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Heart Failure
BY: Shannon, Mi r anda, & N oel l e
He a r t A n a t o m y
Type something
(Anatomy of a Human Heart 2019)
Ca r di a c S y s t e m O v e r v i e w
SA Node
"Each day, the average human heart beats about 100,000
times, pumping 2,000 gallons of blood through the body"(An atom y
Vagus Nerve Innervation
AV Node
Bundle of HIS
Bundle Branches
of a Hu m an Heart 2 0 1 9 ).
of
SA & AV Nodes
Purkinje Fibers
The Coronary Art eries:


Normal Cardiac Vitals:
Provi de the hea rt ti ssue wi th bl ood/nutri ents/O2
Pulse:
RT, LT Ma i n, Ci rcumfl ex, & LT a nteri or descendi ng corona ry
BP:
a rteri es
CO:
60-100 BPM
90/60 mmHg - 120/80 mmHg
5-6 Liters per minute
(Vitalsigns:MedlinePlusMedicalEncyclopedia2021)
Types of Heart Failure:
1.
LT- Sided HF
2.
RT - Sided HF
Pericardium - a sac that surrounds the heart
3.
Congestive HF
(Typesof Heart Failure
References
Cardiac Output. (2019, December 15). Retrieved January 31, 2021, from
https://www.uofmhealth.org/health-
library/tx4080abc#:~:text=What%20is%20a%20normal%20cardiac,when%20a%20person%20is%2
0resting.
Medicine, M. (2019, February 27). Anatomy of a Human Heart. Retrieved January 31, 2021, from
https://healthblog.uofmhealth.org/heart-health/anatomy-of-a-human-heart
Types of Heart Failure. (2017, May 31). Retrieved January 31, 2021, from
https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure
Vital signs: MedlinePlus Medical Encyclopedia. (2021, January 05). Retrieved January 31, 2021, from
https://medlineplus.gov/ency/article/002341.htm#:~:text=Normal%20vital%20sign%20ranges%
20for,to%20100%20beats%20per%20minute
Heart Failure Pathophysiology
Heart Failure: CO < Demand
The heart cannot pump enough blood out to the tissues.
Ventricular failure, MI, valvular issues, hypertrophy cardiac muscle,
arrhythmias
Compensatory Mechanisms

SNS
- baroreceptors, sense low BP, catecholamines, INCREASES: HR, SV,
CO &
contraction
LONG TERM = DAMAGING/exacerbate HF

