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PCCN Congestive Heart Failure

Heart failure, sometimes known as congestive heart failure, occurs when your heart muscle doesn't pump blood as well as it should. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently. In heart failure, the main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. In some cases of heart failure, your heart muscle may become damaged and weakened, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body. Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body.

Signs and Symptoms

• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Fatigue and weakness
• Swelling (edema) in your legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Increased need to urinate at night
• Swelling of your abdomen (ascites)
• Very rapid weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating or decreased alertness
• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain if your heart failure is caused by a heart attack

Causes

Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:

• Coronary artery disease and heart attack
• Hypertension
• Faulty Heart Valves
• Cardiomyopathy
• Myocarditis
• Arrhythmias

Risk Factors

• HTN, CAD, MI, DM
• Sleep Apnea
• Congenital Heart Defects
• Valvular Heart Disease
• Alcohol and Tobacco Use
• Obesity, Irregular Heartbeats

Complications

• Kidney or Liver Damage
• Heart Valve or Rhythm Problems

Treatment

Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger. Treatment may help you live longer and reduce your chance of dying suddenly.

• ACE Inhibitors 
• Angiotensin II Receptor Blockers
• Beta Blockers
• Diuretics, Lanoxin
• Inotropes

 

PCCN Valvular Heart Disease

In heart valve disease, one or more of the valves in your heart doesn't work properly. Your heart has four valves that keep blood flowing in the correct direction. In some cases, one or more of the valves don't open or close properly. This can cause the blood flow through your heart to your body to be disrupted. Your heart valve disease treatment depends on the heart valve affected and the type and severity of the valve disease. Sometimes heart valve disease requires surgery to repair or replace the heart valve.

Signs and Symptoms

Some people with heart valve disease might not experience symptoms for many years. Signs and symptoms of heart valve disease may include:

• Abnormal sound (heart murmur) when a doctor is listening to the heart beating with a stethoscope
• Fatigue
• Shortness of breath, particularly when you have been very active or when you lie down
• Swelling of your ankles and feet
• Dizziness
• Fainting
• Irregular heartbeat

Causes

Your heart has four valves that keep blood flowing in the correct direction. These valves include the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps (leaflets or cusps) that open and close once during each heartbeat. Sometimes, the valves don't open or close properly, disrupting the blood flow through your heart to your body. Heart valve disease may be present at birth (congenital). It can also occur in adults due to many causes and conditions, such as infections and other heart conditions. Heart valve problems may include: 

• Regurgitation
• Stenosis
• Atresia

Risk Factors

Several factors can increase your risk of heart valve disease, including: Older age

• History of certain infections that can affect the heart
• History of certain forms of heart disease or heart attack
• High blood pressure, high cholesterol, diabetes and other heart disease risk factors
• Heart conditions present at birth (congenital heart disease)

Complications

Heart valve disease can cause many complications, including:

• Heart failure
• Stroke
• Blood clots
• Heart rhythm abnormalities
• Death

Treatment

Heart valve disease treatment depends on how severe your condition is, if you're experiencing signs and symptoms, and if your condition is getting worse.  

PCCN Peripheral Artery Disease

Vascular Disease includes any condition that affects your circulatory system, such as peripheral artery disease. This ranges from diseases of your arteries, veins and lymph vessels to blood disorders that affect circulation. Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop peripheral artery disease (PAD), your extremities — usually your legs — don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (claudication). Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs.

Signs and Symptoms

While many people with peripheral artery disease have mild or no symptoms, some people have leg pain when walking (claudication). Claudication symptoms include muscle pain or cramping in your legs or arms that's triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location. The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity. Peripheral artery disease signs and symptoms include:

• Painful cramping in one or both of your hips, thighs or calf muscles after certain activities, such as walking or climbing stairs (claudication)
• Leg numbness or weakness
• Coldness in your lower leg or foot, especially when compared with the other side
• Sores on your toes, feet or legs that won't heal
• A change in the color of your legs
• Hair loss or slower hair growth on your feet and legs
• Slower growth of your toenails
• Shiny skin on your legs
• No pulse or a weak pulse in your legs or feet
• Erectile dysfunction in men

Causes

Peripheral artery disease is often caused by atherosclerosis. In atherosclerosis, fatty deposits (plaques) build up on your artery walls and reduce blood flow. Although discussions of atherosclerosis usually focus on the heart, the disease can and usually does affect arteries throughout your body. When it occurs in the arteries supplying blood to your limbs, it causes peripheral artery disease. Less commonly, the cause of peripheral artery disease may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles, or radiation exposure.

