CHF

CHF is caused by fluid overload in the heart and. CHF is totally different from COPD. COPD is all about the lungs. Why is it called congestive heart failure? Because it's so much fluid. What kills HF pt? How does it kill the pt? It's the hypoxia. The real immediate problem is hypoxia, not fluid overload. It's not how much fluid int the body but it's how much fluid in the lungs. When the pt is having HF, that's the main problem. Why is there fluid in the lungs? Congestion means it's referring to the lungs. If you do a CXRAY, you'll see big heart. What's congestion? What do you see on cxray? You'll see big heart but that's not important, what's important? FLUID IN THE LUNGS. You'll see pulmonary edema = fluid overload/cushiness/leaking out in the lungs. Pulmonary edema  = that's what you'll see. When CHF pt comes in, the real problem is hypoxia. You can help solve that and makes that better by giving oxygen. But ultimately, you also have to know the root cause.  And, the root cause or the cause is pulmonary edema. PULMONARY EDEMA. So, what we need to know is then to get the fluid out of hte lungs. When the pt is SOB and hypoxic, do you care about getting the fluid out of the legs? NO, you care about getting the fluids out of the lungs: you want to get the pt's legs down ont he ground. Is it going to get their fluid in the legs worse? Yes. What's the problem? The LEFT ventricle. The left ventricle takes blood from the lungs and sends to the rest of the body. The right ventricle tkes blood from the rest of the body and sends it to the lungs. So, CHF, we have blood going to the lungs but we can't pump it out. There's fluid in lungs. Our main problem is the Left ventricle is not strong enough to pump fluid out. So if pt has CHF, FLUID IN THE LUNGS = HYPOXIC. And, if I make the Rt ventricle stronger, will that make the problem better or worse? worse. They may have some weakness in the Rt ventricle but the main problem is the Left ventricle is not effective enuf to pump the blood out. So, the way we can treat that is that we can make the heart stronger. This is a temporary fix. Slowing the gas pedal when the engine is already not doing so well. So, the meds like digoxin and dopamine and dobutamine will stimulate the heart and cause the heart to pump more out. If the heart is okay, it will regulate itself and it will try to push the left side harder to get that fluid out. So, how do we address it otherwise? We give them meds that cause pulling blood in the legs? Stand them up, put the legs down, use gravity. You can give the NTG. What does NTG do? It's a vasodilator. If I vasodilate my peripheral vein, what does that do? I pull more fluid out. It will only go so far tho. Bc you didn't get rid of any fluid in the body but you just move it around to somewhere else. How do I get the fluid out of the body? You actually have to use diuretics. If there's less fluid in the body, there's more fluid going to the Rt ventricle or what? Less. The Rt ventricle is going to pump less. And, the Lt ventricle job easier or harder? Easier.

What's the most common cause of CHF? HTN is a common cause. Sure. What else? too much IV fluid - might be a cause acutely in a pt in a hospital and unable to control their fluid bc their doctor/nurse is giving too much fluid but usuaully not in the world. Why does the pt have a weak heart? Not smoking but smoking makes it worse. Kidney failure? pretty close. CORONARY ARTERY DISEASE due to recurrent MI and hyperlipidemia. The 2 most common causes of CHF = CORONARY ARTERY DISEASE due to recurrent ischemia to the heart and infarction which kill the vessels in the heart and make the heart thin and dilated too large  and weak. The other common cause of CHF in older ppl but not until they're very old is HTN leading to thickening of the heart bc the heart to work hard to push the BP so it gets bigger and thicker and the ventricle cavity smaller. And, they have diastolic or systolic HF? DIASTOLIC. Why diastolic HF? Why? bc it's too thick and it cannot dilate. It's old heart and it's thick. Main issue is poor diastolic function. This is a particular common cause in pt who's older and long-standing HTN. So, if 88 y/o women comes to clinic with HF and she never smokes and she hasn't had many medical problems all her life. She's probably has diastolic HF. If 48 y/o african american man, who eats meat smokes and drinks gambles and does drugs doesn't take care of himself and comes to ur clinic and hospitalized, coronary artery disaese HF, primarily systolic HF bc the heart is too thin so it cannot pump.

PE: edema in legs. Hears fluid in the lungs (crackles).

~bf