Pathophysiology

According to Smeltzer and Bare (2010) Congestive Heart Failure is the inability of the heart to pump sufficient blood to meet the needs for oxygen and nutrients. Hudson explained that when the when congestive heart failure occurs and there is a drop in cardiac output; the sympathetic nervous system (SNS) is stimulated. Stimulation of the sympathetic nervous system activates the following compensatory changes in an attempt to increase venous return to the heart: increased heart rate, increased force of contraction, vasoconstriction, increased preload (left end diastolic pressure), increased afterload, and increased systemic vascular resistance. Hudson also explained that the kidneys also attempt compensate for the initial decrease in cardiac output by decreasing renal perfusion and activating the renin-

angiotensin-aldosterone-system (RAAS). When RAAS is activated the following compensatory process begins: Angiotensin II and Aldosterone are released which lead to sodium retention and vasoconstriction. This release activates the release of increased anti-diuretic hormone (ADH). The release of ADH causes the kidneys to reabsorb more water. The combination of increased sodium and water leads to a further increase preload. According to American Heart Association (AHA) the chances to have congestive heart failure is by having one or more conditions that

causes the diseases. As AHA stated, the conditions that leads to congestive heart failure are coronary artery disease, past attack of myocardial infarction, high blood pressure (hypertension), abnormal heart valves, heart muscle disease, heart defects present at birth, severe lung disease, diabetes, sleep apnea, and other conditions such as low red blood cell count (severe anemia), an overactive thyroid gland (hyperthyroidism), abnormal heart rhythm (arrhythmia or dysrhythmia). Since A.M.G. has high blood pressure (hypertension) for about 10 years and has diabetes for about 1 year she is highly at risk to develop this disease. The sign and symptoms of congestive heart failure according to AHA are shortness of breath (also called dyspnea), persistent coughing or wheezing, buildup of excess fluid in body tissues (edema), tiredness, fatigue, lack of appetite, nausea, confusion, impaired thinking, and increased heart rate. Prior to admission of A.M.G. she experienced difficulty of breathing (32 cpm) and tachycardia (103 bpm). According to Manriquez (2011) out of 86,241,697 people in the Philippines, 1,521, 912 have congestive heart failure. It is also the 6 th leading cause of mortality in the Philippines. As umm.edu explained that heart failure have a higher risk in people over age 65, men are at higher risk for heart failure than women but women tend to develop heart failure later in life than men do, African-Americans, people with a family history of cardiomyopathies, obesity, different lifestyle factors

(smoking, sedentary lifestyle, and alcohol and drug abuse), and long term use of anabolic steroids. Although A.M.G. has not known if there is a history of congenital heart disease in her family and she is nonsmoker, non-alcoholic and not a drug abuser she is likely at risk to have congenital heart failure because she is 68 years old. Although this disease is highly to occur in men, A.M.G. is at risk because according to med.yale.edu one in three women above 65 years old has some form of cardiovascular disease.

http://www.med.yale.edu/library/heartbk/19.pdf http://www.umm.edu/patiented/articles/what_symptoms_of_congestive_heart_failure_00 0013_3.htm

Congestive Heart Failure-2 Nursing CEs Author: Kristi Hudson RN MSN CCRN
http://dynamicnursingeducation.com/class.php?class_id=130&pid=23 http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/AboutHeart-Failure_UCM_002044_Article.jsp