Congestive Hearth Failure

Definition
 A physiologic state in which the hearth is unable to pump enough blood the meet
the metabolic needs of the body at rest or during exercise even though filling
pressure are adequate ( Medical Surgical Unit Cardiovascular Disorder )
 Pathology condition of heart to pump enough blood to meet metabolic and this is
only with increase pump left ventricle (Braunward )

Etiology
Congestive heart failure caused by:
1. Abnormal loading condition
2. Abnormal muscle function (myocardium dysfunction )
3. Condition/disease that precipite/exacerbate heart failure:
 Physical or emotional stress
 Dysritmia
 Infection
 Anemia
 Thyroid disorder
 Pregnancy
 Paget’s disease
 Nutritional deficiency
 Pulmonary disease

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Patophysiology

Systemic vascular resistance

Peripheral artery
constriction force
LV contraction
coronary artery constriction
Ephinephrine release
LV oxygen demand

LV hypoxia
Oxygen supply
Systemic blood pressure Force of LV contraction

ADH renal blood flow

LV EDP
renin
LV preload
angiotensin
LA preload
aldosteron
Pulmonary edema
Sodium water & retention
Pulmonary vascular resistance
 Peripheral edema
 Hepatomegaly RV failure
 Ascites
 Weir of jugularis venous RV preload
 Gastro intestine disorder

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Clinical manifestation
Heart failure maybe categories as :
 Left versus right ventricular
 Backward versus forward
 High versus low output
 Systolic versus diastolic

 Left versus right ventricular failure

Left ventricular failure Right ventricular failure
- Weakness - weight gain
- Fatigue - ankle or pretibial swelling and
- mental confusion pigmentation
- insomnia - abdominal distention
- anorexia - anorexia,nausea,gastric distress
- diaphoresis - edema
- anxiety - ascites
- breathleness - jugular vein distention
- cough - hepatomegaly
- orthopnea - increase central venous pressure
- tachicardia
- gallop S3,S4
- pulmonary cracles
- pulsus alternans

 backward versus forward failure

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 backward failure is the term used to refer to the venous congestion arising from
damming of blood behind filling chamber.This is can caused mental confusion etc.
Forward failure refers to the problem of inadequate perfusion
 high versus low output failure
the causes of high output failure include sepsis,pagets disease anemia etc.low
output failure including congenital,valvular rhematic coronary etc
 systolic versus diastolic failure
- systolic heart failure refers to a decrease in the ability of the ventricle to
contracy force fully and maintain and adequate forward cardiac output
atherosklerosis
- diastolic heart failure occurs when ventricular relaxation is incomplete and the
chamber is unable to accept sufficient blood like injured or ischemic
myocardium

Complication
 acute pulmonary edema
 refractory heart failure

Prognosis
The prognosis for the client with congestive heart failure depend on:
1. the degree of cardiac hypertrophy
2. the amount of cardiac reserve
3. the presence of other heart of associated disorder

Diagnostic assessment
 data from client’s health history
 chest radiography

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 arterial blood gases
 liver enzymes
 ECG
 Echocardiography

Medical management
Client with acute congestive heart failure are usually admited to an intensive care
unit. Where they reserve continous assessment and intervention
 Positioning
 Oxygen administration

Pharmacologic management
 Digitalis :Fargoxin,digoxin
 Dopamine and dobutamine : amrinone
 Diuretic to reduce preload
 Nitroglycerine/isosorbidedinirate is to venous dilators
 Hidralazine is to arteriolar dilator
 Combine is use sodium nitroprusside
 Prazosin
 ACE (angiotensin converting enzyme)
 Betablocker or betaadrenergic
Dietary management
 Diet low salt (sodium diet)
 Low fat (for obesitas)
 Excessive water intake
Surgical management
 Veno arterial bypass

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 Conterpulsation
Nursing management
a. Cardiac output decrease R/T heart failure or dysrhitmia
b. Fluid volume excess R/T reduce glorurol filtration , decrease cardiac output ,
intake antidiuretic production sodium water retention
c. Gas exchange impared R/T fluid in alveoli
d. Peripheral tissue perfusion , high risk for decrease R/T decreased cardiac
output and vaso contriction
e. Activity intolerance , high risk for R/T to decrease cardiac output , hypoxia
fear of death or serious consequence
f. Colaborative problem
High risk for digitalis toxicity R/T impaired drug excretion from hepatic and
renal involvement