CacduØ¢Øgy
S/S (LSHF + RSHF) (SATA)
HeacC fau¢uce SVC
NORMAL CIRCULATION
1. Deoxygenated (venous) blood returns to the heart through IVC and - Both sides of the heart has failed.
SVC. - The RA and RV has filled up.
2. All the venous blood (above and below) the heart will return to the - The fluid starts to back up the SVC.
RA.
3. Blood flows from RA > Tricuspid valve > RV.
4. From the RV, it goes into the lungs. Now, we get that venous blood
to become Warm, Red, and Oxygenated.
5. From the lungs > pulmonary vein > LA.
6. Blood flows from LA > Bicuspid valve > LV.
7. From the LV, it goes out through the aorta, to the rest of the
body.
LEFT SIDED HEART FAILURE
- If they're going to say RSHF, they MUST specify RSHF, otherwise it's LSHF or
COMPLETE HEART FAILURE.
- In LSHF, the LA and LV have failed. It prevents that warm, red,
oxygenated blood from going out to the body.
- That warm, red, oxygenated blood is not coming out that aorta.
S/S (SATA)
If theres NO warm, red, oxygenated blood going out:
- Cold and clammy
- Pallor/pale
- Decrease oxygen (deoxygenated)
- Low BP
- Decrease perfusion to the kidneys, therefore Low UOP
(that's why we gain weight)
Fluid is going into the lungs and the veins of the lungs start to
get excess fluid in it:
- Pulmonary edema
- Pink, frothy sputum, d/t micro tears mixing with sputum
- Crackles (rales)
- SOB (dyspnea)
- Orthopnea
Are we FOA?
If the person has fluid in their lungs and they are having trouble
breathing, then it becomes AIRWAY. If it progressed THAT far, that they
have so much fluid in their lungs, then yes - We are FOA.
Is the right side still working?
- In LSHF, the right side is still working.
- The right side has to work harder b/c it has fluid coming back.
- Over time, the right side of the heart is working hard and now the
whole heart has failed. So now we got a complete heart failure.
Remember:
LSHF can eventually lead to RSHF, then we develop CHF.
COMPLETE HEART FAILURE
, S/S (SATA)
- JVD SVC
- Puffy face/ Swollen cheeks
- Periorbital edema - JVD
- Periorbital edema
IVC - Puffy face/ Puffy cheeks
- Peripheral edema
- Pitting edema IVC
- Ascites, increase abdominal girth - same thing. - Cold and clammy
- Hepatosplenomegaly (HS) - Pale/Pallor
- Low O2
SUMMARY - Low UOP
- Over time this person will have LSHF for a long time and eventually - Low BP
the right side will fail. - Peripheral edema
- If they just have left sided, the right side still works, and it just fills - Pitting edema
up the lungs. It doesn't make it to the body until it becomes CHF, - Ascites/ Increase abdominal girth
where both sides have failed. - Hepatosplenomegaly
- Left side can fail first, then over time, both will fail b/c the right
side has to work harder. SUMMARY
- CHF = Heart Failure.
RIGHT SIDED HEART FAILURE - Congestive Heart Failure is Complete Heart Failure.
They MUST specify RSHF if they want to ask about RSHF - LSHF will specifically say left sided.
- The right side is the only portion of the heart that has failed us. Priority Q:
Now the right side is sitting there. - HF, they will use AIRWAY!
- Blood does not go into the lungs, it doesn't pass the pulmonic - Pt will be SOB and drowning in their own lungs.
valve, so there's no warm, red, oxygenated blood going out to the DIAGNOSIS (Freebie)
body. - We can clinically identify HF by looking at S/S. But we need labs to
confirm
- As the ventricles expand, b/c there's a lot of fluid, it releases a
peptide: Brain Natriuretic Peptide (BNP).
