CONGESTIVE

CARDIAC
FAILURE
 HEART FAILURE
HF is the inability of the heart to pump sufficient blood to
meet the needs of the tissues for oxygen and nutrients.
• Characterized by signs and symptoms of fluid overload or of
inadequate tissue perfusion.
• Fluid overload and decreased tissue perfusion result when the
heart cannot generate a CO sufficient to meet the body’s
demands.
• The term HF indicates myocardial disease in which there is a
problem with contraction of the heart (systolic dysfunction) or
filling of the heart (diastolic dysfunction) that may or may not
cause pulmonary or systemic congestion.
 TYPES
• The more common type is an alteration in ventricular contraction called
systolic heart failure, which is characterized by a weakened heart muscle.
• The less common type is diastolic heart failure, which is characterized by a
stiff and noncompliant heart muscle, making it difficult for the ventricle to
fill.
An assessment of the ejection fraction (EF) is performed to assist in
determining the type of HF.
EF is calculated by subtracting the amount of blood present in the left
ventricle at the end of systole from the amount present at the end of
diastole and calculating the percentage of blood that is ejected.
A normal EF is 55% to 65% of the ventricular volume; the ventricle does not
completely empty between contractions. The EF is normal in diastolic HF but
severely reduced in systolic HF.
 ETIOLOGY
• Coronary artery disease
• Cardiomyopathy
• Hypertension
• Valvular disorders
• Patients with diabetes mellitus are also at high risk for HF.
• Pneumonia
• Cardiac dysrhythmias
• Acidosis
• Electrolyte abnormalities
• Antiarrhythmic medications,
PATHOPHYSIOLO
GY
 CLINICAL
GENERAl MANIFESTATIONS
RESPIRATORY
• Fatigue • Dyspnea on exertion
• Decreased activity tolerance • Pulmonary crackles that do not clear
• Dependent edema with cough
• Weight gain • Orthopnea
• Paroxysmal nocturnal dyspnea (PND)
CARDIOVASCULAR • Cough on exertion or when supine
• Third heart sound (S3)
• Apical impulse enlarged with left lateral
displacement
• Pallor and cyanosis
• Jugular venous distention (JVD)
CEREBROVASCULAR GASTROINTESTINAL
• Unexplained confusion or altered • Anorexia and nausea
mental status •
• Light headedness Enlarged liver
RENAL •• Ascites
• Oliguria and decreased frequency Hepatojugular reflux
during the day
• Nocturia
 ASSESSMENT AND DIAGNOSTIC
FINDINGS
• Echocardiogram.
• Radionuclide ventriculography or invasively by ventriculography as part of a
cardiac catheterization procedure.
• Chest x-ray
• Electrocardiogram (ECG)
• Serum electrolytes,
• Blood urea nitrogen (BUN), creatinine,
• Thyroid-stimulating hormone
• Complete blood cell count,
• B-type natriuretic peptide, (BNP level is a key diagnostic indicator of HF; high
levels are a sign of high cardiac filling pressure and can aid in the diagnosis of HF )
• Routine urinalysis.
• Cardiac stress testing or cardiac catheterization
 MEDICAL
MANAGEMENT
Goals of management:
• To relieve patient symptoms, to improve functional status
and quality of life, and to extend survival. Medical
management is based on the type, severity, and cause of
HF.
Specific objectives of medical management include the following:
• Eliminate or reduce any etiologic contributory factors
• Optimize pharmacologic and other therapeutic regimens
• Reduce the workload on the heart
• Promote a lifestyle conducive to cardiac health.
• Prevent episodes of acute decompensated HF.
• Comprehensive education and counseling to the patient and
family
Lifestyle recommendations include:
• restriction of dietary sodium;
• avoidance of excessive fluid intake, alcohol, and smoking;
• weight reduction when indicated; and regular exercise.
 Pharmacological management
1. Angiotensin-converting enzyme (ACE) inhibitors- enalapril (Vasotec),
lisinopril (Zestril) and captopril (Capoten).
2. Angiotensin II receptor blockers- losartan (Cozaar) and valsartan
(Diovan)
3. Aldosterone antagonists- spironolactone (Aldactone)
4. Inotropes- improve heart pumping function and maintain blood pressure.
5. Hydralazine and Isosorbide Dinitrate
6. Beta-Blockers: eg; carvedilol (Coreg) and metoprolol (Lopressor,
Toprol),
7. Digoxin (Lanoxin).
8. Diuretics: Loop diuretics, eg; furosemide (Lasix),
Non-ꢀ
PharmacologicalꢀManagementꢀ
1. Maintainꢀinputꢀ&ꢀoutputꢀofꢀtheꢀpatientꢀ
2. Proppedꢀupꢀpositionꢀofꢀtheꢀpatientsꢀ
3.
Oxygenꢀsupportꢀshouldꢀbeꢀprovidedꢀtoꢀtheꢀp
atient.
SurgicalꢀManagement
1.Coronary
bypassꢀsurgeryꢀ
2.Heartꢀvalveꢀrepairꢀorꢀreplacement.ꢀ
3.Implantableꢀcardioverter-defibrillatorsꢀ
4.Cardiacꢀresynchronizationꢀtherapyꢀ(CRT),ꢀorꢀbiventricular
ꢀpacingꢀ
5.
6.Ventricularꢀassistꢀdevicesꢀ(VAD)ꢀ
Heartꢀtransplant
 NURSINGꢀMANAGEMENT
• ꢀ
Decreasedꢀcardiacꢀoutputꢀrelatedꢀtoꢀchangesꢀinꢀmyocardialꢀcont
• Ineffectiveꢀ breathingꢀ patternꢀ relatedꢀ toꢀ insufficientꢀ supplyꢀ
ractilityꢀ
ofꢀ blood.
oxygenatedꢀ
•ꢀ
Excessꢀfluidꢀvolumeꢀrelatedꢀtoꢀdecreasedꢀglomerularꢀfiltrationꢀra
teꢀ(GFR).ꢀ
• ActivityꢀintoleranceꢀrelatedꢀtoꢀdecreaseꢀCO.ꢀ
•• Anxietyꢀrelatedꢀtoꢀbreathlessnessꢀfromꢀinadequateꢀoxygenation.ꢀ
Ineffectiveꢀ therapeuticꢀ regimenꢀ managementꢀ relatedꢀ toꢀ
•lackꢀ
knowledge.
Powerlessnessꢀrelatedꢀtoꢀchronicꢀillnessꢀandꢀhospitalizations.ꢀ
ofꢀ
ꢀ
 COMPLICATIO
•N
Sꢀ
Kidneyꢀdamageꢀorꢀfail
ure
•
Heartꢀvalveꢀproblems.ꢀ
•
Heartꢀrhythmꢀproblems.
ꢀ
• Liverꢀdamage.
 HEALTHꢀEDUCATIONꢀ
• SmokingꢀCessationꢀ •
• Maintainꢀaꢀhealthyꢀweig
Discussꢀweightꢀmonitoring
• ht.ꢀ
.ꢀ swellingꢀdaily
Checkꢀlegs,ꢀanklesꢀandꢀfee •
.ꢀ
•tꢀforꢀ Limitꢀfatsꢀandꢀcholester
•
Eatꢀaꢀhealthyꢀdi
• ol.ꢀ
sleep
Reduceꢀstressꢀ&ꢀgetꢀpr
water
et.ꢀ
Restrictꢀsaltꢀinꢀyourꢀdietꢀ •operꢀ
ꢀ
&ꢀlimitꢀ Limitꢀalcoholꢀandꢀfluids.
ꢀ
• Activeꢀlifestyleꢀ