HEART FAILURE

Heart Failure
- Inability of the heart to pump sufficient blood to
meet the needs of the tissues
- A clinical syndrome with manifestations of fluid
overload/congestion; inadequate tissue
perfusion and poor activity tolerance
- Also referred to as Congestive Heart Failure
(because of its associated
pulmonary/peripheral congestion) Cardiac
Decompensation, Cardiac Insufficiency and
Ventricular failure
 Classifications of Heart Failure
• Left vs Right (according to Location of
dysfunction)
❖ Left-sided Heart Failure – a condition that
impairs the left ventricle’s ability to pump
blood into the aorta and the systemic
circulation
- Pulmonary s/sx predominate
❖ Right-sided Heart Failure
- Right ventricle fails to pump blood into the
pulmonary artery and into the pulmonary
circulation
- Systemic s/sx predominate
• Backward vs. Forward (according to
direction of blood flow)
❖ Backward Failure
- Involves the retrograde flow of blood
back to the pulmonary and systemic
circulation
❖ Forward Failure
- Inability of the ventricles to pump
blood forward into the systemic and
pulmonary circulation
• High Output vs. Low Output
❖ High Output Failure
- Despite normal or high cardiac output, the heart
cannot cope with the needs of the body
❖ Low Output Failure
- Poor ventricular contraction that leads to
decreased cardiac output
Acute vs. Chronic
❖ Acute Heart Failure
- Sudden change in the heart’s ability to
contract; can cause life threatening
symptoms and pulmonary edema

❖ Chronic Heart Failure

- Occurs when other chronic disorder
gradually compromises the heart’s ability
to pump effectively
Systolic and Diastolic Heart Failure (according to
ventricular functioning)
❖ Systolic Heart Failure
- inability of the ventricles to adequately
contract and pump blood

❖ Diastolic Heart Failure

- inability of ventricles to completely fill because
of stiffening
End-diastolic volume = 120 mL
End-systolic volume = 50 Ml
Etiology of Heart Failure
1. Abnormal preload and afterload conditions
2. Abnormal cardiac muscle functions
3. Limited ventricular filling
PATHOPHYSIOLOGY
: ↓C.O.
↓
Activation of Compensatory Mechanism:
By the heart:
• ↑ H.R.
• ↑ Size and strength of ventricular muscle
• ↑ Ventricular filling capacity
Others:
• Activation of sympathetic nervous system
• Release of catecholamines
• Shunting of blood
• Stimulation of RAAS
• Shifting to Anaerobic metabolism
 ↓
C.O. not maintained
↓
Left-Sided Heart Failure
Failure of the Left Ventricle

Congestion of blood in the left

Cannot forcefully ventricle, then in the left atrium and
contract to eject blood finally in the pulmonary veins
into the aorta and in the lungs
↓ ↓
- Decreased CO - Pulmonary edema
- Decreased Organ, - Impaired Gas Exchange
Tissue and Cellular - CO accumulation in the blood
2
Perfusion - Pulmonary Congestion
 ↓
C.O. not maintained
↓
Right-Sided Heart Failure
Failure of the Right Ventricle

Cannot forcefully contract to Congestion of blood in the

eject blood into the right ventricle, then in the right
pulmonary artery atrium, and finally in the vena
↓ cava and in the venous
- Decreased blood flow to systemic vasculature
the lungs ↓
- Decreased blood to be - Systemic congestion
oxygenated
 COR PULMONALE
- A condition in which the heart (cor) is affected by lung damage (pulmonale)

Respiratory Disorders (COPD, Bronchiectasis)

↓
Impaired Gas Exchange
↓
Increased CO2 in the blood
↓
Constriction of Pulmonary Artery
↓
Pulmonary Hypertension
↓
Increase workload of the right ventricle
↓
Right ventricular hypertrophy
↓
Right-sided heart failure
↓
COR PULMONALE
 Clinical
Right-sided HeartManifestations
Failure Left-sided Heart Failure
- Peripheral edema - Pulmonary Edema
- Ascites - Dyspnea
- Pericardial effusion - Rales/Crackles
- Hepatomegaly - Wheezing
- Hepatojugular reflux - Blood-tinged frothy sputum
- Jugular vein distention - Orthopnea
- Increased ICP - Restlessness
- Irritability and confusion - Anxiety
- Fatigue
- Weakness
- ↓U.O.
- Pallor
- Cool, clammy skin
- Tachycardia, ↑BP
- Chest pain
Laboratory/Diagnostics:
❖ ECG/Stress Test
❖ Echocardiogram
❖ Radionuclide angiography
❖ Chest X-ray
❖ Serum electrolytes
❖ Cardiac Catheterization
❖ Myocardial Biopsy
❖ Pulmonary function studies
A B

C
Medical Management:
Objectives:
1. Eradicate or reduce any etiologic contributory factors
to HF especially those which are modifiable and
curable
2. Reduce cardiac workload
3. Prevent further myocardial damage
✔ Dietary modifications
• Low sodium
• Fluid restrictions if with congestion or edema

✔ Lifestyle changes
• Avoid smoking, alcohol and caffeine
• Sedentary lifestyle
• Exercise program
• Antiembolism stockings
✔ Drug Therapy
• Oxygen administration
• Diuretics
• Inotropic Drugs/Cardiac Glycosides
• Sympathomimetics
• Vasodilators
✔ Surgical Treatments
- Involves the treatment of the etiologic disease
• Cardiac resynchronization therapy (CRT)
• Intraaortic Balloon Pump (IABP)
• Ventricular Assist Device
• Heart Transplant
✔ Management of Pulmonary Edema
CARDIAC RESYNCHRONIZATION
THERAPY
• Cardiac resynchronization
therapy (CRT) is treatment to help
your heart beat with the right rhythm. It
uses a pacemaker to restore the normal
timing pattern of the heartbeat. The CRT
pacemaker coordinates how timing of the
upper heart chambers (atria) and the
lower heart chambers (ventricles).
 INTRA-AORTIC BALLOON
PUMP
• An intra-aortic balloon pump (IABP) is a
mechanical device that helps the
heart pump blood. This device is inserted
into the aorta, the body's largest artery. It
is a long, thin tube called a catheter with
a balloon on the end of it. If you are
hospitalized, your doctor may insert
an IABP.
 VENTRICULAR ASSIST
DEVICE
• A ventricular assist device (VAD) is a
mechanical pump that's used to
support heart function and blood flow in
people who have weakened hearts.
The device takes blood from a lower
chamber of the heart and helps pump it to
the body and vital organs, just as a
healthy heart would.
Nursing Management:
1. Provide adequate oxygenation
2. Promote balance between rest and activity
3. Decrease anxiety and stress levels
4. Facilitate fluid and electrolyte balance
5. Provide proper skin care
6. Promote proper nutrition and elimination
7. Facilitate learning through health teachings
8. Administer medications as prescribed and monitor
patient’s response.
9. Assist in medical and surgical diagnosis and
treatment.
10.Assist in post-op care after heart transplant by
administering immunosuppressive agents.
 After recovery, the patient must
remain under medical supervision and
should continue taking digitalis, diuretics
or potassium supplements as needed.