Hey everyone its Saylor with register nurse RN home and in this video, I want to be going

over an ink Lex review up heart failure this video is part of an ink Lex series over the
cardiovascular system and in this specific video it's going to be part one I'm going to be
covering the pathophysiology of heart failure the causes the signs and symptoms the different
types what triggers it how it's diagnosed and
Things like that and I'm going to be giving you some clever mnemonics on how to remember
this material for NCLEX and your nursing lecture exams and in the next video which will be
part two I'm going to be covering specifically the nursing interventions and the
pharmacological aspect of heart failure which is another important part that in CLECs will
test you on and then after you watch this video be sure to go to my website register nurse RN
calm and take
The free ink Lex quiz that will test you on this material and a card should be popping up so
you can access that so let's get started first let's start out talking about what is heart failure
heart failure is where the heart is too weak to pump efficiently and because it can't pop
efficiently what happens it can't provide the proper cardiac output that your body needs to
maintain its metabolic needs so what's really happening with heart failure is that
That heart muscle has either messed up with how it can contract and pump that blood up
through those valves out through your car out through the other side of the heart or it's
become too stiff and we're mainly talking about the ventricles of the heart we're going to be
talking about mainly our right ventricle and our left ventricle and I'll go over that in depth
whenever we cover the different types now what are the causes of heart failure to help you
Remember this remember the mnemonic failure we're talking about heart failure so it's easy
to remember failure whatever we're trying to think about what causes this condition so first s
heart faulty heart valves what does this mean well you have four different valves in your
heart you have your tricuspid and you're by custom about also called your mitral valve which
or your ventricular valves and then you have your pulmonic valve and
Your aortic valve which are your semilunar valves now your tricuspid valves and your
tricuspid valve and your my cuspid valve can be comes to nose or it can become regurgitating
and whenever it becomes stenosis it's too narrow and whenever it becomes regurgitated it
means it leaks and this can lead to heart failure, I have seen this as a nurse in the clinical
setting patient comes in they have messed up heart valves may be from endocarditis and they
Need their heart valves replaced because whenever those heart valves are messed up it causes
your heart to overwork and they enter into heart failure but whenever they get those valves
replaced it fixes the problem and they're much better okay next a arrhythmias um arrhythmia
is like atrial fibrillation or tachycardia can send you into heart failure and this is where for
instance let's talk about atrial fibrillation atrial fibrillation is where your
Atriums are quivering they're not pumping efficiently so blood is like pulling in there and this
can send a patient into heart failure a lot of times I have seen patients come in they didn't
even know they're in afib and they had the sign of heart failure and also tachycardia this is
where you have a really fast heart rate patient may not know it it's elevated for a long time
that puts a lot of strain on the heart makes that muscle weak and they enter
Into heart failure high infarction such as myocardial infarction and you will get this with
coronary artery disease myocardial infarction heart attack what happens is that they have a
plaque buildup in one of those arteries that feeds that heart muscle all that nutrients that
blocks that all that nutrients go into that heart muscle that heart muscle becomes ischemic and
die and it becomes weak so for instance like left ventricle this happens a lot
Whenever people get left-sided heart failure the arteries that see that mentor cold can become
blocked that muscle dies send them into heart failure l4 lineage this is genetic family history
mom dad grandmother had it so you're more at risk for developing a congenital you're born
with it family history so that can run in families next you uncontrolled hypertension we
talked about in the in CLECs review
Video of hypertension hypertension is a number one it's a silent killer because patients don't
know that they have it they don't have signs and symptoms until it's too late till it's affected
the organs and what happens is whenever you have such that high pressure beating on that
heart it can cause those vegetables to become stiffened so whenever they become stiffened,
they can't that those mint ripples will not feel properly with blood and you can enter into
heart
Failure our recreational drug use such as cocaine or alcohol abuse patients who do cocaine or
have alcohol abuse are more susceptible for developing heart failure II evaders such as
viruses infections that get in and attack of the heart I have seen this again a patient will come
in and they're relatively healthy some of them are young but they've got some type of virus or
infection that is attacked op heart muscle may at week and now they are in
Heart failure now let's look at the different types of heart failure you can have you can have