Risk Factors

Factors that increase your risk of developing peripheral artery disease include:

• Smoking
• Diabetes
• Obesity (a body mass index over 30)
• High blood pressure
• High cholesterol
• Increasing age, especially after reaching 50 years of age
• A family history of peripheral artery disease, heart disease or stroke
• High levels of homocysteine, a protein component that helps build and maintain tissue

Complications

If your peripheral artery disease is caused by a buildup of plaques in your blood vessels (atherosclerosis), you're also at risk of developing:

• Critical limb ischemia. This condition begins as open sores that don't heal, an injury, or an infection of your feet or legs. Critical limb ischemia occurs when such injuries or infections progress and cause tissue death (gangrene), sometimes requiring amputation of the affected limb.
• Stroke and heart attack. The atherosclerosis that causes the signs and symptoms of peripheral artery disease isn't limited to your legs. Fat deposits also build up in arteries supplying blood to your heart and brain.

Treatment

Treatment for peripheral artery disease has two major goals: Manage symptoms, such as leg pain, so that you can resume physical activities

• Stop the progression of atherosclerosis throughout your body to reduce your risk of heart attack and stroke
• You may be able to accomplish these goals with lifestyle changes, especially early in the course of peripheral artery disease. If you smoke, quitting is the single most important thing you can do to reduce your risk of complications.

If you have signs or symptoms of peripheral artery disease, you likely will need additional medical treatment. Your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.  

PCCN Dilated Cardiomyopathy

Dilated cardiomyopathy is a disease of the heart muscle, usually starting in your heart's main pumping chamber (left ventricle). The ventricle stretches and thins (dilates) and can't pump blood as well as a healthy heart can. The term "cardiomyopathy" is a general term that refers to the abnormality of the heart muscle itself. Dilated cardiomyopathy might not cause symptoms, but for some people it can be life-threatening. A common cause of heart failure — the heart's inability to supply the body with enough blood — dilated cardiomyopathy can also contribute to irregular heartbeats (arrhythmias), blood clots or sudden death. The condition affects people of all ages, including infants and children, but is most common in men ages 20 to 50.

Signs and Symptoms

If you have dilated cardiomyopathy, you're likely to have signs and symptoms of heart failure or arrhythmias caused by your condition. Signs and symptoms include:

• Fatigue
• Shortness of breath (dyspnea) when you're active or lying down
• Reduced ability to exercise
• Swelling (edema) in your legs, ankles and feet
• Swelling of your abdomen due to fluid buildup (ascites)
• Chest pain
• Extra or unusual sounds heard when your heart beats (heart murmurs)

Causes

The cause of dilated cardiomyopathy often can't be determined. However, numerous factors can cause the left ventricle to dilate and weaken, including:

• Diabetes
• Obesity
• High blood pressure (hypertension)
• Alcohol abuse
• Certain cancer medications
• Cocaine use and abuse
• Infections, including those caused by bacteria, viruses, fungi and parasites
• Exposure to toxins, such as lead, mercury and cobalt
• Arrhythmias
• Complications of late-stage pregnancy

Risk Factors

Dilated cardiomyopathy most commonly occurs in men, ages 20 to 50. But it can also occur in women. Other risk factors include:

• Damage to the heart muscle from a heart attack
• Family history of dilated cardiomyopathy
• Inflammation of heart muscle from immune system disorders, such as lupus
• Neuromuscular disorders, such as muscular dystrophy

Complications

• Heart Failure
• Heart Valve Regurgitation
• Edema
• Arrhythmias
• Blood Clots
• Sudden Death

Treatment

If you have dilated cardiomyopathy, your doctor might recommend treatment for the underlying cause, if known. Treatment may also be suggested in order to improve blood flow and prevent further damage to your heart.  

PCCN Cardiomyopathy

Cardiomyopathy (kahr-dee-o-my-OP-uh-thee) is a disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body. Cardiomyopathy can lead to heart failure. The main types of cardiomyopathy include dilated, hypertrophic and restrictive cardiomyopathy. Treatment — which might include medications, surgically implanted devices or, in severe cases, a heart transplant — depends on which type of cardiomyopathy you have and how serious it is.

Signs and Symptoms

There might be no signs or symptoms in the early stages of cardiomyopathy. But as the condition advances, signs and symptoms usually appear, including:

• Breathlessness with exertion or even at rest
• Swelling of the legs, ankles and feet
• Bloating of the abdomen due to fluid buildup
• Cough while lying down
• Fatigue
• Heartbeats that feel rapid, pounding or fluttering
• Chest discomfort or pressure
• Dizziness, lightheadedness and fainting

Causes

Often the cause of the cardiomyopathy is unknown. In some people, however, it's the result of another condition (acquired) or passed on from a parent (inherited).