RAAS
- low BP, renal detection, RAAS triggered, vasoconstriction, salt, and
fluid retention
LONG TERM = cardiac dysfunction/remodeling
(Heart failure 1: pathogenesis, presentation and diagnosis 2019)
(Heart failure 1: pathogenesis, presentation and diagnosis 2019)
Heart Failure Classes
No physical activity limitation, no
No evidence of cardiovascular
I
dyspnea, SOB, palpitations w/ physical
A
disease and no symptoms
activity
Slight limitation on physical activity,
Objective evidence of minimal
II
dyspnea, SOB, fatigue, palpitations w/
B
cardiovascular disease, Mild symptoms
physical activity, Comfortable @ rest
III
Marked limitation on physical activity,
Objective evidence of moderately severe
easy to dyspnea, SOB, palpitations, fatigue,
cardiovascular disease, marked physical
C
Comfortable @ rest
limitation due to symptoms
Evidence of severe cardiovascular disease,
Unable to carry on physical activity
severe symptoms, severe physical limitations,
IV
w/o discomfort, symptoms of HF @ rest
(Classes of Heart Failure 2017)
D
symptoms even @ rest
References
Classes of Heart Failure. (2017, May 31). Retrieved February 01, 2021, from
https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-
of-heart-failure
Contributor, N. (2019, August 05). Heart failure 1: Pathogenesis, presentation and
diagnosis. Retrieved January 31, 2021, from https://www.nursingtimes.net/clinical-
archive/cardiovascular-clinical-archive/heart-failure-1-pathogenesis-presentation-and-
diagnosis-21-08-2017/
Heart Failure Diet
Dietary Approach to Stop
Hypertension eating plan
Low Sodium
Low Saturated Fat
More Fruits & Veggies
Studies have shown that following
Whole grains, fish, poultry and nuts.
"Following the reduced-sodium DASH diet plan can lead to an 8% increase in ejection fraction & stroke volume"
(Butler et al., 2018 )
Heart Failure Diet:
Sodium & Fluid Restrictions
Eating too much sodium or drinking too much fluid can increase the
body's water content causing the heart to work harder
(UCSF, 2021)
Fluid intake should be limited to 64oz per day to prevent fluid
retention
(American Heart Association, 2021a)
Limit Sodium intake to 1500mg a day
(Mayo Clinic, 2021)
"One portion of prefabricated food can contain as much as the whole
daily recommended intake of sodium"
(Philipson et al, 2010)
Chronic Heart Failure Actvity Level
Research shows that being active helps people living with heart failure by:
Improving Moods
Reducing Symptoms
Increasing the Heart's
Ability to Pump Blood
(American Heart Association, 2021a)
Heart Failure:
Recommended Physical Activity
Low-intensity Activity 5-10 minutes 3x/Week
Casual Walking,
Pedaling
Light House Work,
Water Aerobics,
Stationary Bike
(National Heart Lung and Blood Institute, 2007)
Stretching Exercises 3x/Week
Torso,
Neck,
Hip,
Hamstring
(American Heart Association, 2021b)
References
Am e rican He art Association. (2021a). How can I im prove m y low e je ction fraction? Re trie ve d from https://www.he art.org/e n/he althtopics/he art-failure /diagnosing-he art-failure /how-can-i-im prove -m y-low-e je ction-fraction
Am e rican He art Association. (2021b). Stre tching and fle xibility e xe rcise s. Re trie ve d from https://www.he art.org/e n/he alth-topics/cardiacre hab/ge tting-physically-active /stre tching-and-fle xibility-e xe rcise s
Butle r, T., Ge orgousopoulou, E. N., & M e llor, D . (2018). D ie tary approache s for patie nts with he art failure and diabe te s. Practical D iabe te s,
35(4), 127– 130a. https://doi-org.blue cc.idm .oclc.org/10.1002/pdi.2179
M ayo Clinic. (2021). D ASH die t: He althy e ating to lowe r your blood pre ssure . Re trie ve d from https://www.m ayoclinic.org/he althylife style /nutrition-and-he althy-e ating/in-de pth/dash-die t/art20048456#:~ :te xt= The %20D ASH%20die t%20e m phasize s%20ve ge table s,sodium %20ve rsion%20of%20the %20die t
National He art and Blood Institute . (2007). Caring for your he art: Living we ll with he art failure . [Pam phle t].lth
Philipson H, Ekm an I, Swe dbe rg K, & Schaufe lbe rge r M . (2010). A pilot study of salt and wate r re striction in patie nts with chronic he art
failure . Scandinavian Cardiovascular Journal, 44(4), 209– 214. https://doi-org.blue cc.idm .oclc.org/10.3109/14017431003698523
U nive rsity of California San Francisco. (2021). D ie t and conge stive he art failure . Re trie ve d from
https://www.ucsfhe alth.org/e ducation/die t-and-conge stive -he art-failure
Pharmacology Therapies
Many Drug Classes Used to Treat HF
Multiple systems involved, multi-drug involvement, proven to prolong life, saved
lives, & improve heart function
HF Medication Types
> ACE (Angiotensin Converting Enzyme) Inhibitor
> Angiotensin II Receptor Inhibitors/Blockers (ARBs)
> Diuretics
> Beta-Blockers (Beta-Adrenergic Blocking Agents)
> Nitroglycerin
(Medications Used to Treat Heart Failure 2017)
ACE Inhibitors
NURSING Implications






Monitor BP and pulses
Assess PT for signs of
angioedema
W/ HF monitor:
Angiotensin-Converting Enzyme Inhibitor




Captopril (Capoten)
Enalapril (Vasotec)
Fosinopril (Monopril)
DRUG INTERACTIONS
Lisinopril (Prinivil, Zestril)
> CAUTION W/ Potassium sparing Diuretics
(e.g., spironolactone), Risk: HYPERKALEMIA
fluid overload
ACE Inhibitor: Action
dyspnea, lung sounds,
weight gain, JVD
Monitor daily
weights while




Angiotensin I
Angiotensin II
> ARB's: hypotension, syncope, hyperkalemia,
Monitor Renal function
Used in the management of HTN & HF
> Sacubitril/valsartan, increased risk of angioedema
Reduces BP and improves symptoms of HF
> Increase sensitivity to antidiabetic agents
SX: dizziness, drowsiness, fatigue, headache, insomnia, vertigo, weakness,
> Lithium: ACE increase concentration of Lithium
hypotension, edema, chest pain, and tachycardia
>DO NOT administer to pregnant patients
(Dalpoas & Samal, 2017)
taking this
(Vallerand & Sanoski, 2021).
medication
Angiotensin II Receptor Blockers (or Inhibitors)
NURSING Implications







