Types of heart failure, compensatory mechanism, Causes, clinical manifestations, Management

1. Heart Failure
Prepared by
Nursing Instructor
Mrs. Safoora Qureshi
CON, PIMS

2. Heart Failure
• Heart Failure is an state in which heart cannot provide sufficient cardiac
output to satisfy metabolic need of the body
• HF formerly called Congested Heart Failure
• An abnormal clinical condition involving impaired cardiac pumping,
results in characteristic pathologic changes of vasoconstriction and fluid
retention
• HF is not a disease, may associated with CAD, HTN, MI
• HF is the heart’s inability to pump an adequate supply of blood to the body.
• A clinical and pathophysiologic syndrome that results from
ventricular dysfunction, volume, or pressure overload, alone or in
combination

3. Heart Compensatory Mechanism

4. Reduce Cardiac Out put
carotid baroreceptor stimulation
Renal Perfusion/GFR
Activation of
CNS
HR & Inotropy
Myocardial toxicity
Activation of
RAAS Vasoconstriction
After load
Negative remodeling
Worsens the LV
Symptoms of HF
shortness of breaths, arrythmias,
edema, chest congestion etc
increased
angiotensin -II
From increased
Aldosterone
water retention
Hemodynamic
alteration
Preload
Myocardial injury
Pathophysiology of
Heart Failure
ANP &
BNP
Heart
CHF

5. Pathology of Ventricular Failure
• Systolic Failure (r-EF); The hallmark of systolic dysfunction is a
decrease in the left ventricular ejection fraction.
• The normal EF is greater than 55% of ventricular volume.
• Systolic failure is caused by
• impaired contractile function(MI)
• increased afterload (hypertension),
• mechanical abnormalities (VHD)
• Diastolic Failure (p-EF):
• is an impaired ability of the ventricles to relax and fill during diastole,
result in decreased in stroke volume and CO.
• High filling pressure due to stiff or noncompliance ventricles, result
in venous engorgement in both pulmonary and systemic circulation.

6. Types Of HF:
Left-sided Heart Failure:
• is the most common type of heart failure.
• Left-sided heart failure occurs when the left ventricle doesn’t pumps efficiently,
result in reduce CO
• This prevents the body from getting enough oxygen-rich blood.
• The blood backs up into the lungs, which causes shortness of breath, pulmonary
congestion and edema
Right-Sided Heart Failure:
• Heart failure can also affect the right side of the heart. Left-sided heart failure is the
most common cause of this.
• Other causes include certain lung problems and issues in other organs.
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7. Causes:
Chronic
• Coronary Artery Disease
• Hypertension
• Rhematic Heart Disease
• Congenital Heart Disease
• Cardiomyopathy, congenital or
acquired
• Valvular disease
• Severe forms of anemia
• Bacterial endocarditis
Acute
• Acute MI
• Dysrhythmias
• Pulmonary Embolism
• Thyrotoxicosis
• Hypertension Crisis
• Rupture of Papillary muscles
(Mitral Valve)
• Ventricular Septal Defect
• Myocarditis

8. Clinical manifestation of (CHF)
• Chest Pain
• Fatigue
• Dyspnea / paroxysmal nocturnal
dyspnea
• Tachycardia
• Edema / peripheral, hepatomegaly,
ascites, and pulmonary
• Nocturia
• Skin changes /dusky, cool, damp,
hair loss
• Behavioral Changes/ restlessness,
confusion, impaired attention and
memory
• Weight Changes

9. CHD/CCF

10. Complication:
• Pleural effusion
• Dysrhythmias
• Left ventricular thrombus
• Hepatomegaly
• Renal failure

11. Diagnosis:
• History
• Physical Examination
• X-rays
• ECG
• Lab: Cardiac Enzyme BNP
• Serum chemistries such as;
• LFT, RFT, TFT, CBC
• Echocardiogram
• Stress testing
• Cardiac Catheterization

12. Collaborative Care
• Treatment of underline cause
• Oxygen therapy 2 --- 6 l/min by nasal catheter
• Rest-activity period
• Drug therapy
• Daily weight
• Sodium restricted diet
• Circulatory/ventricular assist device
• (IABP)
• Cardiac resynchronization therapy with
• cardioverter-defibrillator
• Cardiac transplant

13. ICD IABP

14. Drug therapy in (CHF)
• Diuretics
• Morphine sulphate
• Vasodilators:
• ACE inhibitors
• Nitroglycerin
• BNP (synthetic)
• Beta-Blockers
• Positive inotropes;
• Digoxin
• Dopamine, Dobutamine
• Angiotensin II inhibitor
• Antidysrhythmic

15. Nursing Management
Oxygen therapy:
• Administers oxygen as per need by nasal catheter
• Monitor the effectiveness of the therapy to identify hypoxia and establish a
range of oxygen saturation
Position:
• Semi-Fowler position to alleviate dyspnea and pain
Respiratory Monitoring:
• RR, rhythm, depth, and resp.efforts, to evaluate respiratory status
• Auscultate breath sounds to assess congestion
• Monitor dyspnea to observe the improvement of respiratory status
• Note the events that improve or worsen the distress to detect the events,
influence ADLs

16. Monitor Cardiac status:
• Continue cardiac monitoring to detect arrythmias
 Anxiety reduction:
• Use a reassuring approach to gain client confidence in care provider
• Promote a sense of security by explaining all therapeutic procedures
• Identify source of anxiety/fear and plan anxiety relieving techniques
• Create a atmosphere to facilitate trust
• Instruct the client in use of relaxation techniques (imagery)
• Promote sleep by providing a calm and quiet environment

17. Energy Management:
• Encourage alternate rest and activity period to reduce cardiac workload
• Provide calming diversionary activities to promote relaxation to reduce
oxygen consumption
• Monitor patient’s oxygen demand during self-care/nursing care activities to
determine the level of activity that can be performed
Fluid /Electrolyte management:
• Daily weight to monitor fluid retention/diuresis and weight reduction
• CVP line monitoring
• Monitor serum electrolyte balance to assess response to treatment

18. Hypervolemia management;
• Monitor
• respiratory status/distress/SOB to detect pulmonary edema
• hemodynamic status including CVP, MAP to evaluate effective ness of therapy
• renal function and intake output to monitor fluid balance
• effectiveness of diuretics to assess response to treatment
Dietary Management:
• (DASH ) diet is widely used for patients with HF
• Fluid restriction incase of renal insufficiency
• Sodium restricted diet