Heart Failure

Right-Sided Heart Failure / Left-Sided

Heart failure
 
 HEART FAILURE

HF, often referred to as “congestive heart

failure” (CHF), is the inability if the heart
to pump sufficient blood to meet the
needs of the tissues for oxygen and
nutrients. However, the term CHF is
misleading, because it indicates that
patients must experience pulmonary or
peripheral congestion to have HF, and it
implies that patients with congestion have
HF.
 HEART FAILURE
• HF does not manifest pulmonary or systemic
congestion. The term HF is preferred and indicates
myocardial heart disease in which there is a problem
with contraction of the heart (systolic dysfunction)
or filling of the heart (diastolic dysfunction) and
which may or may not cause pulmonary or systemic
congestion. Some cases of HF are reversible,
depending on the cause. Most often, HF is a life-long
diagnosis that is managed with lifestyle changes and
medications to prevent acute congestive episodes.
CHF is usually an acute presentation of HF.
Pathophysiology
 Causes:
LSCHF
Pulmonary Embolism
Lung diseases (chronic bronchitis and emphysema)
Right ventricular infarction
Congenital septal defects

Reduced myocardial contractility

Increase cardiac workload

Decrease diastolic filling

Contraction of right sided atrial filling

Obstruction of right atrial emptying

Increase right atrial pressure

Right sided CHF

Blood drains back from RV to RA

Increased pressure in the veins

Shortness of breath
Swelling of feet and ankles
Urinating more frequently at night
Pronounced neck veins
Palpitations
Irregular fast heart beat
Fatigue
Weakness
Fainting
 Right-sided HF vs. Left-sided HF
RIGHT-SIDED HEART FAILURE
 Right ventricle fails to eject blood and  pulmonary congestion occurs when the
cannot accommodate all the blood that
normally returns to it from the venous
circulation
 Peripheral tissues predominates
 Impaired gas exchange
 Left-ventricular failure
LEFT-SIDED HEART FAILURE
left ventricle cannot pump the blood out
of the ventricle of the body
 increased left-ventricular end-diastolic
blood volume increases the left-
ventricular end-diastolic pressure
 leads to decreased blood flow from the
left atrium into the left ventricle during
diastole
 blood volume and pressure in the left
atrium increases which decreases blood
flow from the pulmonary vessels
 pulmonary venous blood volume and
pressure rise, forcing the fluid from the
pulmonary capillary into the pulmonary
tissues and alveoli
Manifestations
 CLINICAL MANIFESTATIONS:
RIGHT-SIDED HEART FAILURE LEFT-SIDED HEART FAILURE
 Jugular vein distention (JVD)  dyspnea
 Edema (dependent)  cough
 Pitting edema  pulmonary crackles
 Anorexia  low oxygen saturation level
 Nocturnal dyspnea  paroxysmal nocturnal dyspnea
 Nocturia  large quantities of frothy sputum
 Weakness  oliguria
 Nausea  altered digestion
 Abdominal pain  dizziness
 Jaundice  lightheadedness
 Hepatomegaly  confusion
 Palpable spleen and liver  restlessness
 Ascites  anxiety
 Weight gain  skin feels cool and clammy
 Gastrointestinal distress  skin appears pale or ashen
 tachycardia
 fatigue
Diagnosis
 NURSING DIAGNOSES:

• activity intolerance
• decreased cardiac output
• excessive fluid volume
• fatigue
• imbalanced nutrition : < body requirements
• impaired gas exchange
• ineffective airway clearance
• ineffective breathing pattern
• ineffective tissue perfusion
 Diagnostic Tests and Exams

• Physical examination may reveal an irregular

or heartbeat and increased breathing rate. The
doctor may feel abnormal heart motion when
touching the chest wall.

• Listening to the heart may reveal heart murmurs

or extra heart sounds, and listening to the lungs
may reveal crackles or decreased breath sounds
at the bottom. The lower legs may be swollen
and remain dimpled when pressed.Tests may
include:
• An ECG, to look for signs of thickened heart muscle or
enlarged heart chambers. The electric system of the heart
and heart rhythm may not be normal.
• A chest x-ray, to look for enlargement of the heart and fluid
accumulation in the lungs.
• An echocardiogram (heart ultrasound) and a Doppler study,
which may show heart chambers enlargement, leaky valves,
and poor pumping function.
• Cardiac catheterization may be performed. In right heart
catheterization, a catheter is inserted through a vein into the
right side of the heart to measure the pressures. Sometimes,
an injection of contrast material ("dye") in the right ventricle
is necessary to help understand the problem (right
ventriculography).
• Coronary angiography to determine the underlying cause of
heart failure.
• Heart stress test to assess the severity of condition by
monitoring the patient’s activity intolerance.
 The following lab tests may be performed:

