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Heart Failure is the inability of the heart to pump enough blood to meet the metabolic demands of the body and/or the ability to do so only if the cardiac filling pressures are abnormally high
Type Right Heart Failure Left Heart Failure
Systolic Heart Failure Diastolic Heart Failure
Inability of the heart to adequately pump Inability of the heart Inability of the heart
Problem venous blood into the pulmonary muscle to pump blood muscle to fill with blood
circulation efficiently into the easily
systemic circulation

↑ EDV (preload) ↑ EDV ↓ EDV

↓ SV ↓ SV ↓ SV
Functional
↑ ESV (afterload) ↑ ESV ↓ ESV
Heart Changes ↓ EF ↓ EF Normal EF
↓ CO ↓ CO ↓ CO

1. Atherosclerosis – plaque buildup in and on the arterial walls

2. Coronary Artery Disease (CAD) – damage to the heart’s major blood vessels
3. Myocardial Infarction (MI) – blockage of blood flow to the heart muscle
4. Uncontrolled Hypertension – the force of blood against the arterial walls is too high
Causes 5. Cardiomyopathy – heart muscle damage: i.e. obesity, alcohol, drugs, diet
6. Congenital Heart Defect – abnormalities of the heart/great vessels present from birth
7. Heart Valve Disease – abnormal heart valve function: regurgitation, stenosis, atresia
8. Heart Arrhythmia – improper beating of the heart
9. Chronic Disease – i.e. emphysema & chronic bronchitis, diabetes, HIV, thyroid disease

Goals
 Making physical activity more comfortable
 Improving quality of life
 Prolonging life
Lifestyle Changes
 Limit salt – excess salt can lead to fluid accumulation, increased blood pressure, and
increased workload on the heart
 Manage fluids – excess fluid can lead to increaed blood pressure and fluid backing up in
both the lungs and body
Treatment  Exercise regularly – exercise helps strengthen the heart to better manage its workload
Drug Treatment
 Angiotensin-Converting Enzyme (ACE) Inhibitors
 Angtiotensin II Receptor Antogonists/Blockers (ARBs)
 Beta Blockers
 Vasodilators
 Cardiac Glycosides
 Human B-Type Natriuretic Peptides
 Positive Inotropes
 Diuretics

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ACE Cardiac Natriuretic Positive

Class ARBs Beta Blockers Vasodilators
Inhibitors Glycosides Peptides Inotropes
Names “-prils” “-sartans” “-olols” digoxin nesiritide
lisinopril losartan metoprolol hydralazine digoxin nesiritide milrinone
Drugs (Zestril, Prinivil) (Cozaar) (Toprol XL) (Apresoline) (Digitek, Lanoxin) (Natrecor) (Primacor)
Indications Heart Failure Symptoms of Heart Failure
Increase water
Block enzyme that Block adrenergic Inhibit Na+/K+
Block Angiotensin Cause peripheral elimination and
converts beta receptors to pump to increase Make the heart
II receptors arteries to dilate blood vessel
Angiotensin I to II slow heart rate heart contractility muscle contract
to prevent to decrease blood dilation to
to reduce to increase filling and slow heart rate more forcefully
vasoconstriction pressure decrease blood
vasoconstriction of the ventricles to increase filling
pressure
Beta Blockers

MOA

Intended ↓ Angiotensin II
 
production/activity
Response
↑ Vasodilation     
↓ Excess water and
  
salt in tissue
↓ Blood pressure      
↓ Heart rate  
↑ Heart contractility  
↓ Force of heart 
contraction

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ACE Cardiac Natriuretic Positive

