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Heart Failure

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***Previously Recorded***

Struggling to understand heart failure? Well come ready with those burning questions as we guide you through the process of heart failure, and how to successfully care for those patients!

Video Transcript

Hi Guys, come on. All right. As you guys jump in, let me know you’re here and where you’re coming from. Let me get y’all let me know if you can hear me.
Sure.
Bathing looks good.
Okay.
Oh good. Awesome.
Okay,
awesome.
Okay,
so I am really excited you guys because we have a new little feature that we’re going to start using. Yea that I hope is going to be helpful for you guys, but y’all can let us know if it’s not. So we’re gonna tackle heart failure. So if any of you guys have ever spent any time around me, you know that heart failure is like my favorite thing to talk about. It seems really weird to say that, that I love talking about heart failure, but I do. I think it’s really, really interesting. I’m hoping to kind of demystify it for you guys today. I think it gets a little confusing and complicated. You start talking about left versus right and you start getting all discombobulated in your head. And I don’t want that for you guys. They want you guys to be able to really differentiate and know the difference. So I’ve been a nurse for 10 years and most of my work’s been in ICU so I’ve seen a lot of heart failure patients. And so guys, if you can’t hear me it might be in your side. If you’re on your phone, ty checking on your computer and jump back in. I’m sorry.
So that’s what we’re going to talk about today. So really with heart failure, most of the time you’re going to end up seeing just full heart, heart failure. But a lot of times you’re going to see it start as either a left side or right side. It just depending on what happened. So the first thing they clarify here is what kinds of things can cause heart failure. There’s keeper, he always wants to join. He’s been perfectly content. So what kinds of things you want to have examples of kinds of things that can actually cause heart failure.
Yeah,
he’ll jump in the chat. Yeah, if you can’t here, log out and log back in. Awesome Room. I’m glad you guys made it. So high failure, it’s just pump failure, right? It’s something that is causing your heart, which is a pump to not work. Right? And so if that’s the case, then anything that can cause that pump to malfunction can cause heart failure. Right? Y’All just don’t log out and log in if you can’t hear. Okay. Rima said it worked for her. Okay. So what kinds of things can cause heart failure? What kinds of things can cause that heart pump to malfunction? Yep. In the chat. Let me know.
Perfect.
I know you guys know the stuff. There we go. There’s the line. So hypertension, right? Per Lung, hypertension means the heart has to push against that extra pressure for too long. And that heart starts to give out coronary artery disease because we’re decreasing our profusion to the muscle itself. And then of course, what’s the extreme version of that? If we take away profusion to the heart muscle, what happens to the heart? What do we get?
Good.
We block off profusion to the heart muscle, it dies right once I called Zack or myocardial infarction. So those are all things they touch that these are all things that can actually cause heart failure. So anything that affects the heart muscle and the heart’s ability to comp can cause heart failure. So let’s jump in and look at symptoms and look at what the big linchpin as I’m going to share my screen and I’m super excited about this. So just now while I’m sharing my screen, I can still see you guys in the chat. So still answer my questions. Sell at me now. But you guys should see a blank screen in front of you at this point.
Okay.
So let’s just review really fast. The blood flows through the heart cause that’s how we’re gonna look at our symptoms, right? So do you guys see this blank screen? So remember we started on the right side of the heart. So you guys are not seeing a blank screen. Do you also see my face?
[inaudible]
so some of you, y’all see my screen? Awesome. Perfect. Okay, so right. So no heart from the right side of the heart. We go out to the lungs.
[inaudible]
yeah, see writing. So this is a new feature you guys. So I want to make sure it’s working. Okay, cool.
Yeah,
from the lungs. We go down to the left side of the heart.
[inaudible]
so some of you guys are seeing the screen and some of you are seeing me. Okay.
[inaudible]
chance can you see me writing cause then the new feature so it’s not working. I’m a jump out and I’m going to get you can. Okay. So I’m going to keep going with the screenshare guys and if you are having issues, if you’re on your phone that might be part of the problem. Um, if you are
yeah, if you’re on your phone, so if can jump on to um, desktop, you should be able to see it. So from the rights at the heart, we go to the lungs. From the left side of the heart we go to the body and then we come back to the right side of the heart. Chance. Let me know if you want me to jump on and get my whiteboard. Cause I think we’ve got half of people seeing it and half the people not. So we started on the right side of the heart. Okay. So start on the right side, the heart. And from there we go to the lungs, then we go to the left side of the heart, and then we go to the body and we go back to the right side of the heart. Okay? So the big thing you need to know in heart failure, there’s two things that happen in heart failure. And this is kind of your linchpin. If you can remember this part, you can remember everything else. So the first thing is that we have decreased perfusion for word decreased profusion forward. And the second thing is we have increased congestion.
