CONGESTIVE CARDIAC FAILURE

Anju Rachel Jose

 Introduction
• It is characterized by the heart’s inability to
pump an adequate supply of blood to the
body.
• Without sufficient blood flow, all major body
functions are disrupted.
 Definition
• It is a clinical syndrome resulting from structural
or functional cardiac disorders that impair the
ability of the ventricles to fill or eject blood.
Brunner and Suddarth
• It is a physiologic state in which the heart
cannot pump enough blood to meet the
metabolic needs of the body
Black and Hawks
 Incidence
• Worldwide 2 crore people are affected by
heart failure.
• Approximate 2 % prevalence in developed
countries.
• Women have better survival than men.
• Coronary artery disease is the major cause for
heart failure. (60 – 75%)
 Etiology
 Abnormal volume load
 Abnormal pressure load
 Myocardial abnormalities
 Toxic disorders
 Filling disorders
 Increased metabolic demand
 Risk factors
• Major risk factors
• Minor risk factors
• Toxic precipitants
 Classification
• Based on ejection fraction
 Heart Failure with reserved Ejection Fraction
HFrEF – Ejection fraction ≤ 40% . – These
patients will have systolic dysfunction and
concomitant diastolic dysfunction. Coronary
artery disease is the major cause.
 Classification(contd)
 Heart Failure with Preserved Ejection Fraction
HFpEF – Ejection Fraction 40 – 50%.
–These patients can be diagnosed by 1)clinical
signs and symptoms and 2)evidence of pEF or
normal EF or previously rEF 3)evidence of
abnormal LV diastolic dysfunction (echo / LV
catheterisation)
 Classification(contd)
• Based on cardiac output
 HIGH OUTPUT FAILURE- – The normal heart
fails to maintain normal or increased output in
conditions like anemia, hyperthyroidism,
pregnancy. – Usually right sided failure occurs
followed by left sided failure with presence of
shortened circulatory time
 Classification(contd)
LOW OUTPUT FAILURE – Heart fails to
generate adequate output in conditions like
cardiomyopathy, valvular heart disease,
tamponade and bradycardia.
 Classification(contd)
 Right sided heart failure is characterised by the
presence of peripheral edema, raised JVP and
hypotension and congestive hepatomegaly.
 Left sided heart failure – pulmonary edema is the
striking feature. Other signs are tachypnea,
tachycardia, third heart sound, pulsus alternans,
cardiomegaly.
 Congestive Cardiac Failure – Characterised by
combination of both left and right sided heart failure.
 Classification(contd)
• Based on NYHA classification
• Stage 1 – no limitation of ordinary physical
activity.
Stage 2 – slight limitation of ordinary physical
activity.
Stage 3 – marked limitation of ordinary physical
activity, but comfortable at rest.
 Stage 4 – unable to carry out physical activity,
symptomatic at rest.
 Classification(contd)
• Based on ACCF/ AHA classification
Stage A – At high risk of HF but witout structural
hear disease.
 Stage B – Structural heart disease without signs
or symptoms of HF.
Stage C – Structural heart disease with prior HF
or current HF.
Stage D – Refractory HF requiring special
interventions.
Pathophysiology
Clinical manifestations
Diagnosis
 Complications
• Pleural effusion
• Dysrhythmias
• Left ventricular thrombus
• Hepatomegaly
• Renal failure
Management
 Pharmacological
• Diuretics
• Vasodilators
• ACE inhibitors
• Nitrates
• Human B type natriuretic peptide
 Contd…
• Beta adrenergic blockers
• Digitalis glycosides
• Beta adrenergic agonists
• Angiotensin 2 receptor blockers
• Calcium sensitizers
Non pharmacological management
 Bed rest
 Consuming small but frequent meals
 Moderate sodium restriction (2-4g/day)
 Smoking cessation
 Avoid alcohol intake
 Surgical management
• Cardiac transplantation

• Device therapy
• Biventricular pacing
• ICD’s
Nursing Management
 Nursing management
• Decreasing intravascular volume
• Decreasing venous return
• Decreasing afterload
• Improving gas exchange and oxygenation
• Improving cardiac function
• Reducing anxiety
 Prognosis
• • Annual mortality rate depends on patients
symptoms and LV function
• • 5% in patients with mild symptoms and mild
↓ in LV function
• • 30% to 50% in patient with advances LV
dysfunction and severe symptoms
• • 40% – 50% of death is due to SCD
Conclusion
 Bibliography
• Lewis’s, “Medical surgical nursing”south Asian edition,
Elsevier publications
Page no: 820-838.
• Susan L Woods, “cardiac nursing”, 6th edition, LWW
publications
Pageno: 555-578
• Brunner and Suddarth,”Textbook of medical surgical
nursing”, volume-1, South asia edition, Kluwers
publication
Page no:612-629