Congestive heart failureCongestive heart failure

Dr. Walaa NasrDr. Walaa Nasr

Lecturer of Adult NursingLecturer of Adult Nursing

Second yearSecond year

Congestive heart failureCongestive heart failure outlinesoutlines DefinitionDefinition Causes and pathophysiologyCauses and pathophysiology Types of heart failureTypes of heart failure Compensatory mechanism of heart Compensatory mechanism of heart

failurefailure Clinical manifestationsClinical manifestations Classification of heart failureClassification of heart failure Diagnostic evaluationDiagnostic evaluation Medical managementMedical management Nursing managementNursing management

Congestive heart failureCongestive heart failure DefinitionDefinition

Heart failureHeart failure describes the clinical describes the clinical syndrome that develops when syndrome that develops when the heart the heart cannotcannot maintain an maintain an adequate cardiac output. The adequate cardiac output. The heart pumps blood inadequately, heart pumps blood inadequately, leading to reduced blood flow, leading to reduced blood flow, back-up (back-up (congestioncongestion) of blood in ) of blood in the veins and lungs, and other the veins and lungs, and other changes that may further changes that may further weaken the heart. weaken the heart.

Causes of congestive Causes of congestive heart failureheart failure

Coronary artery diseaseCoronary artery diseaseHeart attackHeart attackHigh blood pressureHigh blood pressureHeart valves disordersHeart valves disordersInflammation of Heart Inflammation of Heart muscle (muscle (myocarditis, myocarditis, cardiomyopathycardiomyopathy))

Causes of congestive heart Causes of congestive heart failure (cont…)failure (cont…)

Severe lung disease ( Severe lung disease ( pulmonary pulmonary hypertensionhypertension) )

Severe anemiaSevere anemiaOveractive thyroid gland Overactive thyroid gland ((hyperthyroidismhyperthyroidism))

Underactive thyroid gland Underactive thyroid gland ((hypothyroidismhypothyroidism))

Abnormal heart rhythms ( Abnormal heart rhythms ( atrial atrial fibrillationfibrillation))

Kidney failureKidney failure

Congestive heart failureCongestive heart failure TypesTypes

Left-sided heart failureLeft-sided heart failure There are two types of left-There are two types of left-

sided heart failuresided heart failure Systolic dysfunctionSystolic dysfunction Diastolic dysfunctionDiastolic dysfunction Right-sided heart failureRight-sided heart failure

Congestive heart failure Congestive heart failure Compensatory Mechanisms of heart failureCompensatory Mechanisms of heart failure

ReninRenin-angiotensin-aldosterone -angiotensin-aldosterone system system

SympatheticSympathetic nervous system nervous system EnlargementEnlargement of the muscular of the muscular

walls of the ventricles walls of the ventricles (ventricular hypertrophy). (ventricular hypertrophy).

Congestive heart failure Congestive heart failure Clinical manifestationsClinical manifestations

SymptomsSymptoms (back up of blood and (back up of blood and fluid)fluid)

DyspneaDyspnea OrthopneaOrthopnea Reduced exercise tolerance, Reduced exercise tolerance,

lethargy, fatiguelethargy, fatigue Nocturnal coughNocturnal cough WheezeWheeze Ankle swellingAnkle swelling AnorexiaAnorexia

Congestive heart failure Congestive heart failure Clinical manifestationsClinical manifestations ( cont…) ( cont…)

SignsSigns Cachexia and muscle wastingCachexia and muscle wasting TachycardiaTachycardia Pulsus alternansPulsus alternans Elevated jugular venous pressureElevated jugular venous pressure Crepitations or wheezeCrepitations or wheeze Third heart soundThird heart sound OedemaOedema Hepatomegaly (tender)Hepatomegaly (tender) AscitesAscites

Congestive heart failure Congestive heart failure Classification of heart failureClassification of heart failureNew York Heart Association (NYHA) Functional New York Heart Association (NYHA) Functional

ClassificationClassification

ClassClass % %of patientsof patientsSymptomsSymptoms

II35%35%No symptoms or No symptoms or limitations in ordinary limitations in ordinary

physical activityphysical activity

IIII35%35%Mild symptoms and Mild symptoms and slight limitation during slight limitation during

ordinary activityordinary activity

IIIIII25%25%Marked limitation in Marked limitation in activity even during activity even during minimal activity. minimal activity. Comfortable only at restComfortable only at rest