Awkward. So remember those two things. Every time we have decreased profusion forward, increase congestion backwards. Okay, so what does that look like? From the right side of the heart? We lose our profusion to the lungs, and from the left side of the heart we lose our profusion to the body. Okay? So decrease perfusion forward. Then we had an increased congestion backwards. So if we’re on the left side of the heart, we’re gonna congest backwards to the lungs. And if on the right side of the heart we’re gonna congest backwards to the body. So these are the major things you need to understand in order to be able to understand what happened happens in terms of symptoms. Okay, so just to recap here, if we are on the right side of the heart, then the blood flows to the lungs, then it flows to the left side of the heart, then it flows to the body. And back to the right side of the heart. If we have perfusion issues, we lose perfusion to the lungs. From the right side, you lose perfusion to the body from the left side.
And if we’re congesting backwards from the left side, we congested the lungs from the right side we can just to the body. Okay, so let’s start talking about what symptoms look like. Let’s look on the right side of the heart first. Okay. If we lose perfusion to the lungs, what symptoms do we see in our patients? So we have decreased perfusion to the lungs, shortness of breath, cause I’m not really getting good blood flow, right? So shortness of breath or dyspnea. What other problems are we going to see? If I lose perfusion to the lungs, what kind of things Matt? I see in my patient, so I’m not getting blood flow through the lungs. If the blood’s not flowing, I might have some fatigue possibly cause I have wet. What happens to my oxygen levels? Decreased perfusion to my lungs.
Yeah, my oxygen levels decrease. So I’m just talking about profusion to the lungs. They lose blood flow through the lungs. Then I decrease oxygen, right? So if my oxygen decreases, I might end up with some cyanosis just depending on what’s happening with my oxygen. Right? So this is things that we might see because I’m not getting that blood flow because I’m not getting that gas exchange that I want. Right. Okay. So that’s the perfusion part of right sided. Let’s talk about the congestion part and the right side of the heart. If I’m congesting, I’m congesting backwards to the body. So what symptoms am I going to see? Because I have congestion or a backup of bled into the body. JVD. Yes. Jaguar venous distention. It looks like a rope in the neck, right? That Dane is there, it’s pulsating, it’s distended. Even when this person is sitting straight up, listen, if I laugh, everyone has JVD, right? Because I’m pushing all that fluid, but even on sitting straight up, I have that JVB and that someone else said, edema. Where am I going to see most of this edema? Congesting atomic fluid back into the body. Where am I going to see a Dema?
Okay.
Where’s the most common places that you’re going to see it? Yeah, in the feet and in the legs. Why? Why am I going to see it down there?
Okay.
Why am I gonna see it in the legs and the feet? Because where is that? It’s down, right? It’s d pendant. So just gravity, right? Gravity is pulling all that fluid down, right? So right now I’m just talking about fluid congesting out into the periphery. Out into the body. So we wouldn’t necessarily see lung symptoms if we’re talking about the heart or the body, right? Right side of the heart. Congests into the body, not into the lungs, right? So dependent edema in the feet and in the legs. We’re going to see JVD. This patient might have some weight gain too, right? I’m increasing. I left fluid in that volume over overload. I actually see them gain some weight because they’re hanging on to all that fluid out in their body, right? So that’s the right side of the heart. You’re going to see decreased profusion to the Lens and increased congestion into the body. Okay, so let’s shift over. Let’s talk about the lungs. The lungs. You’re going to see fluid problems in the lungs and you’re gonna see decreased perfusion to the body. So let’s start with the perfusion issues. Again, if I decrease perfusion to the body, what do I see? What do I see? What kind of symptoms do I have? Oh, decreasing perfusion to the whole, the whole rest of the body. What’s the patient going to present with?
Weak pulses. Yeah, weak pulses. So I don’t have enough perfusion. I don’t have enough blood flow out to my body. So my pulses is going to be a week. I’m going to have cool extremities. What else am I gonna see? My Skin? Yeah, pallor. So remember styling now. So this has to do with oxygenation, not fusion. So in Macy saying, was this over here when I don’t have enough oxygen? But when my issue is perfusion, they’re Pale. Right? Cause I’m losing that blood flow out to the extremities. They’re really pale. Now what’s going to happen to my vital signs if I don’t have enough perfusion out to my body? What’s going to happen to my vital signs? What’s higher heart rate might be higher, but blood pressure’s going to go down, right? I’m going to have hypotension, weak pulses out in my periphery and to compensate, my heart rate might go up because I’m trying to increase that overall output, right? So blood pressure down, heart rate apps, I’m losing perfusion. What about my cap refill? What happens to cap refill if I have poor perfusion?