left or right sided or both now to help you understand the different types of heart failure
because this is a big thing the ink looks like staph and especially your nursing lecture exams
because you need to know those different signs and symptoms that a patient with left-sided
heart failure may be presenting with that someone with right-sided man so you need to know
the
Different ones and let's look at the blood flow how the blood flows boat flows through the
heart and the pathophysiology of it okay first let's get familiar with which side of the heart is
which because that is very important when determining if you're in left-sided or right-sided
heart failure so this right here is the right side of the heart where the blue donated blood is
draining down into the heart this side is the left side of the
Heart where the nice rich red oxygenated blood it's went through the lungs it's going to be
pumped up through the body and we're specifically remember looking at these ventricles
because that's where our problem is with heart failure, they're either too sick or they're not
contracting properly so first let's look at how the blood normally flows through the heart and
then we'll go through how it can back up and cause all those signs and symptoms okay so you
have your
Superior vena cava and you have your inferior vena cava and what these do is they drain all
that blood that your body has used to become reoxygenate it wants to send it through the one
lungs that's the goal of your right side to get that blood to the lungs to become oxygenated so
we can go back to your body so it does that now no this is important later in your inferior
vena cava it's also connected through those hepatic veins to the liver so whatever you start
getting
Congestion in your right side of the heart the liver is going to be affected which will go over
here in a second so it drains down into your right atrium then it flows down through the
tricuspid valve then to your right ventricle the right ventricle squeezes it up through your
pulmonic valve up through your pulmonary artery and out through your lungs and then it
goes through gas exchange through those little sacs it becomes replenished then it's nice and
Oxygenated and it shoots through the heart down through the left atrium down through the
bicuspid valve which is also called your mitral valve then down into that left ventricle and
remember the left ventricle has the most pumping power of all four chambers because it has
to in order to shoot that blood up through the body so that left hand school will squeeze that
blood shoot it up through your aortic valve up through your aorta and then through your
whole
Body and then the cycle starts all over again now with heart failure like I've said there either a
contraction problem with these ventricles they're not contracting properly maybe the muscles
die become ischemic or they're not filling properly and this could be due to an uncontrolled
hypertension where that ventricle has just become too stiff first let's talk about left-sided
Heart failure so what's happening in left-sided heart failure why do you get pulmonary
symptoms well with left-sided heart failure the ventricle either it's too stiff or it's not
contracting properly and you can have diastolic or systolic less intrical dysfunction which
will go over here in a second and what happens is that the blood will backflow up through
your atrium and up into your lungs so the patient will start presenting with pulmonary
symptoms
Because that blood is back flowing into there so they may have crackles a shortness of breath
up Orthopaedic where they can't even lay down and sleep so they're going to get pulmonary
signs and symptoms with left-sided heart failure now with right-sided as a side note
remember this left-sided because it's over here it can increase the pressure in the right
ventricle because of all this back slowing the blood up through here and it can actually cause
a patient
To go into right-sided heart failure as well so remember that so you can have both going on at
the same time but sometimes you can sometimes you can just have right-sided heart failure
and whenever that happens on your right side watch where the blood would backflow where
you have too much blood back flowing because your ventricles aren't pumping out properly
where's that blood going to go it's going to go up into those superior inferior vena cavas out
Through the peripheral area so you're going to be seeing a peripheral edema excessive weight
gain they may have increased abdominal girth in their belly ascites and again back to the
hepatic veins because all this blood is going to congest into the inferior vena cava it's going to
cause hepatomegaly can cause your liver to become enlarged and then you'll get the large
abdomen and just really uncomfortable so that is why you would see the certain signs and
Symptoms with each side so again just recap your left side you are going to see pulmonary
issues because it's back flowing into your lungs on the right side you're going to see
peripheral edema and issues like that okay as I was talking about before you even have left-
sided systolic dysfunction or you can have left-sided diastolic dysfunction and we're talking
about the left side of the heart the left ventricle so let's go over systolic and
You can also see it as less than tricular systolic dysfunction okay now let's think about -
what's this all ik is we talked about this in the other video where we went in depth about