Class ARBs Beta Blockers Vasodilators
Inhibitors Glycosides Peptides Inotropes
↓ Heart workload    
↑ Cardiac output  
 Pregnancy,  Pregnancy,  Acute cardiac  Pregnancy,  Pregnancy,  Pregnancy,  Pregnancy,
Category D Category C (1st failure Category C Category C Category C Category C
 Breastfeeding trimester),  Bradycardia  Concurrent use  Breastfeeding
 Acute renal Category D (2nd  Active with Viagra
Contraindications failure and 3rd trimester) bronchospasm
 Hyperkalemia  Breastfeeding  Renal/hepatic
 Acute renal disease
failure  Hyperthyroidis
 Liver failure m
 Cough  Dizziness, light-  Impotence  Tachycardia  Dysrhythmias,  Hypotension  Hypertension
 Hypotension headedness  Dizziness, light-  Hypernatremia bradycardia  Dizziness, light-  Tachycardia,
 Taste  Headache headedness  Headache  Fatigue headedness dysrhythmias
disturbances  Hypotension  Insomnia  Dizziness  Anorexia  Frequent
Side Effects  Hyperkalemia  Diarrhea  Lethargy,  Hypotension  N/V urination
 Headache  Hyperkalemia weakness  Nausea
 Confusion
 Palpitations
 Fever/chills  Kidney failure  Bradycardia  Neutropenia  Toxicity  Apnea  Ventricular
 Hoarseness  Angioedema  Chest pain (hydralazine) (N/V/D, vision (nesiritide) dysrhythmias
 Angioedema  Liver toxicity  Dyspnea  Circulatory loss, loss of (milrinone)
Adverse Effects  Neutropenia  Drug-induced  Bluish collapse & appetite)
hepatitis fingernails/palm shock  Dysthymias
 Seizures (nitroglycerin)

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ACE Cardiac Natriuretic Positive

Class ARBs Beta Blockers Vasodilators
Inhibitors Glycosides Peptides Inotropes
 Ask about  Check BUN,  Careful use with  Wear gloves to  Digoxin has a  Monitor HR, BP,  For those with
allergies creatinine, and diabetics: signs administer very narrow and RR to assess severe heart
 Teach: take on K+ levels of hypoglycemia nitroglycerin therapeutic for apnea failure
consistent  Teach: report and tachycardia  Remove old range (0.5 to 2  Check IV site  Monitor HR and
schedule angioedema may be masked drug patches and ng/mL) for patency and BP every 1-2 hrs
 Teach: use K+ immediately  Report heart rate rotate sites  Teach: check signs of  Double check
supplements  Check bowel < 60 BPM  Teach: apical pulse for infection IV rate with
carefully and sounds every  Teach: sudden nitroglycerin full minute  Frequent blood another nurse
avoid salt shift (sign of stopping of requires 24 hour before pressure checks  Teach: how to
substitutes increased K+) meds may “drug-free” time  Notify if HR and urine output use infusion
 Teach: report increase risk for  Acetaminophen irregular, < 60 measurement pump
Nursing Implications symptoms of MI may be used to BPM or > 100 needed  Teach: do not
angioedema  Teach: notify if reduce headache BPM stop unless
& Patient Teaching immediately weight gain or caused by  Check K+, Mg+ ordered
 Teach: if dry SOB (sign of nitroglycerin +, Ca++ values  Teach: report
cough develops, worsening heart  Teach: notify if  Teach: weigh chest pain,
notify prescriber failure) 2 or more doses daily and report dyspnea,
 Teach: may are missed gain > 2lbs/day numbness,
cause or worsen  Teach: report  Teach: avoid tingling, burning
depression HR >20 BPM; antacids within
 Antidote: weight gain > 2 hours
Glucagon 3lbs/week  Antidote:
Digibind

Medications to Avoid or Use with Caution:

 Anti-Arrhythmics (quinidine, sotalol, ibutilide): Pro-arrhythmic or cardio-depressant
 Calcium Channel Blockers (non-dihydropyridines, i.e. verapamil, diltiazem): Worsens heart failure
 NSAIDs (ibuprofen, naproxen, diclofenac): Na+ retention and increase toxicity of diuretics/ACE-I
 Thiazolidinediones (TZDs) (pioglitzone, rosiglitazone): Worsens heart failure

References

Cardiac Health. 2015. “Heart Failure Causes, Coronary Artery Disease (CAD).” Retrieved Nov. 20, 2015 (http://www.cardiachealth.org/heart-information/heart-failure).

Huether, Sue E., and Kathryn L. McCance. 2012. Understanding Pathophysiology. 5th ed. St. Louis: Mosby.

Malmivuo, Jaakko, and Robert Plonsey. 1995. Bioelectromagnetism: Principles and Applications of Bioelectric and Biomagnetic Fields. 1st ed. New York: Oxford University Press.

MedlinePlus. 2015. “Heart Failure.” Retrieved Nov. 10, 2015. (https://www.nlm.nih.gov/medlineplus/heartfailure.html#cat78).

U.S. Department of Veteran Affairs. 2012. “Chronic Heart Failure.” Retrieved Nov. 10, 2015. (http://www.queri.research.va.gov/chf/products/nurse_education/).

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