Monitor BP and pulses
ARBs: Commonly Prescribed



Candesartan (Atacand)
Assess PT for signs of angioedema
Losartan (Cozaar)
DO NOT administer to pregnant
DRUG INTERACTIONS
Valsartan (Diovan)
patients
W/ HF monitor:
> CAUTION W/ Potassium sparing Diuretics
ARBs: Action
fluid overload




(e.g., spironolactone), Risk: HYPERKALEMIA
> ACE Inhibitors(concurrent): hypotension, syncope,
ARBs block Angiotensin II receptors - prevents vasoconstriction and aldosterone -
dyspnea, lung sounds,
hyperkalemia, monitor renal function
effects of angiotensin II
weight gain, JVD
NSAIDs and selective COX-2 Inhibitors increased
Prevent reabsorption of sodium and H2O
Monitor daily
risk of renal dysfunction
Lowers BP - Heart beneficial
weights while



SX: Dizziness, hypotension, hyperkalemia, cough, ANGIOEDEMA
taking this
May increase the effects ofamiodarone, fluoxetine,
phenytoin, rosiglitazone,
May
(Dalpoas & Samal, 2017)
hghghgh
Blocks
medication
(Dalpoas & Samal, 2017)
↑
levels and may
(Dalpoas & Samal, 2017)
sertraline
↑
and
the risk of
warfarin.
lithium
toxicity
Diuretics
Diuretics: Types
NURSING Implications










Lasix (furosemide)
Assess fluid status
Watch for edema, skin turgor, lung
sounds
DRUG INTERACTIONS


Bumex (bumetanide)
Increased risk of Hypotension w/
Esidrix (hydrochlorothiazide)
other antihypertensives
Aldactone (spironolactone)
Monitor BP and pulse
Increased fall risk in older adults
Do not administer before sleep
Assess electrolyte balance
Non-K+ sparing diuretics risk of hypokalemia
Diuretics: Action
w/ other diuretics, amphotericin B, laxatives,
corticosteroids
Lasix (furosemide):





Monitor ERYTHEMA MULTIFORME,
inhibits reabsorption of sodium and chloride in the loop of Henle/DRT
STEVENS-JOHNSON SYNDROME,
Promotes excretion of H2O, Na+, CI-, Mg2+, K+, Ca+
TOXIC EPIDERMAL NECROLYSIS, APLASTIC ANEMIA,
Aldactone (spironolactone):
Monitor daily
weights while
AGRANULOCYTOSIS (furosemide)
inhibition of Na+ renal reabsorption
K+ & H+ sparing (aldosterone receptor antagonist)
Use with
eplerenone
↑
ACE inhibitors, NSAIDs,
SX: blurred vision, dizziness, headache, vertigo, dehydration, hypocalcemia, hypochloremia,
taking this


risk of hyperkalemia
potassium supplements,
ARBs, potassium-sparing diuretics, ACE inhibitors, or
hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis, anorexia,
medication
constipation, diarrhea, dry mouth, dyspepsia,
↑
liver enzymes, nausea, pancreatitis, vomiting,
APLASTIC ANEMIA, AGRANULOCYTOSIS, ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, TOXIC
(Dalpoas & Samal, 2017)
EPIDERMAL NECROLYSIS
(Dalpoas & Samal, 2017)
↑
cyclosporine,
risk of hyperkalemia (spironolactone)
(Dalpoas & Samal, 2017)
Beta-Blockers
Beta-Blockers: Types
NURSING Implications



Monitor BP, ECG, & pulses
Monitor intake & output ratios/daily
DRUG INTERACTIONS





↑
↑
atenolol (Tenormin)
General anesthesia,
bisoprolol (Cardicor or Emcor)
may cause
metoprolol (Betaloc or Lopresor)
crackles/rales, weight gain, peripheral
edema, JVD)

Watch for aginal attacks
Beta-Blockers: Action



verapamil
risk of bradycardia when used with digoxin,
clonidine
hypotension may occur with other
antihypertensives, acute ingestion of
Blocks stimulation of beta-1 (myocardial)-adrenergic receptors
BP & HR, frequency of angina, w/ HF
phenytoin, and
myocardial depression
verapamil, diltiazem, or
propranolol
weights
Assess routinely for SX of HF (dyspnea,
↑
IV
cardio mortality,
alcohol, or


nitrates
Use cautiously w/in 14 days of MAOI use
Use with amphetamines, cocaine, ephedrine,
hospitalizations
Abrupt withdrawal =
life-threatening, hypertension, arrhythmias, myocardial ischemia
epinephrine, norepinephrine, phenylephrine, or
pseudoephedrine
may result in unopposed
alpha-adrenergic stimulation
(Dalpoas & Samal, 2017)
SX: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental
status changes, nervousness, constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence,
gastric pain, heartburn,
↑
liver enzymes, nausea, vomiting, hypotension, peripheral
(excessive hypertension, bradycardia)

