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Congestive heart failure

Congestive heart failure. Dr. Walaa Nasr Lecturer of Adult Nursing Second year. Congestive heart failure. outlines Definition Causes and pathophysiology Types of heart failure Compensatory mechanism of heart failure Clinical manifestations

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Congestive heart failure

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  1. Congestive heart failure Dr. Walaa Nasr Lecturer of Adult Nursing Second year

  2. Congestive heart failure outlines • Definition • Causes and pathophysiology • Types of heart failure • Compensatory mechanism of heart failure • Clinical manifestations • Classification of heart failure • Diagnostic evaluation • Medical management • Nursing management

  3. Congestive heart failureDefinition Heart failure describes the clinical syndrome that develops when the heart cannot maintain an adequate cardiac output. The heart pumps blood inadequately, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and other changes that may further weaken the heart.

  4. Causes of congestive heart failure • Coronary artery disease • Heart attack • High blood pressure • Heart valves disorders • Inflammation of Heart muscle (myocarditis, cardiomyopathy)

  5. Causes of congestive heart failure (cont…) • Severe lung disease ( pulmonary hypertension) • Severe anemia • Overactive thyroid gland (hyperthyroidism) • Underactive thyroid gland (hypothyroidism) • Abnormal heart rhythms ( atrial fibrillation) • Kidney failure

  6. Congestive heart failureTypes • Left-sided heart failure • There are two types of left-sided heart failure • Systolic dysfunction • Diastolic dysfunction • Right-sided heart failure

  7. Congestive heart failure Compensatory Mechanisms of heart failure • Renin-angiotensin-aldosterone system • Sympathetic nervous system • Enlargement of the muscular walls of the ventricles (ventricular hypertrophy).

  8. Congestive heart failure Clinical manifestations • Symptoms(back up of blood and fluid) • Dyspnea • Orthopnea • Reduced exercise tolerance, lethargy, fatigue • Nocturnal cough • Wheeze • Ankle swelling • Anorexia

  9. Congestive heart failure Clinical manifestations ( cont…) • Signs • Cachexia and muscle wasting • Tachycardia • Pulsus alternans • Elevated jugular venous pressure • Crepitations or wheeze • Third heart sound • Oedema • Hepatomegaly (tender) • Ascites

  10. Congestive heart failure Classification of heart failureNew York Heart Association (NYHA) Functional Classification

  11. Congestive heart failure Diagnostic evaluation • Patient history • Physical examination • Diagnostic studies • Electrocardiography(ejection fraction) • Radionuclide • magnetic resonance • computed tomography imaging • cardiac catheterization with angiography • a biopsy of heart muscle is needed

  12. Congestive heart failure Treatment • lifestyle change • Salt restriction • Exercises • Smoking and alcoholism • Body weight (daily weight) • Supportive stockings

  13. Congestive heart failure Treatment (cont…) • Drug management • Angiotensin-converting enzyme (ACE) inhibitors • Angiotensin II receptor blockers • Beta-blockers • Other vasodilators ( nitroglycerin) • Cardiac glycosides (digoxin) • Aldosterone receptor blockers (spironolactone) • Loop diuretics

  14. Congestive heart failure Treatment (cont…) • Potassium-sparing diuretics • Thiazide and thiazide-like diuretics • Anticoagulants (heparine) • Opioids (morphine)to relieve anxiety • Positive inotropic drugs (drugs that make muscle contract more forcefully) (dopamine) • Oxygen for pulmonary edema is required

  15. Congestive heart failure Treatment (cont…) • Non pharmacological management of heart failure (surgical intervention) • Coronary artery bypass grafting ( revascularization) • Percutaneous coronary intervention (Angioplasty) • Valve replacement • Biventricular pacemaker • Heart transplantation • Left ventricular assist device (LVAD)

  16. Nursing care of patients with congestive heart failure • Maintain the patient in high fowler's position • Elevate extremities except when the patient is in acute distress • Frequently monitor vital signs • Change position frequently • Monitor intake and output and daily weight

  17. Nursing care of patients with congestive heart failure (cont…) • Restrict fluids as ordered • Teach the patient and family and provide emotional support (life style change) • Explain the side effect of diuretic medications for additional actions ( side effects of diuretics include electrolyte imbalance, symptomatic hypotension • Use aseptic procedures when caring for invasive lines

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