CARDIAC FAILURE
Cardiac failure -Definition
A physiologic state in which the heart is
unable to pump enough blood to meet the
metabolic needs of the body at rest or during
exercise even though filling pressures are
adequate.
Etiology
Acute causes
 Acute M.I
 Dysrthymias
 Pulmonary emboli
 Thyrotoxicosis
 Hypertensive crisis
 Papillary muscle rupture
 VSD
Chronic causes
 CAD
 Hypertension
 RHD
 Congenital heart disease
 Cardiomyopathy
 Pulmonary diseases
 Bacterial endocarditis
 Anaemia
 Valvular disorders
Pathophysiology
Left heart failure
Hypertension
Increase force of LV contraction
Increase LV O₂ demand
CM
Increase LV hypoxia
Decrease force of LV contraction Decrease
B.P
Increase LV preload
Increase LA preload
Pulmonary
oedema
Right heart failure
pulmonary pathology
Increase pulmonary vascular resistance
Increase force of RV contraction
RV hypoxia
Decrease force of RV contraction
Increase RV preload
Increase RA preload
Peripheral oedema
Compensatory mechanisms
 Increase in SNS activity
 Ventricular hypertrophy
 Ventricular dilation
 Renin-angiotensin-aldosterone system
 ADH
 Endothelin
 Proinflammatory cytokines
Counterregulatory mechanisms
 Natriuretric peptides
 Nitric oxide
Clinical features
Left heart failure- symptoms
 Dyspnoea
 Orthopnoea
 Paroxysmal nocturnal dyspnoea, nocturia
dizziness, confusion, diaphoresis and cool
extremities at rest
Right ventricular failure - symptoms
 Weakness
 Anorexia
 Indigestion
 Weight gain
 Mental changes
Left heart failure - signs

Displaced apex beat
 Heart murmurs
 Tachypnea, tachycardia
 Crackles
 Dullness - lung fields to percussion and
diminished breath sounds at the lung bases
(pleural effusion)
 cyanosis, cough, hemoptysis
 Increased PAP
Right-sided signs
1.
Peripheral edema
2.
Ascites
3.
Hepatomegaly
4.
Increased jugular venous pressure
5.
Hepatojugular reflux
6.
Anasarca
7.
Spleenomegaly
Investigations
 Echocardiography
 Chest roentogram
 Electrophysiology
 Angiography
Blood tests
 Electrolytes (sodium, potassium), renal
function, liver function tests, thyroid function
tests, complete blood count, C-reactive protein
B-type natriuretic peptide (BNP)
 Cardiac markers- M.I
Pharmacological management
 Angiotensin-modulating agents
 Diuretics
 Beta blockers
 Positive inotropes
 Vasodilators
 Vasopressin receptor antagonists
 Human b – type natriuretric peptide
Devices and surgery
 Bi-ventricular pacemaker
 Implantable cardioverter-defibrillator
 Ventricular assist devices
 Cardiac transplantation
Nursing management
 High Fowlers position
 Legs in dependent position
 Oxygen
 Activity restrictions
 Emotional rest
 Allay the anxiety
 Monitor ECG,
S. electrolytes
Contd…
 Small meals than larger ones
 Monitor weight daily
 Maintain intake & output chart
 Restrict sodium & fluid intake
 Avoid activities that create valsalva response
 Self care needs
 Increase activity gradually & as tolerated
 Medications
Thank you