Congestive heart failure
Dr. Walaa Nasr
Lecturer of Adult Nursing
Second year
Congestive heart failure
outlines
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Definition
Causes and pathophysiology
Types of heart failure
Compensatory mechanism
failure
Clinical manifestations
Classification of heart failure
Diagnostic evaluation
Medical management
Nursing management
of
heart
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 leftsided heart failure
 Systolic dysfunction
 Diastolic dysfunction
 Right-sided heart failure
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Congestive heart failure
Compensatory Mechanisms of heart failure
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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
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Congestive heart failure
Clinical manifestations ( cont…)
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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
Class
% of patients
Symptoms
I
35%
No symptoms or limitations
in ordinary physical activity
II
35%
Mild symptoms and slight
limitation during ordinary
activity
III
25%
Marked limitation in activity
even
during
minimal
activity. Comfortable only at
rest
IV
5%
Severe
limitation.
Experiences symptoms even
at rest
Congestive heart failure
Diagnostic evaluation
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Patient history
Physical examination
Diagnostic studies
1. Electrocardiography (ejection fraction)
2. Radionuclide
3.
magnetic resonance
4. computed tomography imaging
5. cardiac catheterization with
angiography
6. a biopsy of heart muscle is needed
Congestive heart failure
Treatment
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lifestyle change
1.
2.
3.
4.
5.
Salt restriction
Exercises
Smoking and alcoholism
Body weight (daily weight)
Supportive stockings
Congestive heart failure
Treatment (cont…)
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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)
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Oxygen for pulmonary edema is required
Congestive heart failure
Treatment (cont…)
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Non pharmacological management of heart failure (surgical
intervention)
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Coronary artery bypass grafting (
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Percutaneous coronary intervention
revascularization)
(Angioplasty)
Valve replacement
 Biventricular pacemaker
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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
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Nursing care of patients with
congestive heart failure (cont…)
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Restrict fluids as ordered
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Teach the patient and family and provide
emotional support (life style change)
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Explain the side effect of diuretic medications
for additional
actions ( side effects of
diuretics
include
electrolyte
imbalance,
symptomatic hypotension
Use aseptic procedures
invasive lines
when
caring
for