HEART FAILURE
CONGESTIVE HEART
FAILURE
Heart failure also known as heart decompensation &
cardiac insufficiency.
Can be a physiologic state in which the heart is unable to
pump enough blood to meet the metabolic needs of the
body at rest or exercise.
The heart fail when it can not handle a normal blood
volume or a sudden expansion in blood volume e.g.
exercise.
Heart failure is not a disease itself, it is a group of
manifestations related to inadequate pump performance
from either the cardiac valves or the myocardium.
What ever the cause when the heart fails to propel
forward normally, congestion occurs in the pulmonary
circulation (blood accumulate in the lung).
Because a proper heart function depends on both
ventricle, failure of one ventricle leads to failure of the
other ventricle, this is called ventricular interdependence.
RISK FACTORS:
1- hypertension
2- CAD
3- cardiomyopathy
4- heart valve disease
5- arrhythmia
6- fever
7- infection
8- anemia
9- Thyroid problems
10- pregnancy
11- Pulmonary disease
12- hypervolemia from poor renal function
13- side effects of some medications e.g. chemotherapy, anti-inflammatory
drugs, sedatives , antidepressants.
LF VENTRICULAR FAILURE
Lf ventricular failure causes either pulmonary
congestion or disturbance in the respiratory control
mechanisms which may leads to respiratory distress
according to the pt position, activity or level of stress.
However, many pt with severely impaired ventricular
performance may have few or no symptoms, if heart
failure developed gradually.
SIGN & SYMPTOMS
1- dyspnea
2- paroxysmal nocturnal dyspnea: the pt awakes with the feeling of
suffocation, relieved as the pt become upright and may last more
than 30 min.
3- orthopnea. What is the cause???
4- cough. describe???
5- pulmonary edema: when the pulmonary capillary pressure
incrased causing the fluids to move into alveoli. Causing extreme
dyspnea, anxiety, frothy blood tinged sputum, use accessory
breathing ms, tachypnea, diaphoresis.
6- cerebral hypoxia: due to ↓ COP, causing anxiety, irritability,
restlessness, confusion, bad dreams, insomnia.
7- fatigue & ms cramping or weakness: ↓ COP leads to
hypoxic tissue & slow removal of metabolic wastes.
8- nocturia: (urination at night) at night urine formation
increased as blood flow to the kidneys improved.
Interfere with effective sleep patterns contribute to the
fatigue associated with heart failure.
RT VENTRICULAR FAILURE
CHF or a result of pulmonary embolism.
Rt ventricular failure results in peripheral edema and
venous congestion of the organs.
For example, as liver becomes congested with venous
blood, it become enlarged and abdominal pain occur.
SIGN & SYMPTOMS:
1- peripheral edema.
2- venous congestion of the organs
3- dependent edema: symmetric & occur in the
dependent parts
4- edema in the sacral area or back of the thigh.
5- cyanosis: of the nail beds as venous congestion
reduces peripheral blood flow.
ANEURYSM
ANEURYSM
Is an abnormal dilatation in the inner wall of an artery, vein or
heart.
It occur when the vessel or heart wall become weaken from
trauma, congenital vascular disease, infection or atherosclerosis.
Aneurysm can be either arterial or venous and descripted
according to the specific vessel in which they develop.
Thoracic aneurysm usually involve → the ascending, transverse or
descending portion of the aorta from the heart to the top of the
diaphragm.
Abdominal aneurysm usually involve → the aorta below the
diaphragm.
Peripheral arterial aneurysm affect → the femoral & the popliteal
arteries
THORACIC & PERIPHERAL
ANEURYSM
A dissecting aneurysm; tear develops in the inner lining of the aortic
walls.
The outer & the inner lining peel apart, creating an
extra channel “false vessel”.
- Small tear may not harm but divert blood from the
organs and tissues.
- Rupture occur when a small tear in the intima has
occurred followed by a rupture, massive internal
hemorrhage occurs as blood flows from the aorta into the
Chest.
ABDOMINAL AORTIC ANEURYSMS AAAs
is 4 times more common than thoracic aneurysm.
The most common site for AAA is just below the kidney, with referred pain
to the thoracolumbar junction.
Can be caused by:
1- trauma or weight lifting
2- congenital vascular disease
3- infection
4- atherosclerosis
RISK FACTORS:
1- smoking
2- congenital heart disease
3- surgery to replace or repair aortic valve.
4- recent infection
5- CAD
6- activities involved lifting heavy weights.
The therapist may be prescribing progressive resistive
exercises that can have an adverse effect in an older adult
with any of these risk factors.
Monitoring to the vital signs is important among those adult.
Teaching proper breathing and abdominal support without
using a Valsalva maneuver is important in any exercise
program especially for those pt with increased risk of AAAs.
Recommendations about one time ultrasonography screening
for AAAs for men ages 65 to 75 who presently smoke or who
smoke in the past.
Pt who had orthopedic surgery involving anterior spinal
procedure of any kind are at risk for trauma to the aorta.
CLINICAL SIGNS & SYMPTOMS:
1- chest pain
2- palpable pulsating mass.
3- abdominal heart beat felt by the pt when laying down.
4- dull ache in the mid-abdomen lf flank or low back.
5- hip, groin, scrotal (men), buttock and or leg pain.
6- weakness or transient paralysis of the legs.
CLINICAL SIGNS & SYMPTOMS OF
RUPTURE ANEURYSM:
1- sudden, sever e chest pain with tearing sensation.
2- pain my radiate to the neck, shoulder, between scapula,
lower back or abdomen.
3- pain radiate to the posterior thighs help to distinguish it from
MI.
4- pain is not relieved by changing the position.
5- pulsating abdominal mass.
6- cold, pulse less LL.
7- BP changes: more than 10 mmhg difference in diastolic BP
between arms, systolic BP less than 100 mmhg.
8- pulse rate more than 100 bpm.
9- Ecchymosis in the flank and perianal area.
THANK YOU
