Congestive Heart Failure

Congestive Heart Failure

1. Pathophysiology

   • Ventricular Failure
     • Systolic Failure
       • Cardiomyopathy
       • Inability of heart to pump blood
       • Impaired contractile function
       • Increased afterload (hypertension)
       • Mechanical abnormailites (valvular heart disease)
     • Diastolic failure
       • Decrease in stroke volume
       • High filling pressure
       • Venous engorement
         • In both pulmonary and systemic vascular systems
   • Cardiac output interference

2. Causes of Heart failure

   • F
     • Faulty Heart Valves, Valvular disorders
     • A
       • Arrhythmias (A-Fib or Tachycardia), (dysrthymias)
       • I
         • Infarction - MI, CAD, Ventricular septal defect
         • L
           • U
             • R
               • E
                 • Evaders (viruses or infections) Myocarditis, Bacterial endocarditis
               • Rheumatic heart disease, Rupture of papillary muscle, recreational use (cocaine and excessive alcohol use)
             • Uncontrolled Hypertension
           • Lineage - Congenital, Family history

3. Types of Heart failure

   • Right sided heart failure
     • Causes
       • Left sided failure
       • Cor pulmonaale
       • Right ventricular infarcation
     • Effects
       • backward blood flow to right atrium
       • Hepatomegaly
       • Jugular distension
     • Signs and symtoms
       • Signs - Peripheral edema, weight gain, increase heart rate, ascites, right side pleural effusion, JV distension, murmurs
       • Symtoms- Fatigue, dependent edema, right upper quadrant pain, Anorexia and GI bloating, nausea
   • Left sided heart failure
     • Causes
       • Left ventricular dysfuncation
     • Effects
       • Blood back ups to the left atrium
       • Pulmonary congestion
     • Signs and symptoms
       • Signs - LV heaves, Cheyne-strokes respirations, Pulsus alternans, increases heart rate, LV hypertrophy, S3 & S4, crackles, decreased partial oxygen pressure, and decreased partial carbon dioxide pressure, Central apnea
       • Symptoms- Fatigue, Dyspnea, Orthopnea, Dry hacking cough, Pulmonary edema, Nocturia, Paraoxysmal nocturnal dyspnea

4. Risk factors

   • Modifiable
     • Hypertension
     • Excessive alcohol consumption
     • Obesity
     • Diabetes
   • Non- Modifiable
     • 65 years and older ()
     • Family history
     • Renal failure
     • Women
     • Africans

5. Diagnosis

   • Physical examination
     • Dyspnea on exertion
     • Decreased blood pressure
   • Chest radiograph
   • Electrical cardiograph
   • 2-dimensional echocardiogram coupled with doppler flow studies (Fletcher, L., & Thomas, D. (2001)
   • natriuretic peptide measurement (Fletcher, L., & Thomas, D. (2001)
   • Hemodynamic monitoring
   • Elevated BUN and Creatinine
   • Cardiac enzymes, (Fletcher, L., & Thomas, D. (2001)
   • Complete blood count (Fletcher, L., & Thomas, D. (2001)
   • History

6. Treatments

   • Pharmacologic
     • Medications that decrease the load on heart
       • Diuretics
       • ARBS
       • Vasofilators
       • ACE inhibtors
       • Aldosterone antagonist
     • Medications that increases the function of the heart
       • Calcium channel blocker
       • Beta Blockers
       • Intotropics
       • Digoxin
     • Medications for pain managment
       • Morphine
   • Non- Pharmacologic
     • Decrease sodium intake - (2-3 g) per day (Fletcher, L., & Thomas, D. (2001)
     • Fluid restriction - 1.5-2 L per day (Fletcher, L., & Thomas, D. (2001)
     • Excerise
     • Smoking cessation and Alcohol reduction if CHF is due to this (Fletcher, L., & Thomas, D. (2001)

7. Collaborative Care

   • Physicians
     • Cardiologists
     • Surgeons
     • Family doctors
   • Nurses
     • Providing medications to alleviate symptoms
     • Treating underlying cause
       • O2 Therapy
       • Rest
       • Medications
       • Decrease anxiety
   • Dietians
     • Educate
       • Sodium intake
       • Fluid intake
       • Daily weight checks

8. Nursing interventions

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