This document presents information on congestive heart failure. It begins with definitions of congestive heart failure and heart failure, noting that heart failure means the heart cannot pump enough blood to meet the body's needs. Statistics are provided on the incidence of congestive heart failure in the US, including that 800,000 patients are hospitalized annually and 250,000 die each year. The document discusses classifications, risk factors, signs and symptoms, diagnostic tests, pharmacological and surgical treatments, diet management, and nursing care for patients with congestive heart failure.

1. Presented by :-
Kanchan sharma
Msc(n) 1st year
Medical surgical department

2. INTRODUCTION
 Congestive heart failure is an older term for
heart failure .
 It is still used interchangeably by some to
indicate heart failure in general .
 The newer term heart failure is preferred
because volume overload or congestion either
in the lungs or periphery is not present in
everyone with heart failure or at all times .

3. DEFINITION
 Heart failure is a physiologic state in which the
heart is unable to pump enough blood to meet the
metabolic needs of the body.
 CHF is a condition in which the heart’s function
as a pump is inadequate to deliver oxygen rich
blood to the body.

4. Incidence:-
 Five millions Americans have Congestive heart failure.
 550,000 New cases every year
 800,000 Patients with Congestive heart failure
hospitalized every year
 250,000 die every year
 50% Patients die with in five years
 150% increase in the last 20 year
 2.6% total population has this disease
 Incidence and associated morbidity and mortality is
expected to increase in future

5. CLASSIFICATION


6. CONT……
2. Acute vs chronic heart failure
3. Right sided heart failure vs left sided heart failure
4. Systolic heart failure vs diastolic heart failure
5. Low output vs high output heart failure

7. Risk Factor/Causes

8. Sign and symptoms:-

10. Diagnostic evaluation:-
 Patient history
 Physical examination
 Chest x-ray
 Electrocardiogram

11. Cont….
 Laboratary test
 Cardiac enzymes
BPN (B-type natriuretic peptide)
Liver function test
Thyroid function test
BUN (Blood urea Nitrogen)

13. Pharmacologic therapy
1.ANGIOTENSIN – CONVERTING ENZYME
INHIBITORS:
• ACE inhibitors slow the progression of HF
improve exercise tolerance & decrease the
number of hospitalizations for HF .
• Drug:- Captopril 6.25mg tid and lisinopril
2.5-5mg daily
• Side effect- hypotension,
hyperkalemia,cough

14. 3. BETA - BLOCKERS
Beta blockers directly block the negative
effects of the SNS on the failing heart , such
as increased HR.
E.G :- metoprolol 12.5mg daily
• Side effects- hypotension, bradycardia,
fatigue , fluid retention , worsening heart
failure.

15. 2. ANGIOTENSIN II RECEPTOR
BLOCKERS :
 Prevent action of angiotensin II & produce
vasodilation & increased salt and water
exretion .
 DRUG : Valsartan 20-40mg bid , Losartan
20-50 mg daily
 Side effect- hypotension, hyperkalaemia

16. 4. Diuretics
Thiazides:-
Hydro chlorothiazide 25-100mg once or twice
plus loop diuretic
metolozone 2.5-10mg once + loop diuretic
• LOOP DIURETICS :- Furosemide (Lasix) ,
Torsemide
Less effective for hypertension

17. 5.DIGITALIS
 Digitalis medicines strengthen the force of the
heartbeat by increasing the amount of calcium
in the heart's cells.
 As calcium builds up in the cells, it causes a
stronger heartbeat.
 It control the irregular heart rhythm.

18. SURGICAL MANAGEMENT
 Implantable Cardioverter-Defibrillator
(ICD)
 Heart transplantation
 Percutaneous coronary intervention (PCI)
(also referred to as angioplasty)
 Coronary artery bypass
 Valve replacement

19. Diet management
 Provide low sodium diet 2-3g/day. The purpose of
restrict sodium is to decrease the amount of
circulating blood volume which decreases myocardial
work.
 Avoid drining of excessive amount of fluid to reduce
the symptoms of pulmonary congestion
 Avoid alcohol consumption
 Avoid smoking

20. Nursing management
 Nursing assessment
 Note report of sleep disturbance due to shortness of breath
 Ask patient about edema, abdominal symptoms ,alter
mental status, and ativity that causing fatigue.
 Auscultate lungs to detect crackles and wheeze.
 Document heart rate and rhythm.
 Assess sensorium and LOC
 Measure intake and output to detect the oliguria or anuria .

21.  Nursing diagnose :-
1. Decrease cardiac output r/t impaired contractility &
increased preload & afterload .
Goal : to improve cardiac output
 Intervention:-
 Assist patient in resting position
 Administer oxygen
 Promote low sodium diet and adequate fluid intake
 Keep patient Warm and change position frequently to
stimulate circulation and reduce skin breakdown.

22. 2. Impaired gas exchange related to fluid in alveoli.
 Goal: to maintain gas exhanges
 Intervention:-
 Provide comfortable position to the patient.
 Provide Suctioning to remove secretions.
 Administer oxygen therapy

23. 3.Fluid volume excess related to sodium & water
retention .
Goal :- to maintain fluid volume
Intervention-
 Administer diuretic early in the morning so that
diuresis does not disturb nighttime rest.
 Monitor fluid status regularly, auscultate the lungs
 Provide low sodium diet

24. 4. Activity intolerance related to oxygen supply &
demand imbalance.
Goal :- promoting activity tolerance
Intervention:-
 Monitor patient response to activity.
 Encourage the patient to perform activity more slowly
than usual.
 Identify the barrier that could limit the patient’s ability
to perform an activity.