• Contributing factors for acquired cardiomyopathy include:
• Long-term high blood pressure
• Heart tissue damage from a heart attack
• Chronic rapid heart rate
• Heart valve problems
• Metabolic disorders, such as obesity, thyroid disease or diabetes
• Nutritional deficiencies of essential vitamins or minerals, such as thiamin (vitamin B-1)
• Pregnancy complications
• Drinking too much alcohol over many years
• Use of cocaine, amphetamines or anabolic steroids
• Use of some chemotherapy drugs and radiation to treat cancer
• Certain infections, especially those that inflame the heart
• Iron buildup in your heart muscle (hemochromatosis)
• A condition that causes inflammation and can cause lumps of cells to grow in the heart and other organs (sarcoidosis)
• A disorder that causes the buildup of abnormal proteins (amyloidosis)
• Connective tissue disorders

Complications

• Heart Failure
• Blood Clots
• Valve Problems
• Sudden Cardiac Death

Treatment

The goals of cardiomyopathy treatment are to manage your signs and symptoms, prevent your condition from worsening, and reduce your risk of complications. Treatment varies by which type of cardiomyopathy you have.  

PCCN Myocarditis

Myocarditis is an inflammation of the heart muscle (myocardium). Myocarditis can affect your heart muscle and your heart's electrical system, reducing your heart's ability to pump and causing rapid or abnormal heart rhythms (arrhythmias). A viral infection usually causes myocarditis, but it can result from a reaction to a drug or be part of a more general inflammatory condition. Signs and symptoms include chest pain, fatigue, shortness of breath, and arrhythmias. Severe myocarditis weakens your heart so that the rest of your body doesn't get enough blood. Clots can form in your heart, leading to a stroke or heart attack.

Signs and Symptoms

If you have a mild case of myocarditis or are in the early stages, you might have no symptoms or mild ones, such as chest pain or shortness of breath. In serious cases, the signs and symptoms of myocarditis vary, depending on the cause of the disease. Common myocarditis signs and symptoms include:

• Chest pain
• Rapid or abnormal heart rhythms (arrhythmias)
• Shortness of breath, at rest or during physical activity
• Fluid retention with swelling of your legs, ankles and feet
• Fatigue
• Other signs and symptoms of a viral infection, such as a headache, body aches, joint pain, fever, a sore throat or diarrhea

Causes

Often, the cause of myocarditis isn't identified. Potential causes are many, but the likelihood of developing myocarditis is rare. Potential causes include:

• Viruses
• Parasites
• Bacteria
• Fungi
• Chemicals or Raditation
• Illicit Drugs

Complications

Severe myocarditis can permanently damage your heart muscle, possibly causing:

• Heart Failure
• Heart Attack or Stroke
• Arrhythmias
• Sudden Cardiac Death

Treatment

In many cases, myocarditis improves on its own or with treatment, leading to a complete recovery. Myocarditis treatment focuses on the cause and the symptoms, such as heart failure. In mild cases, persons should avoid competitive sports for at least three to six months. Rest and medication to help your body fight off the infection causing myocarditis might be all you need. Although antiviral medications are available, they haven't proved effective in the treatment of most cases of myocarditis. Certain rare types of viral myocarditis, such as giant cell and eosinophilic myocarditis, respond to corticosteroids or other medications to suppress your immune system. In some cases caused by chronic illnesses, such as lupus, treatment is directed at the underlying disease.  

PCCN Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle (myocardium) becomes abnormally thick (hypertrophied). The thickened heart muscle can make it harder for the heart to pump blood. Hypertrophic cardiomyopathy often goes undiagnosed because many people with the disease have few, if any, symptoms and can lead normal lives with no significant problems. However, in a small number of people with HCM, the thickened heart muscle can cause shortness of breath, chest pain or problems in the heart's electrical system, resulting in life-threatening abnormal heart rhythms (arrhythmias).

Signs and Symptoms

Signs and symptoms of hypertrophic cardiomyopathy may include one or more of the following:

• Shortness of breath, especially during exercise
• Chest pain, especially during exercise
• Fainting, especially during or just after exercise or exertion
• Sensation of rapid, fluttering or pounding heartbeats (palpitations)
• Heart murmur, which a doctor might detect while listening to your heart

Causes

Hypertrophic cardiomyopathy is usually caused by abnormal genes (gene mutations) that cause the heart muscle to grow abnormally thick. People with hypertrophic cardiomyopathy also have an abnormal arrangement of heart muscle cells (myofiber disarray). This disarray can contribute to arrhythmia in some people. The severity of hypertrophic cardiomyopathy varies widely. Most people with hypertrophic cardiomyopathy have a form of the disease in which the wall (septum) between the two bottom chambers of the heart (ventricles) becomes enlarged and restricts blood flow out of the heart (obstructive hypertrophic cardiomyopathy). Sometimes hypertrophic cardiomyopathy occurs without significant blocking of blood flow (nonobstructive hypertrophic cardiomyopathy). However, the heart's main pumping chamber (left ventricle) may become stiff, reducing the amount of blood the ventricle can hold and the amount pumped out to the body with each heartbeat.