So you guys see a Waller, remember a thousand seconds, right? So slow cap refill, which means the number’s going to go up. You’re actually gonna see it greater than three seconds. Okay, so careful when you say low [inaudible] though, cause that doesn’t really make sense. [inaudible] falls measured in time. So we have slow capris though. Or delayed cap refill and then the time goes up. Does that make sense? All right. So let’s shift and let’s talk about the congestion part. Cause I have, we have two aspects with heart failure. You have perfusion problem and you have a congestion problem. So if we’re from the left side of the Patty, we’re congesting to the lungs left lungs. So what symptoms do we see? Because we can just fluid pack into the lungs. Yes. Good Job Danny. You might see some chronicles, we might hear some crackles specifically. They might be shortness of breath also because they’re having so much fluid in their lungs. A security side, p e be specific. Which PE you’re talking about?
Great.
So pink, floppy speed. And because of,
because of pulmonary edema. So the reason I say be specific when you say PE is because common only. When we say PE we’re actually talking about a pulmonary embolism, which is different. So pulmonary edema, fluid in the lungs, pink frothy sputum cause it’s all this blood congesting in the lungs, right? That’s what turns it pink. I literally had a patient get intubated or pulmonary edema and it was pink frothy sputum that shot across the room. It was crazy dyspnea or shortness of breath, possibly an increased respiratory rate of this is going to make it difficult to breathe. So they’re going to try to breathe a little faster. And then the big one here that you really see, um, kind of generally with every uh, aspect is fatigue. These patients are exhausted, they’ve gained a bunch of weight from all this fluid. They’re not getting enough oxygen, they’re not getting enough perfusion and they’ve got all this fluid in their lungs.
They are exhausted. You’re going to see fatigue pretty much with every possible left and right side heart failure. Okay. So one more thing I want to show you guys, cause this is a cheat sheet. I’m going to give you guys the link to here in just a second and then I’m going to come back where you can see me and I’m going to answer your questions. But take a screenshot of this. Take a picture of this if you need to see it. Okay. Cause I’m a move on. I can always go back to that. But this is what I want you to see. Okay, so remember the run an Angiotensin aldosterone system. This is what causes our body to increase blood pressure. If I have heart failure, I have poor perfusion, right? So pet CT profusion to my kidneys, it’s going to initiate this whole process, which is going to increase my fluid retention, increase my volume, increase my blood pressure, and that’s talking to due to my heart that’s already failing and struggling. Is it a good thing?
Not necessarily ready. So this is the remedy angiotensin aldosterone system. It’s a wonderful if I’m actually hypotensive, but this is what I call the cycle of death for a heart failure patient. It really, really is. So when we look at treatment for heart failure, what you’re gonna see is I knew using all of these drugs in an effort to help my heart failure patient not struggle so hard. So we definitely use a combination of all of your different Ras drugs, your anti-hypertensives, your diarrhetics, your basal dilators. We use a combination of all of these to kind of try to break this cycle as best we can for our heart failure patients. Every patient is different in terms of where we start, what drugs we use. I will tell you Beta blockers are your number one. Ace inhibitors are your number two. So it really just depends on the patient and what’s going on.
But we’re just trying desperately to break this cycle. Okay. All right. I’m going to go back to this slide because I’m going to give you guys this cheat sheet link. I want you guys to look at this one more time cause then I’m going to jump off of screen share y’all so y’all can see me and ask me. So don’t ask his heart block considered heart failure. So a heart block isn’t a resume. So specifically you’re talking about a rhythm issue. If you don’t have a perfusion issue, if your heart doesn’t fail because of it, the no, they’re, they’re not the same. But if because you have the heart block, you end up in heart failure. It absolutely can cause the other. Okay. So I’m gonna come back. So you guys should all be able to see me now. Even if you saw me before, they’ll be able to see me now.
I asked ’em. So let me give you guys a couple of links really fast cause I want you guys to have this cheat sheet, this cheat sheet that I just popped up. You can get with this link. And then we have an entire module in the Med surge cardiac course, med surge, cardiac on heart failure. Okay. And so, um, you can go and check that out, which I’m gonna give you that link in a second. But you can also search our library for heart failure. There’s a ton of cheat sheets on understanding left versus right. And then this link will take you to the first lesson in that module. So that module on heart failure, we have a module intro which talks about what I just talked about. We have a module on heart failure pathway itself, which expands on what I just talked about and has a little bit of the same stuff with one on management of heart failure.
