all these problems, right? You've got an increased heart rate, angiotensin I, angiotensin II, we've got vasoconstriction.

02:50 We've got those compensatory measures that we talked about, the RAAS, the SNS, the increased left ventricular end-diastolic pressure is getting more, then you end up with symptomatic heart failure.

03:02 And what happens in that symptomatic heart failure? You've got increased pulmonary vascular resistance and right ventricular load. Okay, how is that a problem? Okay, that's a lot.

03:15 So pause for a minute and just take a breath.

03:19 Let's go back up to the top and make sure that you feel comfortable with this.

03:23 We talked about the cardiac insult that moves toward either impaired diastolic function, impaired ventricular function.

03:29 We've either got it preserved ejection fraction, or a reduced ejection fraction, eventually we're going to end up with a reduced cardiac output.

03:38 That means that organs are not going to be perfused well.

03:41 You have increased heart rate, angiotensin I, angiotensin II, the vasoconstriction that comes with that.

03:46 You've got the compensatory mechanisms, because of the RAAS, the sympathetic nervous system, the left ventricular end-diastolic pressures are going up, and you've got symptomatic heart failure.

03:58 Increased pulmonary vascular resistance, and right ventricular load.

04:02 So, wow, that's a lot. So see where we are.

04:06 This is telling you, now, the heart is struggling.

04:09 It's working harder, it is not as strong as it used to be.

04:12 We've got all these compensatory mechanisms kicking in.

04:16 Now we're starting to see symptoms.

04:18 On the next level, what is going on? We'll follow that line down.

04:24 We talked about ventricular remodeling.

04:27 Remember, it gets that thick wall like we showed you in that picture? Well, I want you now to follow that down all the way to the bottom.

04:34 So, if we start with the compensatory measures, right, the things that the body does to respond, RAAS, SNS, you know with that increased left ventricular end-diastolic pressure.

04:45 Stay with me, I promise you this is going to make sense.

04:49 Because of those compensatory measures that happened, you end up with ventricular modeling.

04:55 We already knew that, right? We knew that was going to happen.

04:59 Now, when the heart is really struggling, it's going to release these natriuretic peptides.

05:05 Okay, that's a BNP lab tests that we can do that lets us know, this patient is experiencing real problems.

05:13 So that BNP lab work when it gets elevated above normal, we know there's some, Wow, there's some real challenge happening in the heart.

05:22 So that ventricular remodeling, about some cool lab work that we can look at.

05:26 Now, you look at the very bottom there.

05:29 You can end up with MR. So mitral valve regurge, you can have pump failure, you can have electrical instability, like atrial fib, or sudden cardiac death.

05:44 Okay, that gets kind of serious, doesn't it? Well, this explains why patients with heart failure can also be an atrial fib.

05:52 We'll get all that has gone on and happened in that body.

05:56 So you've had the ventricular remodeling, got some cool lab work that you can look at.

06:01 We've over to the right side is we're going through those compensatory mechanisms.

06:05 You got the cytokines that are released, like it's a big deal in the body trying to respond to all this.

06:11 You have the additional vasoconstriction, ventricular hypertrophy, left ventricular dysfunction, everything ends up in that one bottom box.

06:20 That's why you might see mitral valve regurge.

06:23 The pump is failing and we're talking about the heart.

06:26 It's not able to adequately pump blood to the rest of the body.

06:31 And the third thing, electrical instability.

06:34 Remember, atrial fib is a really disorganized heart dysrhythmia.

06:39 Normally, we have atrium ventricle, atrium ventricle, atrium ventricle, right? That's how it's supposed to go.

06:44 But an atrial fib, you kind of have atrium going. It's just quivering.

06:50 Lots of firing going through and it doesn't push everything out, drops cardiac output, but at least 20%.

06:56 Sudden cardiac death. That one's pretty self explanatory.

07:00 That puts the patient had an increased risk to literally just have cardiac arrest.

07:05 So, this is why it's so important that you understand as a nurse, what are the early signs of CHF? What questions do we need to asked my patients? See these are the cues that you want to be looking for.

07:17 How do I put them together? How do I analyze them so I can prioritize our hypothesis of what I think is going on with my patient.

07:24 Because just because you've been diagnosed with heart failure, it's a progression. Sometimes it's exacerbated.

07:31 Sometimes it's okay.

07:33 It's our job to help the patient recognize and for us to recognize the earliest signs of an exacerbation.

07:40 We look for weight gain, we look for problems breathing, all those clear, classic cues. You want to be aware.

07:47 So that's it. That is congestive heart failure in a nutshell.

07:52 Thanks for joining us for this video series.