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Congestive heart failure

Congestive heart failure


outlines

Definition
Causes and pathophysiology
Types of heart failure
Compensatory mechanism of heart
failure
Clinical manifestations
Classification of heart failure
Diagnostic evaluation
Medical management
Nursing management

Congestive heart failure


Definition

Heart failure describes the clinical


syndrome that develops when the
heart cannot maintain an adequate
cardiac output. The heart pumps
blood inadequately, leading to
reduced
blood
flow,
back-up
(congestion) of blood in the veins
and lungs, and other changes that
may further weaken the heart.

Causes of congestive
heart failure
Coronary

artery disease
Heart attack
High blood pressure
Heart valves disorders
Inflammation

of
Heart
muscle
(myocarditis,
cardiomyopathy)

Causes of congestive heart


failure (cont)

Severe

lung disease ( pulmonary


hypertension)
Severe anemia
Overactive
thyroid
gland
(hyperthyroidism)
Underactive
thyroid
gland
(hypothyroidism)
Abnormal heart rhythms ( atrial
fibrillation)
Kidney failure

Congestive heart failure

Types
Left-sided

heart failure
There are two types of leftsided heart failure
Systolic dysfunction
Diastolic dysfunction
Right-sided heart failure

Congestive heart failure


Compensatory Mechanisms of heart failure

Renin-angiotensin-aldosterone
system
Sympathetic nervous system
Enlargement of the muscular
walls
of
the
ventricles
(ventricular hypertrophy).

Congestive heart failure


Clinical manifestations

Symptoms (back up of blood and


fluid)

Dyspnea
Orthopnea
Reduced
exercise
lethargy, fatigue
Nocturnal cough
Wheeze
Ankle swelling
Anorexia

tolerance,

Congestive heart failure


Clinical manifestations ( cont)
Signs

Cachexia and muscle wasting


Tachycardia
Pulsus alternans
Elevated jugular venous pressure
Crepitations or wheeze
Third heart sound
Oedema
Hepatomegaly (tender)
Ascites

Congestive heart failure


Classification of heart failure
New York Heart Association (NYHA) Functional
Classification

Class

of patients%

Symptoms

35%

No
symptoms
or
limitations in ordinary
physical activity

II

35%

Mild
symptoms
and
slight limitation during
ordinary activity

III

25%

Marked
limitation
in
activity
even
during
minimal
activity.
Comfortable only at rest

IV

5%

Severe
Experiences

limitation.
symptoms
even at rest

Congestive heart failure


Diagnostic evaluation

Patient history
Physical examination
Diagnostic studies
1. Electrocardiography (ejection
fraction)
2. Radionuclide
3.
magnetic resonance
4. computed tomography imaging
5. cardiac catheterization with
angiography
6. a biopsy of heart muscle is needed

Congestive heart failure

Treatment

Salt restriction
2. Exercises
3. Smoking and alcoholism
Body weight (daily weight)
5. Supportive stockings
1.

4.

lifestyle change

Congestive heart failure

Treatment (cont)

Drug management
Angiotensin-converting
enzyme
(ACE)
inhibitors
Angiotensin II receptor blockers
Beta-blockers
Other vasodilators ( nitroglycerin)
Cardiac glycosides (digoxin)
Aldosterone
receptor
blockers
(spironolactone)
Loop diuretics

Congestive heart failure

Treatment (cont)

Potassium-sparing diuretics
Thiazide and thiazide-like diuretics
Anticoagulants (heparine)
Opioids (morphine) to relieve anxiety
Positive
inotropic drugs (drugs
that make muscle contract more
forcefully) (dopamine)

Oxygen for pulmonary edema is required

Congestive heart failure

Treatment (cont)

Non pharmacological
(surgical intervention)

management

of

heart

failure

Coronary artery bypass grafting


( revascularization)
Percutaneous
coronary
intervention (Angioplasty)
Valve replacement
Biventricular pacemaker

Heart transplantation
Left ventricular assist device (LVAD)

Nursing care of patients with


congestive heart failure
Maintain the patient in high fowler's
position
Elevate extremities except when the
patient is in acute distress
Frequently monitor vital signs
Change position frequently
Monitor intake and output and daily
weight

Nursing care of patients with


congestive heart failure (cont)

Restrict fluids as ordered

Teach the patient and family and provide


emotional support (life style change)

Explain the side effect of diuretic


medications for additional
actions ( side
effects of diuretics include electrolyte
imbalance, symptomatic hypotension

Use aseptic procedures when caring for


invasive lines

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