This presentation provides an overview of heart failure, including: 1. It defines heart failure as when the heart is unable to pump sufficiently to meet the body's needs, which can result from systolic or diastolic dysfunction. 2. Some key statistics on the incidence and prevalence of heart failure worldwide and in India are presented. 3. Heart failure is classified in different ways such as whether it affects the left or right side of the heart, and whether it involves forward or backward failure. 4. The etiology, clinical presentation, diagnostic assessment, medical management including medications, and surgical options for treatment are discussed at a high level.

1. PRESENTATION
ON
HEART FAILURE
Prepred by:
Mr. Sagar Masne
F.y. Msc (N)
MEDICAL SURGICAL
NURSING NUNURSING

2. REVIEW OF ANATOMY AND
PHYSIOLOGY……

3. INTRODUCTION
• Heart failure is often referred as
congestive heart failure (CHF).
Occurs when heart is unable to pump
sufficiently to maintained blood flow
to meets the body needs
This condition results of -
• SYSTOLIC DYSFUNCTIONS OR
• DIASTOLIC DYSFUNCTIONS.

4. INCIDENCE
• More than 20 million people have heart
failure worldwide
• Prevalence of heart failure in India due to
coronary heart disease, hypertension, obesity,
diabetes and rheumatic heart disease to range
From 1.3 to 4.6 million, with an annual
incidence of 491 600-1.8 million.
• Heart failure is the leading cause of
hospitalization in people older than 65

5. CLASSIFICATION
1.Left sided v/s right sided
heart failure
2. Forward v/s backward failure
3. High output v/s low output
failure
4. Acute v/s chronic failure

6. LHF
• In left sided heart failure, left ventricle cardiac
output is less then volume received from
pulmonary circulation; blood accumulates in the
left ventricle, left atrium.
• pulmonary congestion forcing fluid from
pulmonary capillaries into pulmonary tissue and
alveoli causing pulmonary interstitial edema and
impaired gas exchange.

7. RHF
• In right sided heart failure right ventricle cardiac
output is less then volume received from the
peripheral venous circulation, blood
accumulates in RA, RV and peripheral venous
system.
• Increased venous pressure lead to JVD and
increased capillary hydrostatic pressure
throughout the venous system

8. FORVWARD V/S BACKWORD
• In forward failure decresed cardiac output
results in inadequate tissue perfusion
• In backward failure blood remains in ventricles
after systole, increasing atrial and venous
pressure; rises in venous pressure forces fluid
out of capillary membrane into extra cellular
spaces.

9. HIGH/LOW OUTPUT
• High output failure occurs in response to
condition that causes the heart to work harder to
supply blood; the increase oxygen demand can
only met only with an increase in cardiac output.
• Low output failure occurs in response to high BP
of hypovolemia which results in impaired
peripheral circulation and vasoconstrictions.

10. ACUTE V/S CHRONIC
• Acute failure occurs in response to a sudden
decrease in cardiac output which results in rapid
decrease in tissue perfusion.
• So chronic failure, body adjusts to decrease in
cardiac output through compensatory
mechanism which results in systemic
congestion.

11. ETIOLOGY
The incidence of heart failure increases with
advancing age and coronary artery disease
• Diabetes
• Cigarette Smoking
• Obesity
• Elevated Total Cholesterol
• Abnormally High Or Low Hematocrit Level
• Proteinuria
Common Precipitating Causes Of Heart Failure Are As
Follows
• Anaemia
• Infection

12. CONT……
• Thyrotoxicosis
• Hypothyroidisms
• Arrhythmias
• Bacterial Endocarditis
• Valvular Dysfunction
• Pulmonary Embolism
• Pulmonary Disease
• Pagats Disease
• Nutritional Deficiencies
• Hypovolemia

14. CLINICAL PICTURE:
IN LEFT SIDED HEART FAILURE

15. IN RIGHT SIDED HEART FAILURE

16. BIVENTRICULAR FAILURE
• DULLNESS
• PLEURAL EFFUSION

17. Common sign and symptoms of
heart failure

18. DIAGNOSTIC ASESSMENT
• History collection
• Physical examination
• ABG analysis
• Serum chemistries
• Liver profile
• Chest X ray
• Hemodynamic monitoring
• 12 leads ECG
• Nuclear imaging studies
• Cardiac catheterization
• 2D echocardiogram