IVIV5%5%Severe limitation. Severe limitation. Experiences symptoms Experiences symptoms

even at resteven at rest

Congestive heart failure Congestive heart failure Diagnostic evaluationDiagnostic evaluation

Patient historyPatient history Physical examinationPhysical examination Diagnostic studiesDiagnostic studies

1.1. ElectrocardiographyElectrocardiography (ejection (ejection fraction)fraction)

2.2. RadionuclideRadionuclide3.3. magnetic resonancemagnetic resonance4.4. computed tomography imaging computed tomography imaging 5.5. cardiac catheterization with cardiac catheterization with

angiographyangiography6.6. a biopsy of heart muscle is needed a biopsy of heart muscle is needed

Congestive heart failure Congestive heart failure TreatmentTreatment

lifestyle changelifestyle change

1.1. Salt restrictionSalt restriction

2.2. ExercisesExercises

3.3. Smoking and alcoholismSmoking and alcoholism

4.4. Body weight (daily weight)Body weight (daily weight)

5.5. Supportive stockingsSupportive stockings

Congestive heart failure Congestive heart failure Treatment (cont…)Treatment (cont…)

Drug managementDrug management Angiotensin-converting enzyme (ACE) Angiotensin-converting enzyme (ACE)

inhibitorsinhibitors Angiotensin II receptor blockersAngiotensin II receptor blockers Beta-blockersBeta-blockers Other vasodilators Other vasodilators ( nitroglycerin)( nitroglycerin) Cardiac glycosides Cardiac glycosides (digoxin)(digoxin) Aldosterone receptor blockers Aldosterone receptor blockers

(spironolactone)(spironolactone) Loop diureticsLoop diuretics

Congestive heart failure Congestive heart failure Treatment (cont…)Treatment (cont…)

Potassium-sparing diureticsPotassium-sparing diuretics Thiazide and thiazide-like Thiazide and thiazide-like

diureticsdiuretics Anticoagulants Anticoagulants (heparine)(heparine) Opioids Opioids (morphine)(morphine) to relieve anxietyto relieve anxiety

Positive inotropic drugs (drugs Positive inotropic drugs (drugs that make muscle contract more that make muscle contract more forcefully) forcefully) (dopamine)(dopamine)

Oxygen for pulmonary edema is requiredOxygen for pulmonary edema is required

Non pharmacological management of heart failure Non pharmacological management of heart failure (surgical intervention) (surgical intervention)

Coronary Coronary artery bypass graftingartery bypass grafting ( revascularization)( revascularization)

PercutaneousPercutaneous coronary coronary interventionintervention (Angioplasty) (Angioplasty)

ValveValve replacement replacement Biventricular Biventricular pacemakerpacemaker HeartHeart transplantation transplantation Left Left ventricular assist deviceventricular assist device (LVAD) (LVAD)

Congestive heart failure Congestive heart failure Treatment (cont…)Treatment (cont…)

MaintainMaintain the patient in high fowler's the patient in high fowler's positionposition

ElevateElevate extremities except when the extremities except when the patient is in acute distresspatient is in acute distress

Frequently Frequently monitormonitor vital signs vital signs ChangeChange position frequently position frequently MonitorMonitor intake and output and daily intake and output and daily

weightweight

Nursing care of patients with Nursing care of patients with congestive heart failurecongestive heart failure

Nursing care of patients with Nursing care of patients with congestive heart failure (cont…)congestive heart failure (cont…)

RestrictRestrict fluids as ordered fluids as ordered

TeachTeach the patient and family and provide the patient and family and provide emotional support emotional support (life style change)(life style change)

ExplainExplain the side effect of diuretic the side effect of diuretic medications for additional actions medications for additional actions ( side effects of diuretics include ( side effects of diuretics include electrolyte imbalance, symptomatic electrolyte imbalance, symptomatic hypotensionhypotension

UseUse aseptic procedures when caring for aseptic procedures when caring for

invasive linesinvasive lines