So make sure that you check all of those things out because really it’s going to help you understand what the heck is happening when my heart is failing. Okay. So what questions can I answer for you guys to number two, big things. Decreased profusion forward, increase congestion, backwards. So if you understand the blood flow through the heart, you can really understand what you’re going to start to see on either side because of that. Now somebody had posted it, put a little memory device here that said left equals lungs and right equals rest of the body that is specifically referring to the fluid congestion. So fluid overload and congestion, left sided equals lung congestion, right side of equals, rest of the body congestion. Okay, so specifically for fluid, what questions can I answer for you guys though? Heart failure
in terms of treatment. The other thing that, um, we do, so besides medications, it’s a huge thing is the medications. We’ve got to break that cycle because when we lose perfusion to the kidneys, our kidneys go, oh, let me hang on to everything and it just makes it worse, right? So the medications, those cardiac drugs are your number one thing we can do for heart failure. Any kind of, um, thing we can do for the edema, right? So we’re going to want to elevate their legs. Um, any kind of, uh, pulmonary interventions we can do. So give oxygen incentives, barometers, help to help turn coffee, deep breathe and those deep breathing exercises to get fluid off of the lungs. Um, but the medications are going to be the best. The other thing that we’ll do as they start to progress is you’ll start to see things like pacemakers and internal defibrillators to make sure their hearts are efficiently pumping.
Um, and then eventually possibly could see, um, a left ventricular assist device with a bridge to heart transplant. Cause ultimately it’s very difficult to, uh, improve the actual muscle. Once the muscle’s dead, it’s dead, right? Um, if it’s dying, we can do things to help improve it so it doesn’t die. So stents, we can do coronary stents. If it’s an artery disease issue, we get their blood pressure down to decrease the workload on the heart. We get their preload down with those diarrhetics to decrease the workload on the heart. Um, and so really it’s medications is the biggest thing we’re doing for these patients. And then it’s supportive care beyond that. So again, oxygenation, making sure they have enough oxygen, making sure they’re doing deep breathing exercises to get fluid off their lungs. We’re elevating legs if we need to, evaluating pulses, evaluating blood pressure, et cetera. That makes sense to do had asked about interventions. So that’s where that works.
Okay.
What other questions can I answer for you guys about heart failure as a whole or as treatment or anything really? I’ll answer any questions you guys know I will.
Okay.
So again, heart failure, you’re usually going to see right or left when it starts, but most patients will end up with bilateral full heart, global heart failure. So you actually see a little bit of both. You’ll see some of that peripheral edema and some pulmonary edema. You’ll see JVD and you’ll see, um, you know, power because they’re, they’ve got left and right issues and you’re gonna see both eventually, especially as it gets worse. What about this? What about diagnostics? Do you guys know what kind of diagnostic tests we use to test for heart while you’re in evaluate? Heart failure. One really big one. So EKG, maybe that’s going to tell us about the electricity, but it’s not gonna really tell us about the effectiveness of the heart. The Echo. Exactly. Echocardiogram. So EKG is the electro, but echo is what we’re going to use. So an echocardiogram is an ultrasound of the heart where I can look at how efficiently it’s pumping.
Um, I can look at if there’s, maybe there is clear that the right side is really dilated or it’s really clear the right side’s not really moving. So I can really see that. And what specifically on the echo, what’s a a number that we get that we’re looking for on that echo that tells us how the, how other heart’s doing detection fraction. So the ejection fraction is the percentage of blood that comes out of the heart with every pump. So if I fill it, let’s say with a hundred milliliters and 70 milliliters come out, then it’s a 70% right. Is it? So it’s expressed in that percentage. 60, 70%. That’s normal. These heart failure patients sometimes are seeing like 20%, 30%. Um, my grandfather has heart failure. His last ejection fraction was 17%. He’s not doing well. Um, and we call those cardiac cripples. It’s really, really no good. So ejection fraction is one big thing. Not Brenda, you said labs. So what labs do we look for? Heart failure. Cause you’re totally on it. There’s one really important lab Triphala lady entrepreneur is going to tell us if we have damage to the muscle itself. So you might see an elevated troponin and somebody who’s really severe heart failure but BNP guy’s got it. B, N P B naturally B, which stands for brain naturally erotic peptide. And what does BNP tell us if we have an elevated BNP, what does that mean?
Okay.
