Heart failure

DefinitionHeart failure, also called "congestive heart

failure," is a disorder where the heart loses its ability to pump blood efficiently.

Heart failure is almost always a chronic, long-term condition that is managed with medications and lifestyle changes.

Introduction Heart failure occurs when the heart is

unable to pump enough blood through the body. This condition usually occurs over time and is the result of some form of heart disease.

The condition is slightly more common among men than women.

Pathophysiology Heart failure is a clinical syndrome that

occurs when the heart does not function adequately as a pump and fails to pump enough blood to meet the body's metabolic needs.

Congestion (the buildup of fluid).intravascular and interstitial volume

overload and decreased tissue perfusion.

PathophysiologySystolic heart failure occurs when the

heart's ability to contract decreases.Left ventricular systolic heart failure cause

fluid congestion in the lungs, a condition known as pulmonary edema.

Right ventricular heart failure causes hepatomegaly and peripheral edema.

PathophysiologyDiastolic heart failure occurs when the

heart has a problem relaxing. This form of heart failure may lead to fluid accumulation in the pulmonary and peripheral vasculature

Heart failure almost never occurs at the same time as an acute myocardial infarction

The Onset of Heart Failure Is an Indicator of One or More of the Following Problems

Acute myocardial infarction Hypertension Fluid overload Intracranial injury Dysrhythmias

The Onset of Heart Failure Is an Indicator of One or More of the Following Problems

Valvular heart disease Hyperthyroidism Cardiomyopathy Fever Adult respiratory distress syndrome

Heart Failure Can Also Occur in Conjunction With Pneumothorax Oxygen toxicity syndrome Intracranial tumors Uremic pneumonia Drugs (methotrexate, busulfan,

hexamethonium, nitrofurantoin)

Nursing Assessment Symptoms Severe dyspnea (especially on exertion) Orthopnea Weakness & fatigue Paroxysmal nocturnal dyspnea Weight gain

Nursing AssessmentSwelling of extremities Palpitations Reduced exercise capacity Nocturia Gastrointestinal symptoms (nausea,

bloating, constipation, anorexia)

Nursing AssessmentRecord the patient's medical history Diabetes Thyroid disease Cardiomyopathy Collagen vascular disease

Nursing AssessmentAssessed for a history of Previously compromised heart (chronic

heart failure) Hypertension Myocardial infarction Medications Allergies

Nursing AssessmentPerform a physical examination Decreased pulse pressure Diaphoresis Tachycardia Edema (extremities, anasarca, ascites) Tachypnea

Nursing AssessmentPulmonary rales or wheezes Hepatomegaly Distended neck veins Increased venous pressure Third heart sound (gallop) Pulsus alternans Hepatojugular reflux Pleural effusion (hydrothorax)

Diagnostic Procedures

Diagnostic ProceduresChest x-ray Elevated BUN and creatinine levels Hypokalemia (may be present if the patient

is taking thiazides or loop diuretics) Abnormal liver function test values

Diagnostic ProceduresProteinuria and high urine specific gravity Hyponatremia (evident in cases of severe

heart failure) Anemia Impaired gas exchange (anxiety and fear)

Nursing Interventions Airway, breathing, and circulation Provide supplemental oxygen Anticipate the need for endotracheal

intubation Suction as needed Provide humidified oxygen Elevate the head of the bed into a semi- to

high fowler's position

Nursing InterventionsCardiac rhythm and vital signs,

including heart rate, pulse oximetry, blood pressure, lung sounds, and respiratory rate. Monitor the patient's level of consciousness, intake and output, and skin perfusion.

Establish IV access.Laboratory and ABG.Chest x-ray.

Pharmacologic Agent Diuretics (furosemide) decreases

preload secondary to reduction in blood volume =hypokalemia, hyponatremia, need for Foley catheterization

Pharmacologic Agent Morphine venous and arterial vasodilation

by decreasing preload and afterload, reducing anxiety and resulting heart stimulation, and myocardial workload.

Avoid for patients: dyspnea, decreased level consciousness, hypercarbia, or inadequate ventilation.

Pharmacologic AgentVasodilators Vasodilators (nitroglycerin, isosorbide) Arteriolar dilators (hydralazine, minoxidil) Combined dilators (nitroprusside) ACE inhibitors (captopril, enalapril)

Pharmacologic AgentPositive Inotropic agents Sympathomimetics (dopamine,

dobutamine) Digitalis glycosides Phosphodiesterase inhibitors (amrinone,

milrinone) Decrease myocardial workload, improve

oxygen delivery to tissues, and increase contractility and cardiac output

Pharmacologic AgentBronchodilators Monitor the patient for pulmonary wheezing,

as well as side effects such as nausea, vomiting, and tachyarrhythmias

Prepared to initiate advanced cardiac life

Patient EducationA patient who is experiencing heart failure,

with or without pulmonary edema, will be fearful and filled with anxiety. Therefore, it is critical to maintain a calm and efficient manner throughout the assessment, diagnosis, and treatment of the patient.

Patient EducationOnce the patient is out of immediate

danger, always provide a thorough explanation of what is happening in clear, straightforward terms. And whenever possible, educate family members and significant others who are present.

Conclusion The proper identification and management

of heart failure requires a thorough understanding of the pathophysiology of the disease and in-depth knowledge of appropriate diagnostics, interventions, and patient management techniques.

ConclusionWhen an understanding of all these

elements is achieved, better care can be given to the patient experiencing heart failure, and mortality and morbidity can be reduced.