Risk Factors

Hypertrophic cardiomyopathy is usually inherited. There's a 50 percent chance that the children of a parent with hypertrophic cardiomyopathy will inherit the genetic mutation for the disease. First-degree relatives — parents, children or siblings — of a person with hypertrophic cardiomyopathy should ask their doctors about screening for the disease.

Complications

Many people with hypertrophic cardiomyopathy (HCM) don't experience significant health problems. But some people experience complications, including:

• Atrial Fibrillation
• Obstructive Blood Flow
• Heart Failure
• Mitral Valve Problems
• Sudden Cardiac Death

Treatment

The goal of hypertrophic cardiomyopathy treatment is to relieve symptoms and prevent sudden cardiac death in people at high risk. Specific treatment varies depending on the severity of your symptoms. The doctor will discuss with you the most appropriate treatment for your condition.  

PCCN Cor Pulmonale 

Cor pulmonale is a condition that causes the right side of the heart to fail. Long-term high blood pressure in the arteries of the lung and right ventricle of the heart can lead to Cor Pulmonale.

Causes

High blood pressure in the arteries of the lungs is called pulmonary hypertension. It is the most common cause of cor pulmonale.  In people who have pulmonary hypertension, changes in the small blood vessels inside the lungs can lead to increased blood pressure in the right side of the heart. This makes it harder for the heart to pump blood to the lungs. If this high pressure continues, it puts a strain on the right side of the heart. That strain can cause cor pulmonale. Lung conditions that cause a low blood oxygen level in the blood over a long time can also lead to cor pulmonale.  Some of these are:

• Autoimmune diseases that damage the lungs, such as scleroderma
• Chronic obstructive pulmonary disease (COPD)
• Chronic blood clots in the lungs
• Cystic fibrosis (CF)
• Scarring of the lung tissue (interstitial lung disease)
• Severe curving of the upper part of the spine (kyphoscoliosis)
• Obstructive sleep apnea, which causes stops in breathing because of airway inflammation
• Idiopathic (no specific cause) tightening (constriction) of the blood vessels of the lungs

Signs and Symptoms

Shortness of breath or lightheadedness during activity is often the first symptom of cor pulmonale. You may also have a fast heartbeat and feel like your heart is pounding. Over time, symptoms occur with lighter activity or even while you are at rest.  Symptoms you may have are:

• Fainting spells during activity
• Chest discomfort, usually in the front of the chest
• Chest pain
• Swelling of the feet or ankles
• Symptoms of lung disorders, such as wheezing or coughing or phlegm production
• Bluish lips and fingers (cyanosis)

Treatment

The goal of treatment is to control symptoms. It is important to treat medical problems that cause pulmonary hypertension, because they can lead to cor pulmonale. Many treatment options are available. In general, the cause of your cor pulmonale will determine which treatment you receive. If your provider prescribes medicines, you may take them by mouth (oral), receive them through a vein (intravenous or IV), or breathe them in (inhaled). You will be closely monitored during treatment to watch for side effects and to see how well the medicine works for you. Never stop taking your medicines without first talking to your doctor. Other treatments may include:

• Blood thinners to reduce the risk of blood clots
• Medicines to manage heart failure symptoms
• Oxygen therapy at home
• A lung or heart-lung transplant, if medicine does not work

 

PCCN Anaphylactic Shock

Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you're allergic to, such as peanuts or bee stings. Anaphylaxis causes your immune system to release a flood of chemicals that can cause you to go into shock — your blood pressure drops suddenly and your airways narrow, blocking breathing. Signs and symptoms include a rapid, weak pulse; a skin rash; and nausea and vomiting. Common triggers include certain foods, some medications, insect venom and latex. Anaphylaxis requires an injection of epinephrine and a follow-up trip to an emergency room. If you don't have epinephrine, you need to go to an emergency room immediately. If anaphylaxis isn't treated right away, it can be fatal.