blood flow what is this lis systolic is the squeezing phase of your heart remember s systolic
squeezing so it's the contracting phase of your heart so there is an issue with the left ventricle
contracting and squeezing that blood up through the heart
Now with this patients are going to have a low ejection fraction usually less than 40% a less
than 40% ejection fraction is a diagnosis for heart failure and whenever that happens the heart
cannot squeeze that nice fresh oxygenated blood up through all those tissues everything that
needs in those bobble organs so they don't get it and it backs up into the lungs as you just
seen now what is ejection fraction what does it mean it's a calculation tool
That is used to diagnose the contracting ability of your left ventricle so it's the amount of
blood that fills inside the left ventricle that is actually being contracted out of that ventricle
now for instance say that you seen that a patient had an echocardiogram because that's one of
the tools used to diagnose ejection fraction and it said an EF of 38% what does that mean that
means that only 38% of the blood that field inside the left ventricle is being pumped out
That is bad so they are in heart failure now a normal EF is an ejection fraction of greater than
50% that's a normal healthy heart and like I said it can be diagnosed with an echocardiogram
remember this this is really important not only for NCLEX but whenever you work as a nurse
whenever you're reading test results so an echocardiogram can give you an ejection fraction a
heart catheterization can give you an
Ejection fraction and a nuclear stress test can as well give you that now let's look at left-sided
diastolic dysfunction we've just looked at systolic and that was the squeezing part of the heart
there was an issue with the left ventricle being able to squeeze properly with diastolic
dysfunction it is an issue with the ventricle being able to feel properly because the diastolic
diastole is the filling / resting phase of the heart so the ventricle this left
Interval has probably became too stiff to fill with blood so now all the blood that's supposed
to get in there and gets in there but it can tracks normally so it gets just a little bit of blood
and it contracts beautifully so because it's not an issue with contraction it's an issue with it
actually feeling your ejection fraction is usually going to be normal on these patients so
they'll go for an echocardiogram and their EF comes back normal because there's not an issue
With contraction just feeling now with your left sided heart failure just because of where that
left ventricle is you are going to have pulmonary symptoms with your left-sided heart failures
now let's look at right-sided the other type of heart failure right-sided heart failure is not as
common as left-sided heart failure funny enough left-sided heart failure is one of the main
causes of why people would enter into right-sided heart failure along with
It's also caused by a pulmonary heart disease Col called cor pulmonale as a complication of
the patient either has pulmonary hypertension or C yo PD so that can be other causes of it
now just to recap with the right-sided remember on the right ventricle just where it's located
and where the anatomy is and everything that's going to be affected it just makes sense if that
if this ventricle is not contracting properly blood is back flowing it's
Going to go peripherally so you're going to see peripheral signs and symptoms with this with
left side you're going to see pulmonary so now let's look at the signs and symptoms side by
side and let me give you some clever mnemonics on how to remember them okay for right
sided heart failure let's remember the mnemonic swelling and why swelling because
remember these patients are going to have peripheral swelling everywhere so just an easy
mnemonic to
Help you remember the typical signs and symptoms and then for left-sided heart failure we're
going to remember the word drowning because remember our lungs the pulmonary system is
majorly involved in this and they are literally drowning in their own fluids so let's remember
the word drowning okay so let's start with right-sided for the S we're in swelling we're going
to remember swelling of hands the legs the liver they're gonna have a lot of congestion a lot
of fluid
Going on with that w weight gain this is going to be present with both of them but especially
with right-sided heart failure and you want to tell the patients to monitor their weights daily
any fluctuation between 2 to 3 pounds in one day or 5 pounds in a week is something to be
alarmed about because they could be going into heart failure exacerbation a demon these
patients not only will have swelling but they could have pitting edema in their legs and
This is where you can press on the tibia of the leg and it will actually pit in I have seen three
four plus pitting edema very very interesting how much swelling these patients can have l4
large neck veins this is is the jugular veins if you have a video on how to do this but if you
turn the patient's neck to the right side they're setting up you are laying back a little bit you
can actually see a jugular venous distention l4 lethargic these
Patients are going to be extremely tired extremely they can't tolerate it's hard for them to even
get up from the bed to the bedside chair they get very winded because of all this extra fluid