19. MEDICAL MANAGEMENET
-Acute Decompensation
-Chronic management
-Lifestyle
-Medication
-Minimally invasive therapies

20. PHARMACOLOGICAL MANAGMENT
•DIGOXIN
•BETA BLOCKER
•INOTROPES
•ARBS
•ACE INHIBITORS
•WATER PILLS

21. DIGOXIN
• Exerts a direct and beneficial effect on the
myocardial contraction in the failing heart.
• Improved cardiac output enhances kidney
perfusion, which may create a mild dieresis
of sodium and water
• DOSE: 0.125-0.25 mg PO/IV qDay; higher
doses including 0.375-0.5 mg/day rarely
needed

22. BETA-BLOCKERS TO TREAT CHF
• Coreg (carvedilol)—6.25-50 mg; one 3.125, 6.25,
12.5 or 25-mg tablet 2x/day with food.

23. INOTROPES
• Agent such as dopamine, dobutamine and
amrinone may be ordered for clients with very
low output heart failure.
• These medications facilitate myocardial
contractility and enhance stroke volume.
• dopamine given in small doses(< 4 ug/kg/min)

24. ACE INHIBITORS
• ACE inhibitors can raise potassium levels
• Accupril (quinapril)—20-40 mg; one 10 or 20
mg tablet 2x/day on an empty stomach, 1 hour
before or 2 hours after a meal or with a light,
low-fat meal.
• Altace (ramipril)—10 mg; one 5 mg capsule
2x/day with or without food. Swallow capsule
whole.

25. WATER PILLS
• There are many brands of diuretics. Some are
taken once a day. Others are taken 2 times a day.
The most common types are:
• Thiazides. Chlorothiazide (Diuril),
chlorthalidone (Hygroton), indapamide (Lozol),
hydrochlorothiazide (Esidrix, HydroDiuril), and
metolazone (Mykrox, Zaroxolyn)
• Loop diuretics. Bumentanide (Bumex),
furosemide (Lasix), and torasemide (Demadex)

26. SURGICAL MANAGEMENT
HEART TRANSPLANTATION:
 When the heart is irreversibly managed and no
longer functions adequately and when the
client is at risk of dying, cardiac
transplantation and use of an artificial heart to
assist or replace the failing heart are measures
 A heart transplant, or a cardiac
transplant, is a surgical transplant procedure
performed on patients with end-stage heart
failure or severe coronary artery disease when
other medical or surgical treatments have
failed of last resort.

27. CONTAINDICATION
Absolute contraindications:
• Advanced kidney, lung, or liver disease
• Active cancer if it is likely to impact the survival
of the patient
• Life-threatening diseases including acute
infection or systemic disease such as systemic
lupus erythematosus, sarcoidosis, or amyloidosis
Vascular disease of the neck and leg arteries.
• High pulmonary vascular resistance - over 5 or 6
Wood units.

28. Relative contraindications
• Insulin-dependent diabetes with severe organ
dysfunction
• Recent thromboembolism such as stroke
• Severe obesity
• Age over 65 years (some variation between
centers) - older patients are usually evaluated on
an individual basis.
• Active substance abuse, such as alcohol,
recreational drugs or tobacco smoking (which
increases the chance of lung disease)

29. HEART TRANSPLANTATION
Pre-operative
• A typical heart transplantation begins when a
suitable donor heart is identified. The heart
comes from a recently deceased or brain dead
donor, also called a beating heart cadaver.
• . The patient is also given immunosuppressant
medication so that the patient's immune system
does not reject the new heart.

30. PROCEDURE
•ORTHOTOPIC
PROCEDURE
•HETEROTOPIC
PROCEDURE

31. Post-operative
• The patient is taken to the ICU to recover where
they are started on immunosuppressants. When
they are stable, they may move to a special
recovery unit for rehabilitation.
• The duration of in-hospital, post-transplant care
depends on the patient's general health, how
well the heart is working, and the patient's
ability to look after the new heart

32. CARDIOMYOPLASTY
• Cardiomyoplasty is a surgical procedure in
which healthy muscle from another part of the
body is wrapped around the heart to provide
support for the failing heart.
• Most often the latissimus dorsi muscle is used
for this purpose.
• A special pacemaker is implanted to make the
skeletal muscle contract. Cardiomyoplasty is
related to damaged myocardium remodeling.