Signs And Symptoms

Anaphylaxis symptoms usually occur within minutes of exposure to an allergen. Sometimes, however, it can occur a half-hour or longer after exposure. Signs and symptoms include:

• Skin reactions, including hives and itching and flushed or pale skin
• Low blood pressure (hypotension)
• Constriction of your airways and a swollen tongue or throat, which can cause wheezing and trouble breathing
• A weak and rapid pulse
• Nausea or vomiting

Causes

The most common anaphylaxis triggers in children are food allergies, such as to peanuts, and tree nuts, fish, shellfish and milk. Besides allergy to peanuts, nuts, fish and shellfish, anaphylaxis triggers in adults include:

• Certain medications, including antibiotics, aspirin and other over-the-counter pain relievers, and the intravenous (IV) contrast used in some imaging tests
• Stings from bees, yellow jackets, wasps, hornets and fire ants
• Latex

Treatment

During an anaphylactic attack, you might receive cardiopulmonary resuscitation (CPR) if you stop breathing or your heart stops beating. You might also be given medications, including:

• Epinephrine (adrenaline) to reduce your body's allergic response
• Oxygen, to help you breathe
• Intravenous (IV) antihistamines and cortisone to reduce inflammation of your air passages and improve breathing
• A beta-agonist (such as albuterol) to relieve breathing symptoms

 

PCCN Hypovolemic Shock

Hypovolemic shock is a life-threatening condition that results when you lose more than 20 percent (one-fifth) of your body’s blood or fluid supply. This severe fluid loss makes it impossible for the heart to pump a sufficient amount of blood to your body. Hypovolemic shock can lead to organ failure. This condition requires immediate emergency medical attention. Hypovolemic shock is the most common type of shock, with very young children and older adults being the most susceptible.

Causes

Hypovolemic shock results from significant and sudden blood or fluid losses within your body. Blood loss of this magnitude can occur because of:

• bleeding from serious cuts or wounds
• bleeding from blunt traumatic injuries due to accidents 
• internal bleeding from abdominal organs or ruptured ectopic pregnancy
• bleeding from the digestive tract
• significant vaginal bleeding
• Endometriosis

In addition to actual blood loss, the loss of body fluids can cause a decrease in blood volume. This can occur in cases of:

• excessive or prolonged diarrhea
• severe burns
• protracted and excessive vomiting
• excessive sweating

Blood carries oxygen and other essential substances to your organs and tissues. When heavy bleeding occurs, there is not enough blood in circulation for the heart to be an effective pump. Once your body loses these substances faster than it can replace them, organs in your body begin to shut down and the symptoms of shock occur. Blood pressure plummets, which can be life-threatening.

Signs and Symptoms 

The symptoms of hypovolemic shock vary with the severity of the fluid or blood loss. However, all symptoms of shock are life-threatening and need emergency medical treatment. Internal bleeding symptoms may be hard to recognize until the symptoms of shock appear, but external bleeding will be visible. Symptoms of hemorrhagic shock may not appear immediately. Older adults may not experience these symptoms until the shock progresses significantly.  Some symptoms are more urgent than others. Mild symptoms can include:

• headache
• fatigue
• nausea
• profuse sweating
• dizziness

Severe symptoms, which must be taken seriously and warrant emergency medical attention, include:

• cold or clammy skin
• pale skin
• rapid, shallow breathing
• rapid heart rate
• little or no urine output
• confusion
• weakness
• weak pulse
• blue lips and fingernails
• lightheadedness
• loss of consciousness

Complications

A lack of blood and fluid in your body can lead to the following complications:

• damage to organs such as your kidney or brain
• gangrene of the arms or legs
• heart attack

The effects of hypovolemic shock depend on the speed at which you’re losing blood or fluids and the amount of blood or fluids you are losing. The extent of your injuries can also determine your chances for survival. Chronic medical conditions such as diabetes, previous stroke, heart, lung, or kidney disease, or taking blood thinners like Coumadin or aspirin can increase the likelihood that you’ll experience more complications from hypovolemic shock.

Treatment

Once at a hospital, a person suspected of having hypovolemic shock will receive fluids or blood products via an intravenous line, to replenish the blood lost and improve circulation. Treatment revolves around controlling loss of fluid and blood, replacing what’s been lost, and stabilizing damage that both caused and resulted from the hypovolemic shock. This will also include treating the injury or illness that caused the shock, if possible. These include:

• blood plasma transfusion
• platelet transfusion
• red blood cell transfusion
• intravenous crystalloids 

Doctors may also administer medications that increase the heart’s pumping strength to improve circulation and get blood where it’s needed. These include:

• dopamine
• dobutamine
• epinephrine
• norepinephrine 

Antibiotics may be administered to prevent septic shock and bacterial infections. Close cardiac monitoring will determine the effectiveness of the treatment you receive.