Congestive heart failure

Congestive heart failure

outlines
 Definition
 Causes and pathophysiology
 Types of heart failure
 Compensatory mechanism of heart
failure
 Clinical manifestations
 Classification of heart failure
 Diagnostic evaluation
 Medical management
 Nursing management
 Congestive heart failure
Definition

Heart failure describes the clinical

syndrome that develops when the
heart cannot maintain an adequate
cardiac output. The heart pumps
blood inadequately, leading to
reduced blood flow, back-up
(congestion) of blood in the veins and
lungs, and other changes that may
further weaken the heart.
Causes of congestive heart
failure
Coronary artery disease
Heart attack

High blood pressure

Heart valves disorders

Inflammation of Heart muscle

(myocarditis, cardiomyopathy)
Causes of congestive heart failure
(cont…)
 Severe lung disease ( pulmonary
hypertension)
 Severe anemia

 Overactive thyroid gland

(hyperthyroidism)
 Underactive thyroid gland
(hypothyroidism)
 Abnormal heart rhythms ( atrial
fibrillation)
 Kidney failure
 Congestive heart failure
Types
 Left-sided heart failure
 There are two types of left-
sided heart failure
 Systolic dysfunction

 Diastolic dysfunction

 Right-sided heart failure

 Congestive heart failure
Compensatory Mechanisms of heart failure

 Renin-angiotensin-aldosterone
system
 Sympathetic nervous system
 Enlargement of the muscular
walls of the ventricles
(ventricular hypertrophy).
 Congestive heart failure
Clinical manifestations
 Symptoms (back up of blood and fluid)
 Dyspnea

 Orthopnea

 Reduced exercise tolerance,

lethargy, fatigue
 Nocturnal cough

 Wheeze

 Ankle swelling

 Anorexia
 Congestive heart failure
Clinical manifestations ( cont…)
 Signs
 Cachexia and muscle wasting
 Tachycardia
 Pulsus alternans
 Elevated jugular venous pressure
 Crepitations or wheeze
 Third heart sound
 Oedema
 Hepatomegaly (tender)
 Ascites
 Congestive heart failure
Classification of heart failure
New York Heart Association (NYHA) Functional Classification

Class % of patients Symptoms

I 35% No symptoms or limitations

in ordinary physical activity

II 35% Mild symptoms and slight

limitation during ordinary
activity

III 25% Marked limitation in activity

even during minimal
activity. Comfortable only at
rest

IV 5% Severe limitation.
Experiences symptoms even
at rest
 Congestive heart failure
Diagnostic evaluation
 Patient history
 Physical examination
 Diagnostic studies
1. Electrocardiography (ejection fraction)

2. Radionuclide

3. magnetic resonance
4. computed tomography imaging

5. cardiac catheterization with

angiography
6. a biopsy of heart muscle is needed
 Congestive heart failure
Treatment
 lifestyle change
1. Salt restriction
2. Exercises
3. Smoking and alcoholism
4. Body weight (daily weight)
5. Supportive stockings
 Congestive heart failure
Treatment (cont…)
 Drug management
 Angiotensin-converting enzyme (ACE)
inhibitors
 Angiotensin II receptor blockers
 Beta-blockers
 Other vasodilators ( nitroglycerin)
 Cardiac glycosides (digoxin)
 Aldosterone receptor blockers (spironolactone)
 Loop diuretics
 Congestive heart failure
Treatment (cont…)
 Potassium-sparing diuretics
 Thiazide and thiazide-like diuretics

 Anticoagulants (heparine)

 Opioids (morphine) to relieve anxiety

 Positive inotropic drugs (drugs that

make muscle contract more
forcefully) (dopamine)
 Oxygen for pulmonary edema is required
 Congestive heart failure
Treatment (cont…)
 Non pharmacological management of heart failure (surgical
intervention)

 Coronary artery bypass grafting (

revascularization)
 Percutaneous coronary intervention
(Angioplasty)
 Valve replacement
 Biventricular pacemaker
 Heart transplantation
 Left ventricular assist device (LVAD)
 Nursing care of patients with
congestive heart failure
 Maintain the patient in high fowler's
position
 Elevate extremities except when the
patient is in acute distress
 Frequently monitor vital signs

 Change position frequently

 Monitor intake and output and daily

weight
 Nursing care of patients with
congestive heart failure (cont…)
 Restrict fluids as ordered

 Teach the patient and family and provide

emotional support (life style change)

 Explain the side effect of diuretic medications

for additional actions ( side effects of
diuretics include electrolyte imbalance,
symptomatic hypotension

 Use aseptic procedures when caring for

invasive lines