33. VENTRICULAR ASSIST DEVICE (VAD):

34. It is a Electromechanical device for assisting
cardiac circulation, which is used either to
partially or to completely replace the function of
a failing heart.
The function of VADs is different from that
of artificial cardiac pacemakers; some are for
short-term use, typically for patients recovering
from myocardial infarction (heart attack) and
for patients recovering from cardiac surgery

35. CARDIAC RESYNCHRONIZATION
THERAPY

36. Cardiac Resynchronization
Therapy (CRT).
• It resynchronizes the contractions of the
heart’s ventricles by sending tiny electrical
impulses to the heart muscle, which can help
the heart pump blood throughout the body
more efficiently.
• CRT defibrillators (CRT-D) also incorporate
the additional function of an implantable
cardioverter-defibrillator, to quickly
terminate an abnormally fast, life-threatening
heart rhythm.

37. MANAGEMENT
•NURSING MANAGEMENT
• PALLIATIVE CARE
• CARDIAC REHABILITATION
EXERCISE

38. NURSING MANAGEMENT :
• The objective of nursing intervention will be:
• 1. Improving cardiac output
• 2. Improving gas exchange
• 3. Restoring fluid volume balance
• 4. Improving activity tolerance
• 5. Supporting the patient experiencing
hopelessness and
• 6. Educating the patient and family regarding
care.

39. PALLIATIVE CARE
• Fatigue and Breathlessness
• Fatigue and breathlessness are common
problems at the end of life.
• Other symptoms may include tightness in the
chest, feeling as if you are not getting enough air,
or even feeling like you're being smothered.
• Family or caregivers can help by:
• Encouraging the person to sit upright
• Increasing the airflow in a room by using a fan
or opening a window
• Helping the person relax and not panic

40. Eating and Digestive Symptoms
• Symptoms of fatigue, shortness of breath, loss of
appetite, and nausea can make it hard for people
with heart failure to TAKE IN ENOUGH
CALORIES AND NUTRIENTS.
• Wasting of muscles and weight loss are part of
the natural disease process. It can help to eat
several small meals.
• CHOOSING FOODS that are appealing and
EASY TO DIGEST can make it easier to eat.
• Caregivers should NOT FORCE A PERSON
WITH HEART FAILURE TO EAT.

41. Other Symptoms
• Anxiety, fear, and sadness are common among
people with end-stage heart failure.
• Family and caregivers should look for signs of
these problems. Asking the person about his or
her feelings and fears can make it easier to
discuss them.
• Morphine can also help with fearfulness and
anxiety. Certain antidepressants may also be
useful.

42. RESEARCH
• Daily vitamin D supplements significantly
improve cardiac function in patients with
chronic heart failure, according to a recent
study presented at the American College of
Cardiology’s 65h Annual Scientific Sessions in
Chicago.
• Also published in the Journal of the American
College of Cardiology, this study tested the
effects of vitamin D supplementation on heart
failure

43. Cardiac rehab is a medically supervised program that
includes
• Exercise training,
• Education on heart-healthy living and lifestyle,
and often counseling to reduce stress.
• For many people with HF, cardiac rehab plays a critical
role in improving their quality and length of life.
• With regular access to coaching and medical staff, rehab
can do a lot to help you on the road to better heart health
and reduce your chances of future heart problems

44. REHAB TEAM

46. CONCLUSION
• Living with HF is a challenge to the sufferers of
this condition. It also represents a significant
burden for the caregivers. The effective
management of HF is achieved through optimal
medical therapy.

47. • Brunner and Suddarth’s. Textbook of
medical surgical nursing. 12th ed. New Delhi:
wolters kluwar publication; p. 825-39
• Joyce M Black, Jane Hokanson Hawks.
Medical surgical nursing: clinical management
for positive outcome. 8th ed. New Delhi: elsevier
publication; 2009. p. 1430-49