And don’t say it means you have heart failure, but it’s one of the BMP mean bmps or at least anytime. What happens
you guys? Two seconds. So BMP is a peptide or protein that is released anytime. The ventricles that stretch anytime the ventricles stretch or whatever stretch that BNP is released. So remember this is all this congestion. The heart’s not pumping and congesting the heart. It’s getting stretched because of all that extra volume and that is going to release. And so then you could see a BNP as high as, I mean I’ve seen in thousands insanely high bmps. Um, from the heart being overstretched, it really should be like a hundred or less. It should be pretty low. So be NP as a lab value that we also look at for heart failure. Good job you guys. All right, so we’re coming up on the anterior. What other questions can I answer for you guys about heart failure? What other things do you want me to talk about? Ask me anything. What about life in general with cardiac patients or any patients? I’ll answer anything at this point. We’ve got three minutes.
All right, well if there’s no other questions I’ll let you guys get going. But just remember, check out those lessons cause we talked about this, but the two big things is decreased perfusion forward, increased congestion backwards. Actually you say return trips to the hospital? What do you mean? Yeah, I’ll put, I’ll share my screen again and share that little chart here in just a second. So they do tend to come a lot. Um, but if we’re managing them well and appropriately, they should be managed in the clinic. These patients should not be coming back to the hospital every other day. Cause so what you’re saying, cause I’ve seen this is they’ll come, they’ll get a Lasik, they’ll get some lasix, they’ll feel better, then they’ll go home and I’ll come right back two days later they need to be managed well in a clinic.
Great.
They need to be made as well in clinic. So if you’re seeing that we need to follow up because we need to make sure their meds are right at home, that they’re taking what they need to take because they really shouldn’t be doing that. They really shouldn’t be doing that. So the cardiologist who follows up the cardiologist, so we need to follow up. We make sure they’re seeing their cardiologist. We need to make sure they have appointments, meaning to make sure they’re going. Sometimes they’re not going to their appointments because they don’t have a ride. So when you talked to the social worker or somebody to help them get rides, right, we need to figure out what’s happening that they’re not being managed appropriately because really they should be. Um, so if you guys had technical issues, make sure that y’all put that in the feedback or email support and we’ll, we’re going to follow up on kind of what happened there. Screen share is new, so I’m not going to say you have to use your desktop every time cause we want to try to figure out what’s going on. Um, but we need to know kind of who had issues and they can kind of dig into that for us. Okay. There’s not video on demand yet. I said it was coming. It’s not here yet. It’s not here yet.
So let me go. One thing, I talk so direction at heart. So we have right sided from the right side. It goes to the lungs. When left to get her from the Lens, it goes to the left. From the left it goes to the body. And then back to the right. So then we’re talking about things going backwards if we have congestion problems.
Okay.
So Dan is asking if a person is having a heart issue and just wants to be checked or they only have the option to go to a hospital. So this depends, right? If we’re having signs of a heart attack, he should go to the emergency room. There’s no question about that. Um, if they have heart failure and they’re having heart failure symptoms, they should have a plan with their cardiologist about what needs to happen as far as that goes. So it really just depends on the patient. Um, uh, I never want anybody to not be seen, right. If they’re feeling like they’re having a, you know, heart failure exacerbation issues, a lot of times they’ll come to the Er. Um, but if they’re really just, hey, I, I gained a couple of pounds, they’re calling their doctor about that. And so their cardiologist should be managing that, increasing my meds and doing things like that.
So we always want to just kind of figure out what’s going on. Sometimes what’s happening is they’re refusing to go to their cardiologist appointments or they’re not taking their meds appropriately. So this, this is where nurses get to be investigators a little bit. We get to dig and find out what’s really going on. We may not have them to not be seen. We always want them to do something right. Don’t just sit at home, call your, call your provider, call your cardiologist, maybe they’ll tell you to come to the Er. Um, but they should be seen.
Yeah.
So remember we talked weight gain is a possible symptom of heart failure, right? Because they have all this confession. So what we teach our heart failure patients is that they gain more than two pounds in a day or five pounds in a week. Then they should be calling her doctor because that’s too much. It’s you. The two pounds in a day or five pounds in a week is typically what we say is when they need to notify.
Yeah.
Secure. I’m glad. I’m glad that helps.
All right guys. Well good. I’m glad the I’m going to explanation helps. That’s what I’m here for. That’s what we do. Definitely jump back over to that heart failure lesson because we explain all of this again in more detail, and there’s actually three different lessons on heart failure that’ll help kind of expand and break this out for you too. I, and I think there’s a nurse, there’s an a, there’s a popular lesson, there’s a therapeutic management lesson, and there’s a nursing care lesson for heart failure. So breakout, flee. All right guys. Well that’s it. That’s all I’ve got for you today. Um, go out and be your absolute best selves today. And as always, happy nursing.

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