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Heart failure

Heart failure taht ,noitidnoc caidrac a si
eht htiw melborp a nehw sruccostructure
rofunction ytiliba sti sriapmi traeh eht fo
eht teem ot wolf doolb tneiciffus ylppus ot
eruliaf traeh fo esuac sdeen s'ydob
Heart failure
Cardiac arrest, and asystole both refer to
situtations in which there is no caidrac
,tnemtaert tnegru tuohtiW .lla ta tuptuo
.htaed neddus ni tluser eseht
 Heart attack refers to a blockage in a
coronary (heart) artery resulting in heart
muscle damage .
 Cardiomyopathy

causes
Valvular dysfunction
 Infection( myocarditis or endocarditis)
 Uncontrolled hypertention

causes

Heart failure caused by systolic
dysfunction is more readily recognized .
It can be simplistically described as failure
of the pump function of the heart.
 It is characterized by a decreased
ejection fraction (less than ehT .)45%
si noitcartnoc ralucirtnev fo htgnerts
na gnitaerc rof etauqedani dna detaunetta
ni gnitluser ,emulov ekorts etauqeda
.tuptuo caidrac etauqedani

Systolic dysfunction

In general, this is caused by dysfunction
or destruction of cardiac myocytes or their
molecular components
Because the ventricle is inadequately
emptied, ventricular end-diastolic
pressure and volumes increase. This is
transmitted to the atrium .
 On the left side of the heart, the
increased pressure is transmitted to the
pulmonary vasculature, and the resultant
hydrostatic pressure favors extravassation
of fluid into the lung parenchyma, causing
pulmonary edema


.On the right side of the heart, the
increased pressure is transmitted to the
systemic venous circulation and systemic
capillary beds, favoring extravassation of
fluid into the tissues of target organs and
extremities, resulting in dependent
peripheral edema

Heart failure caused by diastolic
dysfunction is generally described as the
failure of the ventricle to adequately relax
and typically denotes a stiffer ventricular
wall.
Diastolic dysfunction

This causes inadequate filling of the
ventricle, and therefore results in an
inadequate stroke volume eruliaf ehT .
noitaxaler ralucirtnev foalso results in
elevated end-diastolic pressures, and the
end result is identical to the case of
systolic dysfunction (pulmonary edema in
left heart failure, peripheral edema in
right heart failure .
Diastolic dysfunction

]Left-sided
failure

Backward sesuac elcirtnev tfel eht fo eruliaf
eht os dna ,erutalucsav yranomlup eht fo noitsegnoc
erutan ni yrotaripser yltnanimoderp era smotpmys

dyspnea (shortness of breath) on exertion (dyspnée
d'effort.tser ta aenpsyd ,sesac ereves ni dna )

Increasing breathlessness called orthopnea, occurs.
It is often measured in the number of pillows required
to lie comfortably, and in severe cases, the patient
may resort to sleeping while sitting up.
Diagnostic criteria

paroxysmal nocturnal dyspnea, a sudden
nighttime attack of severe breathlessness,
usually several hours after going to sleep.

Easy fatigueability and exercise
intolerance are also common complaints
related to respiratory compromise


Right-sided failure
Backward elcirtnev thgir eht fo eruliaf
.seirallipac cimetsys fo noitsegnoc ot sdael
diulf ssecxe etareneg ot spleh sihT
.ydob eht ni noitalumucca

This causes swelling under the skin
(termed peripheral edema or anasarca)
and usually affects the dependent parts of
the body first (causing foot and ankle
swelling in people who are standing up,
and sacral edema in people who are
predominantly lying down.)
Diagnostic criteria
In progressively severe cases:,
 ascites (fluid accumulation in the
abdominal cavity causing swelling)
 hepatomegaly (painful enlargement of the
liver) may develop .
 Significant liver congestion may result in
impaired liver function, and jaundice and
even coagulopathy (problems of
decreased blood clotting) may occur .


I Ordinary physical activity does not
cause undue fatigue, dyspnea,
palpitations, or chest pain
No pulmonary congestion or peripheral
hypotension Patient is considered
asymptomatic .
Usually no limitations of activities of daily
living (ADLs)
Classification Symptoms

II
Slight limitation on ADLs
Patient reports no symptoms at rest but
increased physical activity will cause
symptoms .Basilar crackles and S3
murmur may be detected
Classification Symptoms
III Marked limitation on ADL
Patient feels comfortable at rest but less
than ordinary activity will cause
symptoms Fair Prognosis
 IV Symptoms of cardiac insufficiency at
rest .poor prognosis

Classification Symptoms
Sympathatic nervouse system
 RAAS (rennin angiotonsin -aldesteron
system

Neurohormonal compensatory
mechanism in heart failure

signs and symptoms of pulmonary and
peripheral edema. However, the physical
signs that suggest HF may also occur with
other diseases, such as renal failure, liver
failure, oncologic conditions, and COPD
Assessment and Diagnostic
Findings
An echocardiogram is usually performed
to confirm the diagnosis of HF:
help identify the underlying cause, and
determine the EF , helps identify the type
and severity of HF
 invasively by ventriculography as part of a
cardiac catheterization procedure.

Assessment and Diagnostic
Findings

A chest x-ray and an electrocardiogram
(ECG) are obtained to assist in the
diagnosis and to determine the underlying
cause of HF.
Assessment and Diagnostic
Findings
Pharmacological Treatment



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
ACEI
Hydralazine
Nitrates
Digoxin
Diuretics
Beta blockers

Angiotensin-modulating agents
ACE inhibitor (ACE) therapy is recommended
for all patients with systolic heart failure,
irrespective of symptomatic severity or blood
pressure
ACE inhibitors improve symptoms, decrease
mortality and reduce ventricular hypertrophy
Pharmacological management

Diuretics
Diuretic therapy is indicated for relief of congestive
symptoms. Several classes are used, with
combinations reserved for severe heart failure
Loop diuretics
e.g .Furosemide –most commonly used class in
CHF, usually for moderate CHF .
Thiazide diuretics (e.g .Hydrochlorothiazide, –may
be useful for mild CHF, but typically used in
severe CHF in combination with loop diuretics
Spironolactone is used as add-on therapy to ACEI
plus loop diuretic in severe CHF
Beta blockers
a β-blocker can decrease mortality and
improve left ventricular function. Several
β-blockers are specifically indicated for
CHF including: carvedilol
 Positive inotropes
Digoxin ( for control of ventricular rhythm
in patients with atrial fibrillation; or where
adequate control is not achieved with an
ACEI, a beta blocker and a loop diuretic .

management
Nursing Diagnoses
Decreased Cardiac Output related to
altered preload
 Decreased Cardiac Output related to
altered contractility
 Decreased Cardiac Output related to
altered heart rate
 Decreased Activity Tolerance related to
decreased cardiac output and
deconditioning