• CBC
• Blood chemistry
• Liver function tests
• Urinalysis
• make decisions about hospitalizations,
aggressive treatments, and future
prognosis.Thyroid function tests
• B-Type Natriuretic Peptide (BNP)
 What is BNP???
BNP is…
• substance secreted from the ventricles or lower
chambers of the heart in response to changes in pressure
that occur when heart failure develops and worsens.
• The level of BNP in the blood increases when heart
failure symptoms worsen, and decreases when the heart
failure condition is stable. The BNP level in a person with
heart failure – even someone whose condition is stable –
is higher than in a person with normal heart function.
 Preparation

Preparation
• To test the BNP level, a small amount of blood
is taken and placed in a machine that detects
the level of BNP in your blood. The test takes
about 15 minutes. The BNP level helps to
determine if you have heart failure, rather
than another condition that may cause similar
symptoms. In addition, BNP help the physician
 Results

• BNP levels below 100 pg/mL indicate no heart failure

• BNP levels of 100-300 suggest heart failure is present
• BNP levels above 300 pg/mL indicate mild heart
failure
• BNP levels above 600 pg/mL indicate moderate heart
failure
• BNP levels above 900 pg/mL indicate severe heart
failure
Treatment
 Treatment
The goals of treatments are:
•  Treat the disease that is causing the heart
failure
• Reduce symptoms
• Relieve stress on the heart
• Reduce risks of worsening heart failure
• Improve chances of survival
 Medical Treatment
• Diuretics
• ACE Inhibitors
• ARBs
• Digoxin
• Dopamine
• Nitroglycerin
 Diuretics
• (water pills) can help reduce fluid
accumulation. Furosemide or bumetanide
can help moderate to severe symptoms.
Hydrochlorothiazide, chlorthalidone, and
chlorothiazide may be used for mild
symptoms. Another drug, spironolactone,
can prevent salt retention and help patients
with severe heart failure.
 ACE Inhibitors

ACE Inhibitors
• Medications for right-sided heart failure
include the use of ACE inhibitors or
angiotensin-converting enzyme inhibitors. ACE
inhibitors such as lisinopril help control blood
pressure without affecting cardiac output.
 ARBs

ARBs
• Right-sided heart failure patients may take
angiotensin-receptor blockers for blood
pressure control when ACE inhibitors are not
tolerated. Not first-line drugs, physicians use
caution when prescribing ARBs to patients
with congestive heart failure and taking
diuretics.
 Digoxin

Digoxin
• Many heart failure patients take the cardiac
glycoside digoxin. Digoxin slows down the heart rate
and strengthens the contraction of the ventricles.
This action increases the amount of blood pumped
from the heart with each beat. Increased cardiac
output helps decrease many symptoms associated
with right-sided heart failure such as low blood
pressure, fatigue and shortness of breath.
 Nitroglycerin

Nitroglycerin
• With right-sided heart failure, blood pressure can
become so low a patient experiences shock.
Dopamine stimulates the heart by increasing cardiac
output and blood pressure, relieving shock.
Dopamine also improves blood flow to the kidneys
which helps the kidneys eliminate excess fluid. The
effects of dopamine are dose dependent, with low
doses affecting the kidneys and higher doses
stimulating the heart.
 Nursing
Management
 Nursing Management:

The nurse is responsible for administering the

medications and for assessing their beneficial
and detrimental effects to the patient. It is
balance of these effects that determines the
type and dosage of pharmacology therapy.
Nursing actions to evaluate therapeutic
effectiveness include the following:
• Keeping an intake and output record to identify a negative
balance
• Weighing the patient daily at the same time and on the same
scale, usually in the morning after urination, monitoring for
2-to-3 lb gain in a day or 5 lb weight gain in a week
• Auscultating lung sounds at least daily to detect an increase
or decrease in pulmonary crackles
• Determining the degree of JVD
• Identifying and evaluating the severity of dependent edema
• Monitoring pulse and blood pressure as well as monitoring
for postural hypotension and making sure that the patient
does not become hypotensive from dehydration
• Assessing symptoms of fluid overload
 Medical Management:

Implanted Devices
• Some patients with ECG abnormalities may
benefit from a biventricular pacemaker, which
helps both ventricles contract at the same time
(CRT, cardiac resynchronization therapy).
• A defibrillation device such as an implantable
cardioverter-defibrillator (ICD) helps some
patients. CRT and ICD may be combined and
implanted in a single device (biventricular
pacemaker-ICD).
Transplant
• A patient with severe heart failure that does
not respond to these therapies may require a
heart transplant.
• A number of studies have shown that heart
failure symptoms can be improved with a
special type of pacemaker. It paces both the
right and left sides of heart.
• This is referred to as biventricular pacing or
cardiac resynchronization therapy. Ask your
provider if you are a candidate for this.
• In very severe cases, when medicines alone do not work,
a heart pump (ventricular assist device) can be implanted.
A heart transplant may be needed.
 
• Management also includes, lifestyle changes such as
stopping drinking alcohol, taking maintenance medicines
for high blood pressure. In severe cases, medicines are
given through a vein.

• When heart function decreases significantly, a defibrillator

may be recommended to prevent sudden cardiac death. A
defibrillator is used to prevent dangerous heart rhythms,
which often occur in people with very weak hearts.
 The End
Thank You for Listening!