This document discusses heart failure (also known as congestive heart failure), which refers to the heart's inability to pump enough blood to meet the body's needs. It defines heart failure and lists some common causes such as hypertension, coronary artery disease, and cardiomyopathy. Signs and symptoms like shortness of breath, edema, and fatigue are described. Diagnostic tests and the goals of medical management to relieve symptoms, improve quality of life, and prevent exacerbations are also summarized.

2. HEART FAILURE (
CONGESTIVE HEART
FAILURE)
ANILKUMAR BR
MSC.N
LECTURER (MSN)

3. •Heart failure (HF) or Congestive heart
failure is an abnormal clinical condition
involving impaired cardiac pumping.

4. •Definition
Heart failure refers to the
“inability of the heart to pump
sufficient blood to meet the needs
of the tissues for oxygen and
nutrients.

5. • Fluid over load and decrease tissue tissue
perfusion results when the heart can not
generate a CO sufficient to meet the body’s
demands.
• The term HF indicates myocardial disease in
which there is a problem with contraction of
the heart that may cause or may not cause
pulmonary or systematic congestion.

6. Some causes of HF are reversible,
depending on the cause. Most often,
HF is a progressive, life long diagnosis
that is managed with lifestyle changes
and medications to prevent acute
Congestive episodes.

7. Etiopathophysilogy
HF results from a variety of cardiovascular
conditions including chronic Hypertension, CAD and
vascular disease.
This conditions can result in decreased contraction
(systole) and decreased filling (diastole ) or both .
Significant myocardial dysfunction most often occurs
before the patient experience sings and symptoms of
HF Such as shortness of breath, edema and Fatigue.

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• Myocardial dysfunction is the most often
caused by CAD, cardiomyopathies, HTN, or
Valver disorder. Patient with diabetes
mellitus are also at high risk for HF.
•Atherosclerosis of the coronary arteries is
the primary cause of HF, and CAD is found
in more than 60% of patients with HF.

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Cardiomyopathies and
inflammatory process such as
myocarditis, Valvular heart
disease is also cause of HF.

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•Several systematic conditions can
contribute to the development and
severity of HF.
• Increased metabolic rate (fever)
•Iron over load, hypoxia and severe
anemia all of this conditions increase in
cardiac out put to satisfy of the systemic
oxygen demand.

11. Clinical manifestations
• General
Pale, cynotic skin (with decreased perfusion
to extremities)
Dependent edema
Decreased activity tolerance
Unexplained confusion and altered mental
status

13. Cardiovascular
•Apical pulse
•Third heart sounds
•Cardiac murmurs
•Tachycardia
•Increase JVD

14. Cerbro vascular
•Light headness
•Dizziness
• confusion

15. GIT
•Nausea and Anorexia
•Hepatomegally
•Ascites

16. Renal
•Decreased urinary frequency during the
day
•Nocturia

17. Respiratory
• Dyspnea
•Orthopnea
•PND (Paroxysmal nocturnal dyspnea)
• Cough on exertion when supine

18. Assessment and diagnostic findings
• History and physical examination
•Echocardiography and ECG
• Chest x-ray
• 12 lead ECG
• Cardiac catheterization

19. Laboratory investigation
• serum electrolytes
•BUN
•TSH
•BNP (B-type natriuretic peptide)
• urine analysis

20. Medical management
• The over goals of medical management
in HF are to Relive patient symptoms
to improve functional status and quality
of life and extend to survival.
• Medical management based on the
type, severity and cause of HF.

21. Specific objective include
Eliminate or reduce any etiolgic
contributing factors,esp those that may
be reversible.
Reducing the work load of the heart
Optimize all theraptic regimen
Prevent exacerbations of HF.

22. • Treatment options vary according to the
severity of the patient’s condition and may
include basic lifestyle changes, oral or IV
pharmacologic management, supplemental
oxygen, manipulation of assitve devices,
and surgical approaches, including CABG,
open heart surgery, and heart
transplantation

23. •Basic lifestyle changes (nutrition,
exercise, reducing risk factors)

24. • Managing of the patient includes providing
general education,counseling to the
patient and family.
•It is important patient and family
understand the nature of HF and
importance of their participation in the
treatment regimen.

25. Life Style recommendations including
• Restrictions of sodium intake in diet
•Avoidance of excessive fluid intake
alcohol and smoking cessation
•Weight reduction and maintain idial
body weight
• regular exercise

26. Pharmacologic therapy
• ACE inhibitors
•Beta – blockers
• Diuretic
• Digitals
• Calcium channel blockers

27. Complications
• cardiogenic shock
• Dysrhythmias
• Thromboembolism
• Pericardial effusion

28. Collaborative therapy
• Treatment of underlying cause
• High fowler position
• Oxygen by mask or Nasal canula
• Monitor BP, HR, RR, urinary output at least every
hour.
• Continous ECG and pulse oximetry
• Hemodynamic monitoring (CVP, PAWP, CO, Intra
atrial BP)

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• Monitor daily body weight
• Endotracheal intubation and
mechanical ventilation
• circulatory assitve devices (IABP,
PACEMAKER)

30. Nutritional therapy
•Low sodium (2 or 3 gm/day)
• A excessive amounts of fluid are
usually avoid

31. Additional therapy
• Supplemental oxygen
•PCI
•CRT ( Cardiac resynchronization
therapy) CRT involves the use of
biventricular pacemaker to treat
electrical conduction defects

32. Nursing management
• Administering medications and assessing
the patient response to the
pharmacologic regimen
•Assessing the fluid balance, including
intake and output
•Weighing the patient daily at the same
time and on the same scale, usually after
morning urination

33. Continue
• Auscultation of lung sounds to detect an increase or
decrease pulmonary crackles.
• Determine the degree of JVD distention
• Identify and evaluating the severity of dependent edema
• Monitoring pulse, BP and cardiac function
• Examination of skin turgor and mucous membranes for signs
of dehydration
• Assessing for symptoms of fluid over load (e.g Orthopnea,
PND)

34. Nursing diagnosis
• Activity intorlance and Fatigue related to
imbalance between oxygen supply and
demand because of decreased CO
• Excess fluid volume related to excess fluid or
sodium intake, and retention of fluid Related
to the HF syndrome
• Anxiety Related to breathlessness and
restlessness from inadequate oxygenation

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• Powerlessness related to inability to
perform role responsibilities because
of chronic illness and hospitalization
• Noncompliance related to lack of
knowledge

36. Complications
• cardiogenic shock
•Dysrhythmias
•Thromboembolism
•Pericardial effusion

37. Nursing interventions
• Promoting activity tolerance
•Managing fluid volume
• controlling anxiety
•Minimizing powerlessness