Congestive cardiac failure

Congestive Cardiac Failure
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:+919496743672

Definition
CCF is the inability of the heart to pump
an adequate amount of blood to the
systemic circulation at normal filling
pressure.
Heart failure refers to the inability of
cardiac output to meet the metabolic
demands of the body.
JERIN.T.S, 3RD YEAR BSC
NURSING, KRSMCON
MANGALORE. PH:
+919496743672

According to American Heart
Association:
Heart failure is a complex clinical
syndrome that can result from any
structural or functional cardiac disorder
that impairs the ability of the ventricle to fill
with or eject blood.
JERIN.T.S, 3RD YEAR BSC
NURSING, KRSMCON
MANGALORE. PH:
+919496743672

Etiology
Depending on volume, pressure,
contractility and cardiac output.
1. Volume overload: left to right shunt. Hypertrophy of the right
ventricle to compensate for additional volume of blood.
2. Pressure overload: resulting from obstructive lesions such as valvular
stenosis

3. Decreased contractility: Cardiomyopathy, myocardial ischemia
from severe anemia or asphyxia, heart block.
4. Increased cardiac output demand: in sepsis, hyperthyroidism with
severe anemia

 The causes of systolic failure or mixed systolic
and diastolic failure can be divided into two
groups according to the age.
1) Infants:
Congenital heart diseases
Myocarditis and primary myocardial disease
Paroxysmal tachycardia
Anemia and Infections
Upper respiratory obstructions
Hypoglycemia and Hypocalcaemia
Neonatal asphyxia
Persistent fetal circulation

2) In children
 Rheumatic fever & heart disease
 Congenital heart disease complicated by infection,
anemia, endocarditis
 Hypertension
 Myocarditis and primary myocardial diseases
 Upper respiratory obstruction

Obstructive lesions
 Artesia or critical stenosis= CCF
 If the lesion is mild -asymptomatic till late years
Arrhythmias
CCF in infancy is due to paroxysmal supraventricular
tachycardia
More in males
HR >180/min precipitates CCF

Anemia
In normal heart Hb <5g% =CCF
In compromised heart Hb <7g%=CCF
Infections
URTI & LRTI=CCF
Other infections in the body where cardiac output demand increases
even after compromise.

Pathophysiology
In right sided failure: develop around 6-
8wks of life
a) Right ventricular function is impaired
b) Right ventricular end diastolic
pressure is increased
c) Elevated CVP & systemic venous
engorgement
d) Systemic venous hypertension
causes hepatomegaly and edema
in the extremities

In left sided failure: within few days of life
a) Left ventricular function is impaired
b) Left ventricular end diastolic pressure increases
c) Increased pressure in left atrium & pulmonary veins
d) Lungs become congested with blood
e) Increased pulmonary pressure and pulmonary edema

Compensatory mechanisms
1) Hypertrophy and dilatation of cardiac muscles
2) Stimulation of sympathetic nervous system
3) Systemic venous congestion

Clinical manifestations

Symptoms
 Slow weight gain
1) Infant takes small feeds due to easy fatigue
2) Excessive loss of calories from increased work of breathing
 Wheezing
 Excessive perspiration
 Pedal edema & Puffiness of face
 Irritability & persistent hoarse crying

Signs
Systemic manifestations
 Growth failure
 Exercise intolerance
 Diaphoresis

Cardiac manifestations
1) Tachycardia
2) Increased precordial activity
3) Gallop rhythm
4) Altered perfusion:
i. diminished pulses
ii. pulses paradoxicus
iii. pulses alternans

Respiratory manifestation
1) Tachypnea
2) Wheezing / cough
3) Rales
4) Cyanosis

Manifestations of systemic
venous congestion
 Hepatomegaly
 Jugular venous distension
 Peripheral edema
 Ascitis
 Periorbital edema
JERIN.T.S, 3RD YEAR BSC NURSING,
KRSMCON MANGALORE. PH:
+919496743672

Diagnostic assessment
1) Chest radiography
2) ECG
3) Echocardiography
4) Lab investigations:
 ABG analysis
 Electrolytes
 Glucose
 CBC

Treatment
Goals:
A. To improve cardiac function
B. Reduce the cardiac work
C. Remove accumulated fluid and sodium
D. To Decrease cardiac demand
E. To decrease 02 consumption, improve tissue
oxygenation

Improve cardiac functioning
Pharmacological:
1) Digitalis glycosides:
To improve myocardial contractility, and reduces the
heart rate.
lanoxin, digoxin
2) ACE inhibitors:
To reduce after load of heart,
captopril, enalapril

Reduce the cardiac work
 Restricting the patients activities
 Sedatives
 Treatment of fever, anemia, obesity
 Vasodilators
Nitroglycerine-IV-0.05-20m/k/min IV infusion
Iso-sorbide dinitrate-IV-0.01mg/kg q6hr
Prazosin-IV or Arterial 5-25mcg/kg q6hr

Reduce heart size-
Remove accumulated
sodium and fluid1) Diuretics
2) Possible fluid restriction
3) Possible sodium restriction

To decrease cardiac demand:
Minimize metabolic demand by:
Neutral temperature
Treat infections
Reduce efforts of breathing
Provide rest & reduce environmental stimuli.
Improve tissue oxygenation:
Cool humidified 02

Correcting the underlying
cause
 By curative or palliative surgery For rheumatic heart
disease.
 In supraventricular tachycardia lanoxin or verapamil IV
0.1-0.2mg/kg very effective but used with caution.
Keep ready atropine
 Prolonged bed rest with anti congestive measures
 In cardiomyopathies use betablockers

Stepwise management of
CCF
 Step 1: use of furosamide with K+
S diuretic
 Step 2: digoxin
 Step 3: ACE Inhibitors & stop K+
S diuretic
 Step 4: isosoride dinitrate
 Step 5: dopamine or combined with
dobutamine
 Step 6: myocardial biopsy+steroids
 Step 7: cardiac transplantation (when
above fail)

Goals of nursing
management
Child will
 exhibit improved cardiac output
 Experience decreased cardiac demands
 Improve respiratory function
 Maintain adequate nutritional status by frequent diet
 No evidence of fluid excess : I/O chart, weight check
 Adequate family support & education

Nursing management
Assess for signs of CHF
 Tachycardia
 Tachypnea
 Profuse sweating
 Increased weight
 Edema
 Respiratory distress
 Fatigue and irritability

Congestive cardiac failure

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