BRAIN NATRIURETIC PEPTIDE
- BNP more than 100 indicates HF
- Normal BNP = <100
nin T
,TREATMENT (Diuretics) 4. Milrinone
- Goal is to get fluid off 5. Amiloride
3 types of Diuretics:
- Loop
- Thiazide
- K sparing
1. Loop Diuretic
Suffix: -ide
1. Furosemide
2. Torsemide
3. Bumetanide
S/S
▸ OOHH DANG
Orthostatic hypotension
• Low BP
• Change position slowly, b/c too much fluid is coming off.
That BP goes up against gravity, so let them get up slowly.
Ototoxicity
• Occurs if you infuse it TOO FAST - so SLOW the infusion rate.
• S/S: Tinnitus, Fullness of the ear, balance issue, ringing in the
ears, vertigo - IDENTIFY IT.
Hypokalemia
• We're dehydrating them.
• Pt might be in bed watching tv and they start to develop leg
cramps; Check their K levels. - IDENTIFY with muscle cramps.
Hypomagnesemia
• Tremors (not the highest yield)
Dehydration
• Can become dehydrated If done too long.
• Check lab values for Kidneys!
• Signs of dehydration: Tachycardia, Oliguria, Decreased
mucous membranes
Allergy to Sulfa drugs
• Loop is a sulfa drug. "SAT for a PHOTO"
• Educate on Photosensitivity.
Nephrotoxic
• It works on the kidney, so we have to be careful.
• Be concerned with labs: BUN and Cr
• Normal Cr: 0.6-1.2 (2 and up indicates kidneys in trouble)
Gout
2. Thiazide diuretic
Suffix: -thiazide
1. Hydrochlorothiazide (HCTZ)
2. Chlorthalidone (one that they might throw at you)
S/S
- Causes increases Na + H2O
- Decrease K+ or hypokalemia, because its K+ wasting
- Orthostatic hypotension
- Nephrotoxic
- Dehydration
- Sulfa based
3. Potassium sparing diuretic
Suffix: normally end in -one
1. Spironolactone
2. Aldactone
3. Eplerenone
, - If a pt that has a sulfa allergy or hypokalemic, give a K sparing. RVA PictureS - Pulmonic Stenosis
- Drug Class: Aldosterone Antagonist Overriding aorta Of A - Overriding Aorta
○ Aldosterone increases Na, it controls Na, H2O follows it, Na VSD RancH - Right ventricular Hypertrophy
and K+ go in opposite directions, via the sodium potassium
pump; So Na goes up and K+ goes down.
○ Aldosterone ANTAGONIST knocks out aldosterone. If we knock Boards want to know HOW you are going to MANAGE this patient.
out aldosterone, Na goes down, H2O follows it, and K+ goes
up.
S/S
- Watch for signs of Hyperkalemia
S/E
- Gynecomastia. (If they ask)
EDUCATE
1. Check daily weights.
- Either no clothes on in the AM or wear the same clothes. If
this person goes into HF they're gonna gain 2-5 lbs
overnight
2. Monitor I/O
- Make sure that if you're taking in water, you're
actually getting rid of it.
3. Avoid anything with Na
- Why? Because they're gonna retain water.
- AVOID, NOT DECREASE, AVOID Na.
Ex: Packaged food, frozen food, fast food, processed food.
- CAN have a salt substitute
4. Get them in some sort of cardiac rehab
5. Decrease alcohol or not consume alcohol
6. Do not smoke.
- If a pt comes in, the pt is going to make a statement, and is going
to need a FTFI.
- "once in awhile I can have a bag of chips" No you can't! B/c you're
gonna be puffy and swollen. So you're going to AVOID.
WE NEVER SAY THE OPPOSITE:
Nutrition
- diet
Exercise
Etoh
Dont Smoke
ADMINISTRATION
- Take in the morning or when the pt wakes up.
- Don't take it at night or before going to sleep or they'll be up
all night peeing.
HF presents as:
- PRIORITY when you see fluid overload with trouble breathing, b/c
this becomes an AIRWAY problem!
PEDIATRIC CARDIO
TeCcaØ¢Øgy Øf Fa¢¢ØC
- Four pathologies happening at the same time.
