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Evidence

Based Practice: Congestive Heart Failure


Evidence Based Practice: Congestive Heart Failure


Anthony Cline
University of South Florida
College of Nursing

Evidence Based Practice: Congestive Heart Failure


As medicine continues to advance, congestive heart failure is starting to become more


common in the elderly population. There are over 5 million people affected by heart failure
which costs over $39 billion being spent annually on prevention, treatment, and research. (Lien
& Alexis, 2012) Taking a look at the pathophysiology, risk factors and treatment allows better
understanding of how to identify, prevent or even slow the progression of congestive heart
failure and its symptoms.
To put it simply, congestive heart failure is form of heart disease that causes vesicular
congestion due to the heart failing to pump a sufficient amount of blood. The total output of the
heart or cardiac output can be calculated with a simple equation: heart rate multiplied by the
stroke volume. The human body needs to pump a certain amount of blood through the body, 5.5
liters for males and 5.0 liters for females every minute in order to maintain adequate tissue
perfusion in organs. (Wedro, 2013) When total cardiac output starts to drop, the body starts to
compensate by activating the renin-angiotensin system and sympathetic nervous system. With
these mechanisms now in action, the body will start to retain salt and water, which in turn
increases preload and afterload on heart. While this is not harmful if only short term, the longer
the heart has to deal with the high pressures it can cause extra strain which can eventually lead to
pulmonary congestion and heart failure. (Hollenberg & Heitner, 2012) The added workload put
on the heart can lead to ventricular hypertrophy and dilated cardiomyopathy which further
reduce the effectiveness of the heart, in turn reducing cardiac output.
Typically, a patient would present with other cardiac diagnoses that would lead to
mortality, but with the use of contemporary medicine patients are able to live longer and now are
more commonly developing heart failure. (Hollenberg & Heitner, 2012) While not all inclusive,
the most common risk factors that can lead to a higher chance of contracting heart failure include

Evidence Based Practice: Congestive Heart Failure


coronary artery disease, hypertension, diabetes and previous myocardial infarctions. With 70%
of heart failure cases resulting from coronary artery disease, more focus has been put on slowing
or even stopping factors that can exacerbate heart failure. Some of these improvements are faster
response to myocardial infarction and angina, and better management of factors that can cause
transient embolisms. When the left ventricle starts to reduce cardiac output, blood flow starts to
slow in the pulmonary vasculature and raises the pulmonic arterial pressure. This congestion if
untreated will start to cause pulmonary edema and will cause higher afterload on the right
ventricle. The most common cause of right sided heart failure is left sided heart failure. (Wedro,
2013)
Caring for a patient with congestive heart failure can depend on the severity of the
patients signs and symptoms. Patients present with symptoms of evectional dyspnea, orthopnea,
and other forms or shortness of breath due to the fluid buildup in the lungs caused by left sided
heart failure. During patient assessment, expected sign would be percussion dullness over the
lung bases found in left side failure, jugular vein distention, and peripheral edema which are
related to right sided heart failure or systemic vesicular congestion. (Lien & Alexis, 2012) As
progress is made in pharmacokinetics and pharmacodynamics we are starting to see more
accurate use of drugs that better treat the signs and symptoms of heart failure. Drugs like
Angiotensin-Converting Enzymes (ACE) inhibitors are used to suppress the synthesis of
angiotensin II from angiotensin I in the renin-angiotensin system. Slowing the renin-angiotensin
system will decrease the retention of salt and water thus reducing edema and workload on the
heart. (Lien & Alexis, 2012) Other symptoms like orthopnea can be relived temporarily with the
stacking of pillows behind a patients back or by raising the head of bed to semi fowler or

Evidence Based Practice: Congestive Heart Failure


fowlers position. This will allow the pulmonary congestion to clear, and the patient will have an
easier time breathing. (Lien & Alexis, 2012)
Early detection of cardiomyopathy and prevention of risk factors such as hypertension
and myocardial infarctions will contribute to a lower chance of developing congestive heart
failure. As medicine advances, more information is being discovered that can almost stop the
progression of congestive heart failure. Currently, the only real way to stop heart failure is by
using preventative medicine and early detection. (Hollenberg & Heitner, 2012) Total health care
costs will decrease and overall patient health will increase as more emphasis is put on
preventative medicine.

Evidence Based Practice: Congestive Heart Failure


References

Hollenberg, S., & Heitner, S. (2012). Cardiology in family practice. (2 ed., pp. 91-111). New
York: Humana Press. DOI: 10.1007/978-1-61779-385-1_5
Lien, S., & Alexis, J. (2012). Manual of outpatient cardiology. (1 ed., p. 281). London: Springer.
DOI: 10.1007/978-0-85729-944-4_11
Wedro, B. (2013, October 16). Congestive heart failure (chf). Retrieved from
http://www.medicinenet.com/congestive_heart_failure_chf_overview/article.htm

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