5. What other etiologies or precipitation factors are associated with heart failure?

Common Causes of Heart Failure

Coronary Heart Disease
CHD is a condition in which a waxy substance called plaque builds up inside the coronary arteries. These
arteries supply oxygen-rich blood to your heart muscle.
Plaque narrows the arteries and reduces blood flow to your heart muscle. The buildup of plaque also
makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely
block blood flow.
High Blood Pressure
Blood pressure is the force of blood pushing against the walls of the arteries. If this pressure rises and
stays high over time, it can weaken your heart and lead to plaque buildup.
Blood pressure is considered high if it stays at or above 140/90 mmHg over time. (The mmHg is
millimeters of mercurythe units used to measure blood pressure.) If you have diabetes or chronic
kidney disease, high blood pressure is defined as 130/80 mmHg or higher.
Diabetes
Diabetes is a disease in which the body's blood glucose (sugar) level is too high. The body normally
breaks down food into glucose and then carries it to cells throughout the body. The cells use a hormone
called insulin to turn the glucose into energy.
In diabetes, the body doesn't make enough insulin or doesn't use its insulin properly. Over time, high
blood sugar levels can damage and weaken the heart muscle and the blood vessels around the heart,
leading to heart failure.
Other Causes
Other diseases and conditions also can lead to heart failure, such as:
A. Cardiomyopathy or heart muscle disease. Cardiomyopathy may be present at birth or caused by
injury or infection.
B. Heart valve disease. Problems with the heart valves may be present at birth or caused by
infection, heart attack, or damage from heart disease.
C. Arrhythmias or irregular heartbeats. These heart problems may be present at birth or caused by
heart disease or heart defects.
D. Congenital heart defects. These problems with the heart's structure are present at birth.
E. Myocarditis is inflammation of the heart muscle. It is usually caused by a viral infection and can
sometimes lead to heart failure.
Other factors also can injure the heart muscle and lead to heart failure.
Examples include:
1.
2.
3.
4.

Treatments for cancer, such as radiation and chemotherapy

Thyroid disorders (having either too much or too little thyroid hormone in the body)
Alcohol abuse or cocaine and other illegal drug use
HIV/AIDS

5. Too much vitamin E

12. What nursing diagnosis apply in this case?
NURSING DIAGNOSIS
1. Decreased Cardiac Output
The heat fails to pump enough blood to meet the metabolic needs of the body. The blood flow that
supplies the heart is also decreased therefore decrease in cardiac output occurs, blood then is insufficient
and making it difficult to circulate the blood to all parts of the body thus may cause altered heart rate and
rhythm, weakness and paleness
2. Excess Fluid Volume
When blood flow through the renal artery is decreased, the baroreceptor reflex is stimulated and renin is
released into the bloodstream. Renin interacts with angiotensinogen to produce angiotensin I. When
angiotensin I contacts ACE, it is converted to angiotensin II, a potent vasoconstrictor. Angiotensin II
increases arterial vasoconstriction, promote release of norepinephrine from sympathetic nerve endings,
and stimulates the adrenal medulla to secrete aldosterone, which enhances sodium and water absorption.
Stimulation of the renin-angiotensin system causes plasma volume to expand and preload to increase.
3. Acute Pain
In ischemic heart disease, atherosclerosis develops in the coronary arteries, causing them to become
narrowed or blocked. When a coronary artery is blocked, blood flow to the area of the heart supplied by
that artery is reduced. If the remaining blood flow is inadequate to meet the oxygen demands of the heart,
the area may become ischemic and injured and myocardial infarction may result. Neural pain receptors
are stimulated by local mechanical stress resulting from abnormal myocardial contraction.
4. Ineffective Tissue Perfusion
Due to decreased cardiac output, there is decreased preload and stroke volume thus there is decreased
blood pumped out from the blood. Decrease in stroke volume decreases perfusion throughout the body.
5. Hyperthermia
Presence of microorganisms stimulates the release of pyrogen from the leukocytes resetting the bodys
thermostat to febrile level and then there would be activation of the hypothalamus, which will result in
increase in epinephrine and norepinephrine, vasoconstriction of cutaneous vessels. The heat will be
produced as peripheral vasodilation results in skin flushing and skin is warm to touch.
6. Ineffective Breathing Pattern
Ineffective Breathing Pattern occurs when there is presence of spasm and inflammation of the lung tissue
and parenchyma , these results in inability of the patient to move air in and out of the lungs as needed to
maintain adequate tissue oxygenation and perfusion.
7. Activity Intolerance

As heart failure becomes more severe, the heart is unable to pump the amount of blood required to meet
all of the bodys needs. To compensate, blood is diverted away from less-crucial areas, including the arms
and legs, to supply the heart and brain. As a result, people with heart failure often feel weak (especially in
their arms and legs), tired and have difficulty performing ordinary activities such as walking, climbing
stairs or carrying groceries

8. Impaired Gas Exchange

The exchange in oxygenation and carbon dioxide gases is impeded due to the obstruction caused by the
accumulation of bronchial secretions in the alveoli. Oxygen cannot diffuse easily.
9. Fatigue
Heart failure is a physiologic state in which the heart cannot pump enough blood to meet the metabolic
demands of the body. Since the patient has inadequate cardiac output, it can lead to hypoxic tissue and
slowed removal of metabolic wastes, which in turn cause the patient to tire easily.