- Anatomical defect (born with it)
There's 4 different things that are going on:
Pulmonic stenosis VarieD - Ventricular septal Defect
S/S (LSHF + RSHF) (SATA)
HeacC fau¢uce SVC
NORMAL CIRCULATION
1. Deoxygenated (venous) blood returns to the heart through IVC and - Both sides of the heart has failed.
SVC. - The RA and RV has filled up.
2. All the venous blood (above and below) the heart will return to the - The fluid starts to back up the SVC.
RA.
3. Blood flows from RA > Tricuspid valve > RV.
4. From the RV, it goes into the lungs. Now, we get that venous blood
to become Warm, Red, and Oxygenated.
5. From the lungs > pulmonary vein > LA.
6. Blood flows from LA > Bicuspid valve > LV.
7. From the LV, it goes out through the aorta, to the rest of the
body.
LEFT SIDED HEART FAILURE
- If they're going to say RSHF, they MUST specify RSHF, otherwise it's LSHF or
COMPLETE HEART FAILURE.
- In LSHF, the LA and LV have failed. It prevents that warm, red,
oxygenated blood from going out to the body.
- That warm, red, oxygenated blood is not coming out that aorta.
S/S (SATA)
If theres NO warm, red, oxygenated blood going out:
- Cold and clammy
- Pallor/pale
- Decrease oxygen (deoxygenated)
- Low BP
- Decrease perfusion to the kidneys, therefore Low UOP
(that's why we gain weight)
Fluid is going into the lungs and the veins of the lungs start to
get excess fluid in it:
- Pulmonary edema
- Pink, frothy sputum, d/t micro tears mixing with sputum
- Crackles (rales)
- SOB (dyspnea)
- Orthopnea
Are we FOA?
If the person has fluid in their lungs and they are having trouble
breathing, then it becomes AIRWAY. If it progressed THAT far, that they
have so much fluid in their lungs, then yes - We are FOA.
Is the right side still working?
- In LSHF, the right side is still working.
- The right side has to work harder b/c it has fluid coming back.
- Over time, the right side of the heart is working hard and now the
whole heart has failed. So now we got a complete heart failure.
Remember:
LSHF can eventually lead to RSHF, then we develop CHF.
COMPLETE HEART FAILURE
, S/S (SATA)
- JVD SVC
- Puffy face/ Swollen cheeks
- Periorbital edema - JVD
- Periorbital edema
IVC - Puffy face/ Puffy cheeks
- Peripheral edema
- Pitting edema IVC
- Ascites, increase abdominal girth - same thing. - Cold and clammy
- Hepatosplenomegaly (HS) - Pale/Pallor
- Low O2
SUMMARY - Low UOP
- Over time this person will have LSHF for a long time and eventually - Low BP
the right side will fail. - Peripheral edema
- If they just have left sided, the right side still works, and it just fills - Pitting edema
up the lungs. It doesn't make it to the body until it becomes CHF, - Ascites/ Increase abdominal girth
where both sides have failed. - Hepatosplenomegaly
- Left side can fail first, then over time, both will fail b/c the right
side has to work harder. SUMMARY
- CHF = Heart Failure.
RIGHT SIDED HEART FAILURE - Congestive Heart Failure is Complete Heart Failure.
They MUST specify RSHF if they want to ask about RSHF - LSHF will specifically say left sided.
- The right side is the only portion of the heart that has failed us. Priority Q:
Now the right side is sitting there. - HF, they will use AIRWAY!
- Blood does not go into the lungs, it doesn't pass the pulmonic - Pt will be SOB and drowning in their own lungs.
valve, so there's no warm, red, oxygenated blood going out to the DIAGNOSIS (Freebie)
body. - We can clinically identify HF by looking at S/S. But we need labs to
confirm
- As the ventricles expand, b/c there's a lot of fluid, it releases a
peptide: Brain Natriuretic Peptide (BNP).
