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 Classification of heart failure Diagnostic evaluation Medical management Nursing management

Congestive heart failure Definition 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.

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

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

Congestive heart failure Types Left-sided heart failure There are two types of left-sided heart failure Systolic dysfunction Diastolic dysfunction Right-sided heart failure

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).

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

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

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 II Marked limitation in activity even during minimal activity. Comfortable only at rest 25% III Severe limitation. Experiences symptoms even at rest 5% IV

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

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

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

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

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)

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

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