Congestive heart failure (CHF) is a clinical syndrome where the heart is unable to pump enough blood to meet the body's demands. It is a major public health problem and most common in the elderly. CHF results from conditions that increase the heart's workload like valvular diseases or decrease the heart's ability to contract effectively from issues such as a myocardial infarction. As the heart fails to meet circulatory demands, compensatory mechanisms activate but eventually fail, leading to symptoms of fluid overload and organ congestion. Treatment involves controlling symptoms with medications that lower preload and afterload on the heart like diuretics, ACE inhibitors, and beta blockers as well as addressing any underlying causes of heart muscle dysfunction.
2. C H F
Definition: It is a clinical syndrome
resulting from the inability of heart
to pump enough blood at rest or
during exercise even though the
filling pressures are adequate.
4. Etiology
Divided in to 3 subgroups
-Abnormal loading conditions
-Abnormal muscle function
-Precipitating factors
5. Etiology (contd..)
Abnormal loading conditions
Increased preload
Refers to the length of the ventricular
myocardial fibers just before ventricular
contraction and EDV
-Valvular regurgitation
-Hypervolemia
-Congenital diseases
(ASD,VSD,PDA)
6. Etiology (contd..)
Increased after load
Correspond to the amount of intra
myocardial wall tension that the heart
must generate to overcome systolic
pressure and allows ventricular emptying.
-Aortic valvular stenosis
-pulmonary valve stenosis
-Systemic and pulmonary hypertension
-Increased PVR
-Increased blood viscosity
7. Etiology (contd.)
Abnormal muscle function
-Conditions that interfere with myocardial
contractibility
MI
Myocarditis
Cardiomyopathy
ventricular aneurism
-External compression
(constrictive pericarditis,cardiac
tamponade)
11. Pathophysiology (contd…)
Increased pressure in pulmonary
vascular system
Right ventricular dilation&hypertrophy
Fails
Engorgement of systemic venous
system
Congestion in GIT,Liver
viscera,Kidneys,Legs,sacrum
13. Pathophysiology (contd..)
Cardiac reserve (Hearts ability to
increase the output in response to
stress(5 the times the normal)
But in the diseased heart, it fails to
respond to body’s increased
demands
Compensatory mechanism will be
initiated
14. Pathophysiology contd..
Compensatory mechanisms are
-Ventricular dilation: Lengthening of
the muscle fibers Increased
volume of heart chambers
Increased preload and cardiac out
put leads to reduced contractibility
when stretched beyond capacity
Increased oxygen demand
hypoxia
15. Pathophysiology (contd..)
Ventricular hypertrophy-Increase in
the diameter of muscle fibers
Size and weight of heart increases
Increased oxygen demand
Hypoxia and reduced contractibility
16. Pathophysiology(contd..)
Increased sympathetic stimulation
Increased heart rate and peripheral
vascular resistance
Reduced renal flow and increased
renal conservation of water and
sodium
Fluid overload and increased workload
17. Forms of heart failure
Systolic versus diastolic failure
Systolic-Inability to contract normally
Diastolic-Inability to relax or fill normally
High output versus low output
Low output-IHD,
HT,cardiomyopathy,pericardial diseases
Highoutput-
Hyperthyroidism,anemia,pregnancy,paget
disease
18. Forms (contd..)
Acute versus chronic
Acute –Acute large MI
Chronic-Dilated cardiomyopathy
multivalvular heart disease
Right sided versus left sided
RVF-PAH,Pulmonary
stenosis,pulmonary embolism,
LVF-Aortic stenosis,Post MI
19. Types (contd..)
Backward versus forward H F
backward-ventricles fail to fill
normally Increased pressure in
the atrium and venous system
sodium and water retention edema
Forward-Inadequate discharge of
blood in to the arterial system
29. Medical management
Removal of precipitating factors
Correction of underlying causes
Prevention of deterioration of cardiac
function
Control of CHF state
31. Management contd
Digitalis-Increses ventricular emptying,
slow conduction of impulses through AV
node, Increases stroke volume and
cardiac output
-effective in systolic heart failure
-0.25 6 hourly for adults, for elderly o.125
mg 6 hourly
-Reduce dose in renal impairement
-Should not be given in heart failure with
high output
-Digitalis toxicity should be monitered
37. Management contd
Reduction of cardiac workload
Reducing the physical activity
Emotional rest and reduction of
anxiety
Diet: sodium 1 gm / day
Water 1000 ml / day
potassium supplements
vasodilators – sodium nitroprusside and
Isosorbid dinitrate
Aminophylline 240- 480 mg IV
38. Surgical management
Surgical correction of valvular disorders
Heart transplantation
Cardiopulmonary bypass
Intra aortic balloon pump
39. Nursing management
Impaired gas exchange related to to fluid
in the alveoli
Decreased cardiac output related to heart
failure and Dysrrhythmias
Fluid volume excess related to reduced
cardiac output and Na and water retention
Decreased peripheral tissue perfusion
related to reduced cardiac output
Activity intolerance related to reduced
cardiac output
40. Nursing management
High risk for impaired skin integrity
related to reduced peripheral tissue
perfusion
High risk for digitalis toxicity related
to impaired excretion
Anxiety and fear of death related to
reduced cardiac output and hypoxia