BRAIN NATRIURETIC PEPTIDE
- BNP more than 100 indicates HF
- Normal BNP = <100
nin T
,TREATMENT (Diuretics) 4. Milrinone
- Goal is to get fluid off 5. Amiloride
3 types of Diuretics:
- Loop
- Thiazide
- K sparing
1. Loop Diuretic
Suffix: -ide
1. Furosemide
2. Torsemide
3. Bumetanide
S/S
▸ OOHH DANG
Orthostatic hypotension
• Low BP
• Change position slowly, b/c too much fluid is coming off.
That BP goes up against gravity, so let them get up slowly.
Ototoxicity
• Occurs if you infuse it TOO FAST - so SLOW the infusion rate.
• S/S: Tinnitus, Fullness of the ear, balance issue, ringing in the
ears, vertigo - IDENTIFY IT.
Hypokalemia
• We're dehydrating them.
• Pt might be in bed watching tv and they start to develop leg
cramps; Check their K levels. - IDENTIFY with muscle cramps.
Hypomagnesemia
• Tremors (not the highest yield)
Dehydration
• Can become dehydrated If done too long.
• Check lab values for Kidneys!
• Signs of dehydration: Tachycardia, Oliguria, Decreased
mucous membranes
Allergy to Sulfa drugs
• Loop is a sulfa drug. "SAT for a PHOTO"
• Educate on Photosensitivity.
Nephrotoxic
• It works on the kidney, so we have to be careful.
• Be concerned with labs: BUN and Cr
• Normal Cr: 0.6-1.2 (2 and up indicates kidneys in trouble)
Gout
2. Thiazide diuretic
Suffix: -thiazide
1. Hydrochlorothiazide (HCTZ)
2. Chlorthalidone (one that they might throw at you)
S/S
- Causes increases Na + H2O
- Decrease K+ or hypokalemia, because its K+ wasting
- Orthostatic hypotension
- Nephrotoxic
- Dehydration
- Sulfa based
3. Potassium sparing diuretic
Suffix: normally end in -one
1. Spironolactone
2. Aldactone
3. Eplerenone
, - If a pt that has a sulfa allergy or hypokalemic, give a K sparing. RVA PictureS - Pulmonic Stenosis
- Drug Class: Aldosterone Antagonist Overriding aorta Of A - Overriding Aorta
○ Aldosterone increases Na, it controls Na, H2O follows it, Na VSD RancH - Right ventricular Hypertrophy
and K+ go in opposite directions, via the sodium potassium
pump; So Na goes up and K+ goes down.
○ Aldosterone ANTAGONIST knocks out aldosterone. If we knock Boards want to know HOW you are going to MANAGE this patient.
out aldosterone, Na goes down, H2O follows it, and K+ goes
up.
S/S
- Watch for signs of Hyperkalemia
S/E
- Gynecomastia. (If they ask)
EDUCATE
1. Check daily weights.
- Either no clothes on in the AM or wear the same clothes. If
this person goes into HF they're gonna gain 2-5 lbs
overnight
2. Monitor I/O
- Make sure that if you're taking in water, you're
actually getting rid of it.
3. Avoid anything with Na
- Why? Because they're gonna retain water.
- AVOID, NOT DECREASE, AVOID Na.
Ex: Packaged food, frozen food, fast food, processed food.
- CAN have a salt substitute
4. Get them in some sort of cardiac rehab
5. Decrease alcohol or not consume alcohol
6. Do not smoke.
- If a pt comes in, the pt is going to make a statement, and is going
to need a FTFI.
- "once in awhile I can have a bag of chips" No you can't! B/c you're
gonna be puffy and swollen. So you're going to AVOID.
WE NEVER SAY THE OPPOSITE:
Nutrition
- diet
Exercise
Etoh
Dont Smoke
ADMINISTRATION
- Take in the morning or when the pt wakes up.
- Don't take it at night or before going to sleep or they'll be up
all night peeing.
HF presents as:
- PRIORITY when you see fluid overload with trouble breathing, b/c
this becomes an AIRWAY problem!
PEDIATRIC CARDIO
TeCcaØ¢Øgy Øf Fa¢¢ØC
- Four pathologies happening at the same time.
- Anatomical defect (born with it)
There's 4 different things that are going on:
Pulmonic stenosis VarieD - Ventricular septal Defect
