Seminar for postgraduateAdult Nursing

الجامعي الممرض إعدادالحمداني نزار صالح

Congestive Heart Failure

Congestive heart failure

Definition(The heart does not pump efficiently with fluid

collect around the heart)

Organs in the body do not get enough oxygen rich blood that they need to work well

Causes of Heart Failure

♥Coronary Artery Disease ♥Untreated High Blood Pressure (neglected)

♥Defect Heart Valves ♥Cardiomyopathy

♥Lung Disease ♥Diabetes ♥Infections

( ♥Bad life Style ). eg Smoking & Alcohol ♥Toxic Drugs

Ischemia (myocardial dysfunction)

Hypoxia and acidosis (accumulation of lactic acid)

Myocardial infarction (muscle necrosis)

Loss of contractility

Heart Failure

Coronary Artery Disease

It is a condition where fatty deposits and cell-proliferation build-up in the arteries’ wall

supplying the heart muscle

Genetic factors or a diet high in cholesterol or saturated fat that result in high blood

cholesterol can increase the risk for this disease

Fatty deposits form silently; no symptoms ariseuntil they are large enough to significantly restrict

blood flow to an area of heart muscle

When this occurs, angina pectoris (chest tightness or discomfort ) usually results .

70% or greater blockage in the diameter of a coronary artery will cause symptoms of chest

discomfort or pain with exercise

An sudden closure of a coronary artery due to a blood clot forming can cause a heart attack

(myocardial infarction)

Hypertension (High Blood Pressure)

Increases afterload (resistance to ejection)

Increases the workload of the heart

Hypertrophy of myocardial

HF

Heart Failure and Lungs

As the left ventricle's abilities are diminished, blood tends to pool and back-up behind it in the pulmonary circulation

(lung)

This back-up under increased pressure ,as the right side of the heart

is still pumping into pulmonary circulation

This result in fluid leakage into the lungs (a condition called pulmonary edema)

This situation translates into shortness of breath

Heart Failure and Lungs

Congestive heart failure Classification of heart failure

New York Heart Association (NYHA) Functional Classification

Symptoms %of patients Class

No symptoms or limitations in ordinary physical activity 35% I

Mild symptoms and slight limitation during ordinary activity

35% II

Marked limitation in activity even during minimal activity. Comfortable only at rest

25% III

Severe limitation. Experiences symptoms even at rest

5% IV

Types

1 \Left-side heart failure

Two types of left-side heart failure

a\ Systolic dysfunction

b\ Diastolic dysfunction

2 \Right-sided heart failure

3 \Congestive heart failure

Congestive heart failure Clinical manifestations

SignsCachexia and muscle wastingTachycardiaIncreased jugular venous distention (JVD)Bilateral crackles that (do not clear with cough)Third heart sound (S3)Murmurs (with valvular dysfunction)EdemaHepatomegaly (tender)AscitesCardiomegaly

SymptomsDyspneaOrthopneaReduced exercise tolerance, lethargy, fatigueNocturnal coughWheezeAnkle swellingAnorexia

(B )When the pressure is released, an indentationremains in the edematous tissue

(A )Example of pitting edema. The nurse applies fingerpressure to an area near the ankle

Diagnostic EvaluationPatient historyPhysical examinationLaboratory Investigations Electrocardiography ECG

Echocardiogram(ejection fraction) & U\S Magnetic resonance

Computed tomography imaging Cardiac catheterization with angiographyA biopsy of heart muscle is neededTreadmill Test

Treatment ♥Medications management

♥Oxygen ♥Angiotensin-converting enzyme (ACE) inhibitors

♥Beta-blockers ♥vasodilators

♥Cardiac glycosides (digoxin) ♥Diuretics

♥Anticoagulants (heparin) ♥Opioids (morphine) to relieve anxiety

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

Non pharmacological management Non pharmacological management of heart failure

(surgical intervention ) ♥Coronary artery bypass grafting ( revascularization)

♥Percutaneous coronary intervention (Angioplasty) PCI ♥Valve replacement

♥Biventricular pacemaker ♥Heart transplantation

♥Left ventricular assist device( LVAD )

Nursing care of patients with congestive heart failure

♥High fowler's position ♥Oxygen supply

♥Elevate extremities except when the patient is in acute distress ♥Frequently monitor vital signs

♥Change position frequently ♥Monitor Fluids intake and output

♥Daily weight ♥Restrict salt and fluids as ordered

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

♥Explain the side effect of medications like ( side effects of diuretics include electrolyte imbalance, symptomatic hypotension)

♥Use aseptic procedures when caring for invasive lines

Thank you for listening