they're carrying and their heart is just so weak it can't pump efficiently to get that blood going
everywhere I for irregular heart rate a lot of times whenever patients come in with congestive
heart failure they can flip into a regular heart rate like atrial fibrillation
Another thing is knock-knock yuria in the end and this is very interesting this is where they
have all of a sudden frequent urination in the middle of the night them at the time they don't
want to have it and this is because normally a patient people are up moving around but at
night whenever you're laying down your legs are elevated it allows that fluid to enter back
into the vascular system goes to the kidneys so your kidneys try to start putting out that
Fluid so that's why there may have excessive urination at night with this and g4 girth the
abdominal girth of their belly can be increased and this is because remember of the
hepatomegaly where all this congested fluid is going to the liver so they can have that
whenever they have that they have this big belly of extra fluid it can cause them not to
breathe very well they'll have difficulty breathing because it's pushing on those lungs and it's
also
Going to be pushing on the stomach so they could have anorexia just don't feel like eating
and they can feel nauseous with this now left-sided heart failure we're drowning because we
got pulmonary issues going on first d rimmer dis via this is because of all that fluid backing
up into that lungs causing that patient not to breathe very well our four rails this is another
word for crackles this is when you listen with your stethoscope and you can hear in the
Lungs this crackling noise how I like to do is take your hair and take it by your ear and that's
what it sounds like Oh for ortho kini this is one of the tell-tale signs of a patient tells you and
to have a history of congestive heart failure at night I've been having to use some pillows to
set up to sleep and breathe because I just can't breathe that as a warning find them they may
be going in to see it to heart failure exacerbation so that's
What that is and then W for weakness again just like with right-sided heart failure they're
going to be extremely weak just because that heart cannot put out the cardiac output it needs
to to meet your body's metabolic needs in for nocturnal proximal dis p.m. this is where at
night they will just wake up all of a sudden breathing difficulty just can't breathe at all it's
very frightening for them and this is one of the things that going to happen
Left-sided heart failure because you're having those pulmonary issues I for increased heart
rate and the reason they have increased heart rates because they have the heart the body says
it's how we have all this blood in the heart but we need to get out to the organs so it's just
staying there so that heart will increase that heart rate and make it become tacky so it can
pump it out to get to those vital organs in for nagging cough again that's you have the lung
Issues going on to have this persistent nagging call and sometimes it can become frothy or
blood-tinged sputum and if this happens this is a really really bad sign that something
horrible is going on you need to get them Diaries fast because they have some major fluid
overload so if you see that that's usually a late sign G for gaining weight again just with right-
sided heart failure and they if they gain more than 2 to 3 pounds in a day or 5 pounds in a
Week that is a red flag okay let's look at real fast how heart failure is diagnosed in the
hospital setting okay a lot of times physicians will order a lab result called a B in P stands for
B type naturally MEK peptide we call it B and P and what it is it's a biomarker that's released
by your ventricle when there's excessive pressure on the heart due to heart failure and
readings if you have less than 100
There's no heart failure going on and if you have a hundred to three hundred reading its
present greater than 300 it's mild greater than 600 it's moderate and greater than 900 it's
severe and I have seen these in the 2000s with heart failure patients other things that are used
to diagnose this a chest x-ray looking to see if there is any congestion in those lungs leaning
at the heart to see if it's enlarged and an echocardiogram I'm a heart cath and a
Nuclear stress test which is what we talked about earlier with the ejection fraction now heart
failure can be maintained for patients and they can take medications they can do diet regimen
and other treatments so they can maintain it however a heart failure can go into exacerbation
where it comes out in full force and some things that can trigger that or maybe the patient
isn't compliant with their diet they eat a lot of fast food a lot of sodium they don't
Restrict their fluids they drink a lot of soda a lot of water that can trigger them to go into
heart failure infection they get really sick stresses the heart out go into heart failure
uncontrolled atrial fibrillation or renal failure because renal patients have issues with fluid
overload already and that can put more stress on the heart that already is more susceptible to
heart failure so in the next video be sure to check out part 2 because I'm going to be going
Over nursing interventions and all those medications to use to treat heart failure so thank you
so much for watching this video and please consider subscribing to this YouTube channel