Heart failure occurs when the heart cannot pump enough blood to meet the body's needs. Fluid backs up in the lungs and body, causing congestion. Common causes include coronary artery disease, heart attacks, high blood pressure, and congenital or valvular heart defects. Symptoms include shortness of breath, swelling, fatigue, and reduced exercise capacity. Treatment involves medications, lifestyle changes, and potentially surgery or devices. Nursing focuses on managing symptoms like fatigue and anxiety while monitoring for fluid retention.

1. “Congestive” heart failure.
Prepared By: Justin V Sebastian, MSc N, RN, PhD Scholar

2. DEFINITION
Heart failure is a physiologic state in which the heart cannot
pump enough blood to meet the metabolic needs of the body.
Because a weakened heart moves less blood with each pump,
fluid backs up in the lungs. As a result, the body does not receive
enough oxygen. The kidneys cannot work properly in removing
excess fluid from the body and fluid accumulates in parts of the
body, particularly the feet and lower legs. The body becomes
“congested” with fluid–hence the phrase, “congestive” heart
failure.

3. ETIOLOGY
• Coronary artery disease: This causes blood moves slowly through narrowed arteries.
• Heart attack: This causes weakening of the heart muscle.
• High blood pressure (hypertension): If blood pressure is high, heart muscle may become
either too stiff or too weak to effectively pump blood.
• Faulty heart valves: A damaged valve forces heart to work harder to keep blood flowing
as it should.
• Myocarditis: It's most commonly caused by a virus and can lead to left-sided heart failure.
• Congenital heart defects: If heart and its chambers or valves haven't formed correctly, the
healthy parts of heart have to work harder to pump blood through heart, which in turn may
lead to heart failure
• Heart arrhythmias: Abnormal heart rhythms may prevent heart from getting enough
blood out to the body and may also lead to heart failure
• Other diseases: Chronic diseases such as diabetes, severe anemia, hyperthyroidism,
hypothyroidism, etc...also may contribute to heart failure.

4. RISK FACTORS
Non modifiable risk factors
•Age: As people age, their risk for heart disease goes up because heart muscles weaken with
age.
•Gender: Men have a higher rate of heart failure than women, according to the National
Heart, Lung and Blood Institute.
Modifiable risk factors
•High blood pressure: Heart works harder than it has to if blood pressure is high.
•Coronary artery disease: Narrowed arteries may limit heart's supply of oxygen-rich blood.
•Heart attack: Damage to heart muscle from a heart attack may mean heart can no longer
pump as well as it should.
•Irregular heartbeats: These abnormal rhythms can create extra work for heart, weakening
the heart muscle.
•Diabetes: Having diabetes increases risk of high blood pressure and coronary artery
disease.

5. •Sleep apnea: Results in low blood oxygen levels and increased
risk of abnormal heart rhythms.
•Congenital heart defects: Some people who develop heart failure
were born with structural heart defects.
•Viruses: A viral infection may have damaged heart muscle.
•Alcohol use: Drinking too much alcohol can weaken heart muscle
and lead to heart failure
•Smoking. Smoking damages blood vessels, raises blood pressure,
reduces the amount of oxygen in blood and makes heart beat faster.
•Kidney conditions. These can contribute to heart failure because
many can lead to high blood pressure and fluid retention.

6. TYPES OF HEART FAILURE
•Left-sided heart failure: Most common form of heart failure. Fluid
may back up in lungs, causing shortness of breath.
•Right-sided heart failure: Often occurs with left-sided heart
failure. Fluid may back up into abdomen, legs and feet, causing
swelling.
•Systolic heart failure: The left ventricle can't contract vigorously,
indicating a pumping problem.
•Diastolic heart failure: The left ventricle can't relax or fill fully,
indicating a filling problem.

8. CLINICAL MANIFESTATION
Chronic heart failure signs and symptoms
•Shortness of breath (dyspnea)
•Fatigue and weakness.
•Swelling (edema) in legs, ankles and feet.
•Rapid or irregular heartbeat.
•Reduced ability to exercise.
•Persistent cough or wheezing with white or pink blood-tinged
phlegm.
•Hepatojugular reflex syndrome
•Swelling of abdomen (ascites).

