CONGESTIVE HEART FAILURE

 Heart failure or congestive heart failure is an abnormal clinical condition involving impaired
cardiac pumping.

 Heart failure refers to the inability of the heart to pump sufficient blood to meet the need of
the tissues for oxygen and nutrients.

 Fluid over load and decrease tissue perfusion results when the heart cannot generate a CO
sufficient to meet the body’s demands.

 The term HF indicates myocardial disease in which there is a problem with contraction of the
heart that may cause or may not cause pulmonary or systemic congestion.

 Some causes of HF are reversible, depending on the cause. Most often, HF is a progressive,
lifelong diagnosis that is managed with lifestyle changes and medication to prevent acute
congestive episodes.

PATHOPHYSIOLOGY
 HF results from a variety of cardiovascular conditions including chronic hypertension,
CAD and vascular disease.

 This condition can result in decrease contraction (systole) and decreased filling
(diastole) or both. Significant myocardial dysfunction most often occurs before the
patient experience signs and symptoms of HF such as shortness of breath, edema and
fatigue.

 Myocardial dysfunction is the most often caused by CAD, cardiomyopathies, HTN or

valve disorder. Patient with diabetes mellitus are also at high risk for HF.

 Atherosclerosis of the coronary arteries is the primary cause of HF, and CAD is found
in more than 60% of patients with HF. Cardiomyopathies and inflammatory process such
as myocarditis, valvular heart disease is also cause of HF.

 Several systematic conditions can contribute to the development and severity of HF.

 Increased metabolic rate (fever)

 Iron over load, hypoxia and severe anemia all of this conditions increase in cardiac
output to satisfy the systemic oxygen demand.

CLINICAL MANIFESTATIONS
GENERAL

 Pale, cyanotic skin (with decreased perfusion to extremities)

 Dependent edema
 Decreased activity tolerance
 Unexplained confusion and altered mental status

CARDIOVASCULAR

 Apical pulse
 Third heart sounds
 Cardiac murmurs
  Tachycardia
 Increase JVD

CEREBROVASCULAR

 Light headedness
 Dizziness
 Confusion

GIT

 Nausea and anorexia

 Hepatomegaly
 Ascites

RENAL

 Decreased urinary frequency during the day

 Nocturia

RESPIRATORY

 Dyspnea
 Orthopnea
 PND ( Paroxysmal nocturnal dyspnea )
 Cough on exertion when supine

MEDICAL MANAGEMENT

 The overall goals of medical management in HF are to relieve patient symptoms to

improve functional status and quality of life and extend to survival.
 Medical management based on the type, severity and cause of HF.

SPECIFIC OBJECTIVE INCLUDE

 Eliminate or reduce any etiologic contributing factors especially those that may be
reversible.
 Reducing the work load of the heart
 Optimize all therapeutic regimen
 Prevent exacerbations of HF
 Treatment options vary according to the severity of the patient’s condition and may
include basic lifestyle changes, oral or IV pharmacologic management, supplemental
oxygen, manipulation of assistive devices and surgical approaches, including CABG,
open heart surgery, and heart transplantation.
 Basic lifestyle changes ( nutrition, exercise, reducing risk factors )
 Managing of the patients includes providing general education, counseling to the patient
and family.
 It is important that patient and family understand the nature of HF and importance of
their participation in the treatment regimen.

LIFESTYLE RECOMMENDATION INCLUDING

 Restrictions of sodium intake in diet.

 Avoidance of excessive fluid intake alcohol and smoking cessation.
 Weight reduction and maintain ideal body weight.
 Regular exercise
PHARMACOLOGIC THERAPY

 Ace inhibitors
 Beta-blockers
 Diuritic
 Calcium channel blockers

COMPLICATIONS

 Cardiogenic shock
 Dysrhythmias
 Thromboembolism
 Pericardial effusion

COLLABORATIVE THERAPY

 Treatment of underlying cause

 High fowler position
 Oxygen by mask or nasal cannula
 Monitor BP, HR, RR, urinary output at least every hour
 Continuous ECG and pulse oximetry
 Hemodynamic monitoring (CVP, PAWP, CO, Intra atrial BP
 Monitor daily body weight
 Endotracheal intubation and mechanical ventilation
 Circulatory assistive devices ( IABP, PACEMAKER )

NUTRITIONAL THERAPY

 Low sodium ( 2 or 3 gm/day )

 Excessive amounts of fluid are usually avoid

NURSING MANAGEMENT

 Administering medications and assessing the patient response to the pharmacologic

regimen.
 Assessing the fluid balance, including intake and output.
 Weighing the patient daily at the same time and on the same scale, usually after morning
urination.
 Auscultation of lung sounds to detect an increase or decrease pulmonary crackles.
 Determine the degree of JVD distension.
 Identify and evaluate the severity of dependent edema.
 Monitoring pulse, BP and cardiac function.
 Examination of skin turgor and mucous membranes for signs of dehydration.
 Assessing for symptoms of fluid over load ( e.g. orthopnea, PND )