HEART FAILURE

DEFINITION

The inability of the heart to pump sufficient blood to meet the needs of the
tissues for oxygen and nutrients characterized by signs and symptoms of
fluid overload or inadequate tissue perfusion. The low cardiac output
cannot meet body's demands.

Types of Heart Failure

1. Systolic heart failure- weakened heart muscle, poor contraction.

(most common)
2. Diastolic heart failure- stiff and non-compliant heart muscle, hard for
ventricle to fill. (least common)
3. Left-sided heart failure- fluid may back up into the lungs causing
shortness of breath
4. Right sided heart failure- fluid may back up into the abdomen, legs,
feet, causing swelling
CAUSE

Heart failure primarily caused by artherosclerosis (narrowing of the arteries

and build up of fatty deposits) of the coronary arteries. Heart failure
develops when the heart is damaged or weakened. Conditions that can
weaken or damage the heart is hypertension, valvular disorders, damage to
the heart muscle (cardiomyopathy), myocarditis, congenital heart defects,
abnormal heart rhythm, and chronic diseases such as diabetes mellitus,
HIV, hyperthyroidism, hypothyroidism, build up of iron (hemochromatosis),
build up of protein (amyloidosis), renal failure, electrolyte abnormalities,
acidosis,

Acute heart failure may be caused by viruses that attack the heart muscle,
severe infections, allergic reactions, blood clots in the lungs, and
medications (anti-arrhythmic) and illnesses that affect the whole body
RISK FACTORS

1. High blood pressure

2. Diabetes mellitus
3. Coronary Artery Disease
4. Heart attack
5. Sleep apnea
6. Congenital heart defects
7. Valvular heart disease
8. Viruses
9. Alcohol use
10.Tobacco use
11.Obesity
12.Irregular heart rhythm
13.Medications that increase the risk of heart problems: NSAIDS,
anti-arrhythmics, certain anesthetics
ASSESSMENT
Signs and Symptoms Assessing for Heart Failure:
General
Fatigue
Decreased activity intolerance
dependent edema
weight gain
Cardiovascular
Third heart sound (S3)
Apical impulse enlarged with left lateral displacement
pallor and cyanosis
jugular venous distention
Respiratory
Dyspnea on exertion
crackles that do not clear with cough
 orthopnea
paroxysmal nocturnal dyspnea
cough on exertion or supine
Cerebrovascular
unexplained confusion or altered mental state
lightheadedness
Renal
Oliguria and decreased frequency during the day
Nocturia
GI
Anorexia and nausea
Enlarged liver
Ascites
Hepatojugular reflux
PATHOPHYSIOLOGY

The sympathetic nervous system is then

stimulated to release epinephrine and
nonepinephrine to increase heart rate and
contractility and support the failing

vasoconstriction of the
skin, GI tract, and Renin produces angiotensin I
kidneys

ACE in the lumen of the pulmonary blood vessels

converts angiotensin I to angiotensin II which
increases blood pressure and afterload

Angiotensin II releases aldosterone which causes Na and

fluid retention because of ADH ultimately leading to fluid
volume overload leading to edema, weight gain

Neurohormones: Angiotensin and

aldosterone increase preload and
afterload of the heart

Counter regulatory mechanism by natriuretic peptides

and atrial natriuretic peptide (ANP) and b-type (BNP) are
released which promote vasodilation and diuresis

increased heart workload causes decrease in

contractility of the myocardial muscle fibers

Increased blood volume in the ventricle causing stretching and

thickening of the myocardial muscle fibers and increasing the size of the
ventricle causing ventricular hypertrophy causing diastolic heart failure

resistance to ventricular filling which

increases ventricular pressure. Less blood in
ventricles causes decreased cardiac output
 abnormal proliferation of myocardial cells
(ventricular remodeling)

Neurohormones produce large myocardial cells that

are dysfunctional and eventually die and leave the
normal myocardial cells to struggle

the compensatory mechanisms of heart failure aka vicious cycle of

HP because heart cannot pump enough blood to meet body's
demands causing heart to work harder, this leads to heart failure

LABORATORY/DIAGNOSTIC PROCEDURE

Echocardiogram to confirm diagnosis, identify cause, determine

EF for severity and to distinguish whether it is systolic or diastolic
heart failure
Chest x ray to confirm diagnosis
Electrocardiogram to confirm diagnosis for heart rhythm problems
and damage to the heart
Serum electrolytes to check for abnormalities
Complete Blood Count - to check liver, kidney, and thyroid function
B-type Natriuretic Peptide key diagnostic indicator. High levels
are a sign of high cardiac filling pressure
Urinalysis- high levels of protein and iron
BUN
creatinine
thyroid stimulating hormone
NURSING DIAGNOSIS

1. Activity intolerance and fatigue related to decreased cardiac output

- Encourage patient to do 30 minutes a day of physical activity. Physical

activity reduces the risk of bed sores, venous thrombosis, pulmonary
edema.

- Evaluate client's actual and perceived limitations, and severity of deficit.

Provides comparative baseline and information about needed education
and interventions

- Monitor vital and cognitive signs, watching for blood pressure, heart and
respiratory rate, skin pallor and/or cyanosis and presence of confusion.
Over exertion may cause increased workload of the heart leading to
hypoxia.

2. Excess fluid volume related to the heart failure syndrome

- Monitor patient's fluid status closely, auscultating the lungs, monitoring

daily body weight, and assisting patient in following a low sodium diet.
Auscultating the lungs for presence of fluid that may indicate pulmonary
edema. Monitoring the daily body weight indicates how much fluid is being
retained and released from the body. A low sodium diet reduces fluid
retention in the body.

- Administer diuretics as prescribed. Diuretics promote diuresis causing

fluid volume in the body to decrease.

- Elevate edematous extremities, change position frequently. To reduce

tissue pressure and risk of skin breakdown

3. Anxiety related to breathlessness from inadequate oxygenation

- Administer oxygen. Increase patient comfort and lessen workload of

heart.
- Teach patient ways to control anxiety and avoid anxiety-proking situations.
The patient learns how to use relaxation techniques which may improve
cardiac function and decrease symptoms of heart failure

- Provide accurate information about the situation. Helps client identify

what reality is and understand the situation.

MEDICATION/TREATMENT

1. Angiotensin Converting Enzyme (ACE) inhibitors

Decrease blood pressure and afterload
Relieves signs and symptoms of heart failure
Prevents progression of heart failure
2. Angiotensin Receptor Blockers (ARBs)
decrease blood pressure and afterload
relieves signs and symptoms of heart failure
prevents progression of heart failure
3. Beta Blockers
dilates blood vessels and decrease afterload
decrease signs and symptoms of heart failure
improves exercise capacity
4. Diuretics
decrease fluid volume overload
decrease signs and symptoms of heart failure
5. Digitalis
improves contractility
decrease signs and symptoms of heart failure
6. Calcium Channel Blockers
vasodilation and reduction of systemic vascular resistance
7. Nutritional therapy
low sodium diet (2 to 3g/day) reduces fluid retention and
symptoms of peripheral and pulmonary congestion. This diet
also decreases the amount of circulating blood volume which
decreases myocardial work.
Avoid drinking excessive amounts of fluid
8. Supplemental oxygen
depending on the degree of pulmonary congestion
9. Coronary artery bypass surgery
improve ventricular function
10. Cardiac resynchronozation therapy
to treat electrical conduction defects. Improves cardiac
output, optimize myocardial energy consumption, reduce
mitral regurgitation, and slow the ventricular remodeling
process
11. Ultrafiltraion
For patients with severe fluid overload
for patients with severe fluid overload