9. •Sudden weight gain from fluid retention.
•Lack of appetite and nausea.
•Difficulty concentrating or decreased alertness.
Acute heart failure signs and symptoms
•Symptoms similar to those of chronic heart failure, but more
severe and start or worsen suddenly.
•Sudden fluid build-up.
•Rapid or irregular heartbeat (palpitations).
•Sudden, severe shortness of breath and coughing up pink,
foamy mucus.

10. DIAGNOSTIC MEASURES
•Blood tests: To check for a chemical called brain natriuretic peptide
(BNP) can help in diagnosing heart failure.
•Chest X-ray: X-ray images help doctor see the condition of lungs and
heart.
•Electrocardiogram (ECG): This test helps doctor diagnose heart
rhythm and damage to heart from a heart attack that may be underlying
heart failure.
•Echocardiogram: An echocardiogram uses sound waves to produce a
video image of heart.
•Ejection fraction: An ejection fraction is an important measurement of
how well heart is pumping and is used to help classify heart failure and
guide treatment

11. •Stress test: Stress tests determine how well body is
responding to heart's decreased pumping effectiveness.
•Cardiac computerized tomography (CT) or
magnetic resonance imaging (MRI): Used to diagnose
heart problems, including causes of heart failure.
•Coronary catheterization (angiogram): This test
helps doctors identify narrowed arteries to heart
(coronary artery disease) that can be a cause of heart
failure

12. COMPLICATIONS OF HEART FAILURE
•Kidney damage or failure: Heart failure can reduce the blood flow
to kidneys, which can eventually cause kidney failure if left untreated.
•Heart valve problems: The valves of heart can become damaged
from the blood and fluid buildup from heart failure.
•Liver damage: Heart failure can lead to a buildup of fluid that puts
too much pressure on the liver, which makes it more difficult for liver
to function properly.
•Heart attack and stroke. Because blood flow through the heart is
slower in heart failure than in a normal heart, it's more likely to
develop blood clots, which can increase risk of having a heart attack
or stroke.

13. MANAGEMENT OF HEART FAILURE
1) MEDICAL THERAPY
• Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors are a type of
vasodilator, that improve blood flow and decrease the workload on the heart.
Examples include enalapril (Vasotec) and captopril (Capoten)..
• Digoxin (Lanoxin): This drug increases the strength of heart muscle contractions.
It also tends to slow the heartbeat
• Beta blockers: This class of drugs not only slows heart rate and reduces blood
pressure but also limits or reverses some of the damage to heart.
Examples include carvedilol (Coreg) and bisoprolol (Zebeta).
• Diuretics: Diuretics make urinate more frequently and keep fluid from collecting in
body.
Examples include bumetanide (Bumex) and furosemide (Lasix).

14. 2) SURGERY AND MEDICAL DEVICES
• Coronary artery bypass graft: In this procedure, blood vessels from leg, arm or chest
bypass a blocked artery in heart to allow blood to flow through heart more freely.
• Heart valve repair or replacement: Surgeons also can repair the valve by reconnecting
valve leaflets or by removing excess valve tissue so that the leaflets can close tightly. In
valve replacement surgery, the damaged valve is replaced by an artificial (prosthetic)
valve.
• Implantable cardioverter-defibrillators (ICDs): The ICD monitors the heart rhythm. If
the heart starts beating at a dangerous rhythm, or if heart stops, the ICD tries to pace
heart or shock it back into normal rhythm.
• Heart pumps (left ventricular assist devices, or LVADs): Implanted heart pumps can
significantly extend and improve the lives of some people with severe heart failure who
aren't eligible for or able to undergo heart transplantation or are waiting for a new heart
• Heart transplant: Some people have such severe heart failure that surgery or
medications don't help. They may need to have their diseased heart replaced with a
healthy donor heart.

