HEART FAILURE

when the heart cannot pump enough blood to meet the body's metabolic needs

Common to all HF pts:

Chronic, progressive changes to the heart that result in declining pumping ability

HEART FAILURE

cont.

more people are living longer w/Heart disease so the incidence of develping may be higher

INCREASE RISKS:

Aging

DM

Obesity

Hyperlipidemia

ETOH/alcohol abuse

Prognosis depends on nature of underlying heart disease & whether or not the cause can be identified & TX.

CLASSIFICATION

of

HEART FAILURE

Systolic vs. Diastolic

Left vs. Right

Acute vs. Chronic

Compensatory

Mechanisms

Activation of the sympathetic nervous system

*releases catecholamines to increase HR, myocardial contractility, & perpheral vasoconstriction.

*Stroke volume (SV) increases to maintain Cardiac output

compensatory mechanisms of HF over time

SYMPATHETIC STIMULATION

can lead to

increased myocardial O2 consumption

ventricular hypertrophy

increased cardiac work load

which means...

DECREASED Cardiac output

compensatory mechanisms of HF over time

ACTIVATION

of

RENIN- ANGIOTENSIN-ALDOSTERONE

SYSTEM

DECREASED cardiac output leads to KIDNEYS to respond w/renin-angiotensin-aldosterone sysytem:

Causes:

INCREASED systemic vascular resistance

INCREASED Na+ & H2O absorption

-results in ehanced preload, afterload, & cardiac contractility

compensatory mechanisms of HF over time

RENIN-ANGIOTENSIN-ALDOSTERONE

Enhanced preload dilates the LEFT ventricle: eventually becomes over stretched

Ventricular contractility depresses

Congestive symptoms develop

CONSEQUENCES

of

COMPENSATORY
MECHANISMS

of

HEART FAILURE

elevation of pressure in the chambers of the heart

results in accumulation of blood in systemic & pulmonary veins

eventually results in congestion of organs drained by these veins

SYSTOLIC HEART FAILURE

(more common)

LEFT ventrical cannot contract adequately

PRELOAD INCREASES & STROKE VOLUME DECREASES

Pressure builds in PULMONARY VENOUS SYTEM

DIASTOLIC HEART FAILURE

(less common, but still 40% of people)

VENTRICULAR FILLING & relaxation during diastole is IMPAIRED

Occurs when hearts ability to relax DECREASES

EX. hypertension

Require higher volume of blood in VENTRICLES to maintain cardiac output

Causes PULMONARY congestion & PERIPHERAL EDEMA

LEFT SIDED HEART FAILURE

(Blood backs up into lungs)

LEFT ventricle stroke volume reduced

Blood backs up into the LEFT side of the heart & pulmonary circulation

Pulmonary pressure increases

RIGHT SIDEDE HEART FAILURE

(blood backs up into systemic circulation)

RIGHT ventricle cannot empty or blood backs up into it from the PULMOARY circulation

Bllod backs up into systemic circulation to cause LIVER congestion & peripheral EDEMA

S/SX

of

RIGHT SIDED HEART FAILURE

fatigue

diff. concentrating

edema & dependent edema

increased abd. girth

nocturia

JVD (jugular vein distension)

S/SX

of

LEFT SIDED HEART FAILURE

dyspnea

crackles

orthopnea (SOB when lying flat)

Paroxymal Nocturnal Dyspnea

(SOB @night, can wake pt)

cough

Cheyne Stoke breathing

(abnormal breathing pattern=deeper; sometimes faster w/periods of apnea)

weakness

fatigue

diif. concentrating

palpitations

decreased exercise tolernce

NSG

Assesment

of pt.'s

HEART FAILURE

ASSESS:

GENERAL:

 fatigue

decreased activity intolerance

dependent edema

wt gain

CARDIO:

3rd heart sound (S3)

apical impulse enlarged w/left lateral displacement 

pallor & cyanosis

 Jugular vein distention (JVD)

RESP:

 dyspena on exertion

 pulmonary crackles that do not clear w/cough

 orthopnea

 paroxymal nocturnal dyspnea (PND)

 cough on exertion or when supine

CEREBROVASCULAR:

 unexplained confusion or altered mental status 

lightheadedness

RENAL:

 oliguria & decreased freq. during the day

 nocturia

GASTRO:

 anorexia

 nausea

 enlarged liver (right sided)

 ascites (accumulation of serous fluid in peritoneal cavity)

 hepatojular reflux

(distention of neck veins precipiated by the firm pressure on liver)

DX TESTS
of

HEART FAILURE

chest xray

ECG

echocardiogram

radionuclide studies

serum bilirubin, BNP assay, ABGs

cardiac enzymes

liver enzymes

pulmonary artery catheters

TX

for

HEART FAILURE

clients

aim to relieve symptoms & improve exercise tolerrnace

do this with:

rest

reduced PRELOAD

reduced AFTERLOAD

improve cardiac contractility

TX of HEART FAILURE:

cont.

REDUCE PRELOAD:

Na+ & H2O restriction

Diuretics

Vasodilators

REDUCE AFTERLOAD:

Ace inhibitors

beta blockers

vasodilators

IMPROVE CARDIAC CONTRACTILITY:

DIGOXIN (Digitalis)

-Dig toxicity of concern

S/SX

of

DIGOXIN (DIGITALIS) TOXICITY:

CARDIO:

bradycardia

tachycardia

Bigeminy: arrhythmia; abnormal heart beats occur every other concurrent beat.

Ectopic beats: beats occur outside regions of the heart.

Pulse deficit: deficit b/t count of HR & pulse rate.

GASTRO:

anorexia

N/V/D

abd. pain

NEURO:

HA

double vision

blurred or colored vision

drowsiness

confusion

restlessness

irritability

muscle weakness

TREATMENT of HF

in

addition to MEDS.

Rest & activity:

encourage to be as active as possible

divide tasks to min. resp. distress/diff. or extreme fatigue

Oxygenation:

positioning

O2 & O2 monitoring

ABGs

Fluid & Nutrition:

daily wts

monitor I/O (may have foley)

may need fluid restriction

monitor LS

assess for edema

monitor electrolyte changes (esp., when on diuretics)

Na+ restricted diet, when fluid retention is a prob.

avoid excessive fluid intake (about 2L a day)

Altered health maintenance

R/T

knowledge deficit

of

HEART FAILURE

what to teach:

explain S/SX of worsening HF

discuss exercise programs

teach about meds

teach about specific diet & fluid restrictions

*simple clear explaination about patho of HF.