Short-term treatment of CHF unresponsive to digoxin, diuretics, and vasodilators.
Increases myocardial contractility. Decreases preload and afterload by a direct dilating effect on vascular smooth muscle. Therapeutic Effects: Increased cardiac output (inotropic effect).
Adverse Reactions/Side Effects
Resp: dyspnea. CV: arrhythmias, hypotension. GI: diarrhea, hepatotoxicity, nausea, vomiting. F and E: hypokalemia. Hemat: thrombocytopenia. Misc: tachyphylaxis, fever, hypersensitivity reactions.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.
Assess signs and symptoms of CHF (dyspnea, rales/crackles, peripheral edema, jugular venous distention, exercise intolerance) to help document whether drug therapy is effective in reducing these symptoms. Be alert for a sudden increase in symptoms that might indicate a rapid decrease in drug effectiveness (tachyphylaxis).
Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.
Report any muscle weakness, aches, or cramps that might indicate low potassium levels (hypokalemia).
Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.
Monitor and report signs of thrombocytopenia, including bruising, nose bleeds, and bleeding gums.
Design and implement aerobic exercise and endurance training programs to improve myocardial pumping ability and reduce symptoms of CHF.
Use caution during aerobic exercise and endurance conditioning because of an increased risk of cardiac arrhythmias. Terminate exercise if patient exhibits untoward symptoms (chest pain, shortness of breath, etc.) or displays other criteria for exercise termination (See Appendix L).
Remind patients to take medication as directed to control CHF even if they are asymptomatic.
Instruct patients to weigh themselves every day and to call their physician if they gain 3 lb or more in
1 day or more than 5 lb in 1 week. Sudden weight gain may indicate fluid buildup due to worsening heart failure.
Counsel patients about additional interventions to help control cardiac dysfunction, including regular exercise, weight loss, sodium restriction, stress reduction, moderation of alcohol consumption, and smoking cessation.
Advise patient about the likelihood of GI reactions, including nausea, vomiting, and diarrhea. Instruct patient to report severe or prolonged GI problems or signs of liver toxicity (yellow skin or eyes, abdominal pain, severe nausea and vomiting, fever, sore throat, malaise, weakness, facial edema).