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Defintion
HF, often referred to as congestive heart failure (CHF), is the inability of the heart to pump
sufficient blood to meet the needs of the tissues for oxygen and nutrients
The term HF is preferred and indicates myocardial heart disease in which there is a problem
with contraction of the heart (systolic dysfunction) or filling of the heart (diastolic dysfunction)
and which may or may not cause pulmonary or systemic congestion.
Anatomy and Physiology of the Heart
The basic function of the heart is to pump blood.
The hearts ability to pump is measured by cardiac output (CO), the amount of blood pumped in
1 minute.
CO is determined by measuring the heart rate (HR) and multiplying it by the stroke volume (SV),
which is the amount of blood pumped out of the ventricle with each contraction. CO usually is
calculated using the equation CO = HR SV.
Preload is the amount of myocardial stretch just before systole caused by the pressure created by the
volume of blood within the ventricle. Like a rubber band, the ventricular muscle fibers need to be
stretched (by the blood) to produce optimal ejection of blood. Too little or too much muscle fiber
stretch decreases the volume of blood ejected.
Another factor that determines preload is ventricular compliance, which is the elasticity or amount of
give when blood enters the ventricle.
Afterload refers to the amount of resistance to the ejection of blood from the ventricle. To eject blood,
the ventricle must overcome this resistance. Afterload is inversely related to SV. The major factors that
determine afterload are the diameter and distensibility of the great vessels (aorta and pulmonary
artery) and the openingand competence of the semilunar valves (pulmonic and aortic valves).
Contractility, which refers to the force of contraction, is related to the number and status of myocardial
cells. Catecholamines, released by sympathetic stimulation such as exercise or from administration of
positive inotropic medications, can increase contractility and stroke volume.
Etiology
coronary artery disease,
cardiomyopathy,
Pulmonary hypertension,
valvular disorders.
*Hepatomegaly
Ascites
*Weakness
*Anorexia
providing general
Diuretics
medications used to increase the rate of urine production and the removal of excess
extracellular fluid from the body
Of the types of diuretics prescribed for patients with edema from HF, three are most common:
thiazide, loop, and potassium-sparing diuretics
Digitalis
The most commonly prescribed form of digitalis for patients with HF is digoxin (Lanoxin).
The medication increases the force of myocardial contraction and slows conduction through the
AV node.
It improves contractility, increasing left ventricular output.
The medication also enhances diuresis, which removes fluid and relieves edema.
The effect of a given dose of medication depends on the state of the myocardium, electrolyte
and fluid balance, and renal and hepatic function
Calcium Channel Blockers
First-generation calcium channel blockers, such as verapamil (Calan, Isoptin, Verelan), nifedipine
(Adalat, Procardia), and diltiazem (Cardizem, Dilacor, Tiazac), are contraindicated in patients
with systolic dysfunction, although they may be used in patients with diastolic dysfunction.
Amlodipine (Norvasc) and felodipine (Plendil), dihydropyridine calcium channel blockers, cause
vasodilation, reducing systemic vascular resistance.
They may be used to improve symptoms especially in patients with nonischemic
cardiomyopathy, although they have no effect on mortality.
Heart Failure: Nursing Intervention
Promoting Activity Tolerance
* Minimizing Powerless
Reducing fatigue
* Controlling Anxiety