15. LIFESTYLE MODIFICATION OF PATIENT WITH HEART
FAILURE
1, Dietary Factors
All patients with heart failure should limit their salt intake to less than
1,500 mg a day, and in severe cases, very stringent salt restriction may be
necessary.
2, Exercise
A person with heart failure needs to make time for moderate aerobic
exercise, like walking, swimming or biking. Remind the client about the
importance of always staying within the physician's recommendations
and their own comfort zone.

16. 3, Daily Weight check up
•Excess weight can put a strain on the heart muscle, which can
eventually lead to CHF.
•One indicator of healthy weight is body mass index. BMI of 25 and
above is associated with high blood cholesterol, high blood
pressure, and increased risk of heart disease.
4, Stress Reduction
Here are some strategies for reducing stress.
•Talk with family, friends or other trusted advisers about concerns
and stresses and ask for their support.
•Take 15 to 20 minutes a day to sit quietly, breathe deeply and think
of a peaceful scene.

17. 5, Bad Habits
•Fight the urge by going places where smoking isn't allowed and staying around
people who don't smoke.
•Avoid situations that tempt to smoke, like drinking coffee or alcohol.
6, Avoiding Infection
•As much as possible, people with heart failure should avoid anyone who has a
cold or the flu. They also should stay out of crowds during the height of the flu
season.
•Family members need to remember the frequent hand washing rule as well,
because their hands can transmit potentially life threatening infections.
7, Be Alert to Changing Symptoms
•Sudden weight gain — three or more pounds in one day, five or more pounds in
one week, or other amounts the physician designates.
•Increased shortness of breath while at rest, not related to exercise or exertion.
•Increased swelling of the lower limbs (legs or ankles).

18. 8, Sex
•Choose a time when rested, relaxed and free from the stressful feelings.
•Avoid having sex right after eating a heavy meal.
•If feel uncomfortable or tired during intercourse, stop and rest for a short time.
9, Rest and Relaxation
•If a person has heart failure they need to schedule time every day for rest and
relaxation.
•Rest times are essential because it gives the heart a chance to pump more
easily.
10, Vitamins and Supplements with Heart Failure
•Certain food supplements have been linked to positive results in individuals
with heart failure symptoms.
•Coenzyme-Q-10 (CoQ10) is a food supplement that many individuals who
have heart failure have claimed aids them to feel better.

19. 11, Emotional and social support
People with heart failure who have emotional support from family
and friends often feel better and have a more positive outlook on
life. Many people with heart failure also find that getting involved
socially helps them to keep their symptoms and improve their
quality of life.

20. NURSING MANAGEMENT
• Assessment
• -Assess for signs and symptoms
• -Assess sensorium and level of consciousness
• -Assess for edema and other signs and symptoms

21. NURSING DIAGNOSIS AND INTERVENTIONS
• Activity intolerance related to imbalance between oxygen
supply and demand secondary to decreased cardiac output
- Instruct patient to avoid prolonged bed rest , patient
should rest if symptoms are severe
- Encourage patient to perform an activity more slowly
than usual, for a shorter duration, or with assistance
initially
-Take vital signs , especially pulse before, during and
immediately after an activity

22. • Excess fluid volume related to sodium intake or
retention secondary to heart failure.
-Administer diuretics
-Monitor fluid status closely, auscultate lungs , compare
daily body weights, monitor intake and output
-Advice patient about dietary restriction of sodium.

23. • Anxiety related to breathlessness and restlessness
secondary to inadequate oxygenation
-Assess the patient’s anxiety level.
-Clarify their doubts
-Provide psychological support
- Speak in a slow , clam and confident manner .

24. • Fatigue secondary to heart failure
-Encourage patient to alternate activities with periods of
rest
-Identify patient’s peak and low periods of energy, and
plan energy consuming activities accordingly
-Assist the patient in daily activities

25. CONCLUSIONS
Heart failure is a life long diagnosis managed
with life style changes and medications to prevent
acute congestive episodes. Commonly underlying
conditions include coronary atherosclerosis, valvular
disease , cardiomyopathy, inflammatory or
degenerative muscle disease and arterial hypertension