Congestive Heart Failure
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
Pulmonary edema causes anxiety because of a sensation of suffocation, severe dyspnea, and restlessness. Often, there is coughing that produces a reddened sputum, cyanosis, pallor, and extreme sweating. There may be frothing from the mouth, but extreme hemoptysis is rare. While the BP can be variable, the pulse is rapid but of low volume. Significant hypertension indicates that the cardiac reserve is increased. A dangerous sign is hypotension in which the systolic BP is lower than 100 mg Hg. Over both lung fields, inspiratory fine crackles are dispersed anteriorly and posteriorly. Severe cardiac asthma may develop, causing wheezing. Efforts to breathe are noisy and often complicate auscultation of heart sounds. A merger of the third and fourth heart sounds, known as a summation gallop, may develop. Signs of RV failure may occur, including neck vein distention and peripheral edema.
The patient with acute cardiovascular problems
Peate Ian, Dutton Helen in Acute Nursing Care, 2020
Cardiac output decreases in sleep and rises during vigorous exercise, increasing in a trained athlete by up to 7 times (up to 35L/minute). In illness, the demand may increase as with sepsis; or the ability to maintain cardiac output may reduce, as with heart failure, and a mismatch of demand and supply may ensue. The cardiac reserve enables the output to increase by increasing the ejection fraction (and therefore stroke volume) and increasing heart rate. Stroke volume depends mainly on three factors: Preload.Contractility.Afterload.
The patient with acute cardiovascular problems
Ian Peate, Helen Dutton in Acute Nursing Care, 2014
Cardiac output decreases in sleep and rises during vigorous exercise, increasing in a trained athlete by up to seven times (up to 35L/minute). In illness, the demand may increase, as with sepsis; or the ability to maintain cardiac output may reduce, as with heart failure, and a mismatch of demand and supply may ensue. The cardiac reserve enables the output to increase by increasing the ejection fraction and therefore stroke volume and increasing heart rate. Stroke volume depends mainly on three factors: PreloadContractilityAfterload.
Management of fluid status and cardiovascular function in patients with diffuse skin inflammation
Published in Journal of Dermatological Treatment, 2019
Arash Taheri, Amanda D. Mansouri, Parisa Mansoori, Rahimullah Imran Asad
Patients with chronic, widespread skin inflammation, such as erythroderma, usually develop their pathology and vascular changes gradually over time. First, there is a mild reduction in blood pressure. Patients with access to water and good nutrition will compensate for this reduction in blood pressure by retaining salt and water. Fluid retention leads to an increase in intravascular and extravascular volume and presents as peripheral edema. After adequate compensations, these patients have sufficient preload and venous return to the heart and do not require intravascular fluid infusion. However, the blood pressure of most of these patients remains lower than their baseline due to peripheral vasodilation in the skin. Most patients with good cardiac reserve function can compensate for peripheral vasodilation and blood shunting with increased cardiac output and blood pumping (1). They can maintain their blood pressure at a level sufficient for internal organ perfusion. However, if the heart cannot support increased cardiac output, the patients’ blood pressure may remain too low. Patients with heart failure or reduced cardiac reserve cannot pump more blood to compensate for the shunting of blood through the skin. The resulting hypotension and internal organ hypo-perfusion cause severe compensatory fluid retention, which leads to a significant increase in central venous pressure and pulmonary vascular pressure, decompensated congestive heart failure, and pulmonary edema (17). This condition is called high-output heart failure (12).
Perioperative pharmacotherapy to prevent cardiac complications in patients undergoing noncardiac surgery
Published in Expert Opinion on Pharmacotherapy, 2021
Kirtipal Bhatia, Bharat Narasimhan, Gaurav Aggarwal, Adrija Hajra, Soumya Itagi, Shathish Kumar, Sandipan Chakraborty, Neelkumar Patel, Vardhmaan Jain, Dhrubajyoti Bandyopadhyay, Birendra Amgai, Wilbert S Aronow
Tremendous advances in cardiovascular medicine have left us with a large and growing elderly demographic with a significant comorbidity burden. Similar strides in surgical and anesthetic techniques have led to increasingly complicated and intricate surgeries on patients previously deemed too high risk for such undertakings. The logical consequence of the aforementioned progress is that a greater number of patients with cardiovascular comorbidities are undergoing high-risk surgeries than ever before. The impact of these interventions – either as a result of anesthesia, the surgery itself, or the physiological consequences of a catecholaminergic state – imposes varying degrees of stress on the cardiovascular system. These are often well tolerated by healthy individuals but are of particular significance in high-risk patients with an impaired cardiac reserve. The importance of perioperative care is of vital importance in these patients.
Association between heart rate variability and haemodynamic response to exercise in chronic heart failure
Published in Scandinavian Cardiovascular Journal, 2019
Aaron Koshy, Nduka C. Okwose, David Nunan, Anet Toms, David A. Brodie, Patrick Doherty, Petar Seferovic, Arsen Ristic, Lazar Velicki, Nenad Filipovic, Dejana Popovic, Jane Skinner, Kristian Bailey, Guy A. MacGowan, Djordje G. Jakovljevic
In our study the cardiac power increase in response to exercise stress was due to an increase in cardiac output and mean arterial blood pressure. The increase in cardiac output was due to an increase in heart rate and stroke volume. The heart rate response to exercise is blunted in chronic heart failure and is often further suppressed by beta blockers [1]. As a compensatory response, one would expect an increase in stroke volume via the Frank-Starling mechanism. Although stroke volume can increase two-to-three times in response to exercise stress, patients with heart failure demonstrate a reduced cardiac reserve and inability to respond to exercise stress compared with other chronic conditions as we have recently demonstrated [31].