Use of insulins and thyroid medications may
alter effectiveness
vasoconstriction, BRADYCARDIA, HF, PULMONARY EDEMA
(Dalpoas & Samal, 2017)
Nitroglycerin
Nitroglycerin



DRUG INTERACTIONS
Pharmacologic Class: Nitrates
NURSING Implications

Therapeutic Effect: relief OR prevention of anginal attacks,
Assess location, duration, quality, the
Concurrent use of avanafil, sildenafil,
CO,
Management of angina pectoris
intensity of PTs anginal pain

May cause falsely
↑
serum cholesterol
Nitroglycerin: Action
↑





Coronary blood flow; dilating coronary arteries
Vasodilation (more venous VS. arterial)
urine catecholamine and
urine vanillylmandelic acid concentrations
Excessive doses may cause
tadalafil, or vardenafil contradicted (severe
hypotension)


(severe hypotension)
Improves collateral flow to ischemic regions
levels
May cause
BP
Concurrent use of riociguat contradicted
Monitor BP and pulses; IV requires ECG




↑
LT ventricle end-diastolic pressure & preload
Myocardial O2 consumption
Antihypertensives, alcohol, beta-blockers,
calcium channel blockers, haloperidolOr
phenothiazines (additive hypotension)

Anticholinergics (tricyclic antidepressants,
antihistamines, phenothiazines)
may
↓
absorption of TL or SL nitroglycerin
methemoglobin concentrations
SX: dizziness, headache, apprehension, restlessness, weakness, hypotension,
tachycardia, syncope, abdominal pain, nausea, vomiting
(Dalpoas & Samal, 2017)
(Dalpoas & Samal, 2017)
(Dalpoas & Samal, 2017)
References
Auty R. (2004). Pharmacological management of chronic heart failure in adults: a
review of the literature. Malawi medical journal : the journal of Medical Association of
Malawi, 16(1), 22–26.
Dalpoas, S., & Samal, L. (2017, May 3). ACE inhibitors: Johns Hopkins Diabetes Guide.
Retrieved February 01, 2021, from
https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Diabetes_Guide/54
7002/all/ACE_inhibitors
Medications Used to Treat Heart Failure. (2017, May 31). Retrieved January 31, 2021,
from https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-
heart-failure/medications-used-to-treat-heart-failure
Vallerand, A. H., &amp; Sanoski, C. A. (2021). Davis's drug guide for nurses
(Seventeenth ed.). Philadelphia, PA: F.A. Davis Company.
Treatments & Other Therapies
Smoking Cessation
"Cigarette smokers are 2 to 4 times
"Smoking cigarettes increases
more likely to get heart disease
than nonsmokers"
your heart rate and blood
pressure. Smoking can also
(Smoking and cardiovascular disease).
contribute to clumping or
stickiness of the blood"
"One out of every 5 smoking-related
deaths is caused by heart disease"
(Lifestyle Ch an ges for Heart Failu re 2017).
(Smoking and cardiovascular disease).
Treatments & Other Therapies
Limiting Alcohol
High Alcohol consumption leads to a rise in triglycerides, with
high LDL or low HDL can lead to artery wall fatty build-up and
Consumption

Limiting alcohol consumption or
avoiding drinking alcohol. 1-2 drinks per
day for men and 1 drink per day for
women.
risk for myocardial infarction or stroke
Excessively drinking can lead to:




Cardiomyopathy
Hypertension
Cardiac arrhythmias
Arteries age prematurely over time (esp. men)
(Lifestyle Changes for Heart F ailure2017).
CARDIOTOXIC
Treatments & Other Therapies
Cardiac Rehab
Physical Activity
Low Impact Exercise:


Stationary Bike
Education
Education Designed to Inspire a
Heart Healthy Lifestyle & Care
Treadmill Walking


Plan Compliance
Resistance Training
Flexibility
Support
Helping Patients and Family
Manage Living With a Chronic
Illness
Medical Evaluations
Regular Medical Evaluations to
Ensure No Deterioration of
Patients Condition
Treatments & Other Therapies
Surgical Procedures & Devices
S urg ically placed and deliver pacing – or an
electric counter-shock – when a lifeImplantable
threatening abnorm al rhythm is detected
cardioverter
defibrillator (ICD)
AKA biventricular pacing , a special pacem aker
Cardiac
Resynchronization
Therapy (CRT)
m akes the ventricles contract m ore
norm ally/in synchrony
This therapy can im prove heart function,
hospitalization risk and
survival
Left ventricular
assist device (LVAD)
A battery-operated, m echanical pum p-like
device that’s surg ically im planted, helps
m aintain the pum ping ability of a heart that
can’t effectively work on its own
Treatments & Other Therapies
Surgical Procedures & Devices
Valve Replacement:
Mechanical valve (metal/plastic/ human/animal tissue) During the surgery, the patient is connected to a
Type
something
heart-lung machine that supplies blood to the brain and body.
Coronary Artery Bypass:
Surgeons remove healthy blood vessels from another part of the body, such as a leg or the chest wall.
They then surgically attach the vessels to the diseased artery so that the blood can flow around the blocked section
Percutaneous Coronary Intervention (PCI, AKA angioplasty):
Privacy news data policies analytics documents.Now digital designs id anywhere atoms. Now strategy
startups documents designs. Venture crypto adopters niche
through to the diseased artery. Then the balloon is inflated to push open the artery
Small tube (catheter) with a tiny deflated balloon on the end is inserted through an incision in the groin and pushed
Heart Transplant:
Surgeons replace the damaged heart with a healthy one from a donor who has been declared brain dead. The surgeon
connects the patient to a heart-lung machine, removes diseased heart and replaces it with the donor heart
Resources
American Heart Association. (2021). Lifestyle changes for heart failure. Retrieved from
https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/lifestyle-changes-for-heart-failure
Cardiac Rehabilitation. (2020, November 26). Retrieved January 25, 2021, from https://www.mayoclinic.org/tests-
procedures/cardiac-rehabilitation/about/pac-20385192
Devices and Surgical Procedures to Treat Heart Failure. (2017, May 31). Retrieved February 15, 2021, from
https://www.heart.org/en/health-topics/heart-failure/treatment-options-for-heart-failure/devices-and-surgical-procedures-to-
treat-heart-failure
Smoking and Cardiovascular Disease. (n.d.). Retrieved February 14, 2021, from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/smoking-and-cardiovascular-
disease#:~:text=Facts%20about%20smoking%20and%20heart,get%20heart%20disease%20than%20nonsmokers.
Slips, Trips, and Falls
Don't rush to the bathroom
Keep cords tidy
Move furniture & keep floor clear
Walkers & wheelchairs
Safety Precautions
Bathroom Safety

Shower chair/bathtub grips
Prevent Falls

Assistance w/fatigue, safe home mobility
(DMESUSA)2021
Stay Safe From Infection
(EHHF 2020)
(PHCSLTC) 2021
Daily Checks
Blood Pressure
HR
O2 Saturation
Weight - Daily
3 lbs+ rapid weight gain - seek medical attention
Log in Journal or App
Medication Safety
Pill Planner/ Set Alarms
Patient Medication Knowledge





Know adverse reactions
know drug to drug interactions
Know when to not take med (e.g., HR<60)
Know general action
Know expected outcomes
Watch for Side Effects


Log new side effects
Report to physician
Medication Therapy Adherence



Do not self adjust
Do not stop taking, unless permitted by a physician
Do not self medicate
(EH H F 2020) (ncbi 201 3) (N AN DA 201 4)
Ref
References
Personal Home Care Services LTC (PHCSLTC) 2021
https://www.facebook.com/PHCSLTD/
DME Supply USA (DMESUSA) 2021
https://dmesupplyusa.com/drive-medical-folding-universal-sliding-transfer-bench.html?gclid=CjwKCAiAjeSABhAPEiwAqfxURR-i1b80r_1O_kjLJy2vt-vg5wxPJRfa8LRTyW3nmLiB2hi0HP7WZBoCRAQQAvD_BwE
DH-Whole sale 2021 https://www.dhgate.com/wholesale/anti+slip+shower+stickers.html
Lee, K., Pressler, S. J., & Titler, M. (2016). Falls in Patients With Heart Failure: A Systematic Review. The Journal of cardiovascular nursing, 31(6), 555–561. https://doi.org/10.1097/JCN.0000000000000292
National Center for Biotechnology Information (2013 Jan 10). Home Monitoring for Heart Failure
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254025/
ElevatingHOME (2020) Heart Failure
https://www.elevatinghome.org/heartfailurehomehealth
Wiley-Blackwell (2014) Nursing Diagnoses Definitions and Classification, NANDA International