موضوع تقديمي مبسط حول عجز القلب الاحتقاني والعناية التمريضية تقديم الممرض الجامعي صلاح نزار عبد الوهاب / كلية التمريض / جامعة بغداد Salah Nezar

1. Seminar for postgraduate
Adult Nursing
‫الجامعي‬ ‫الممرض‬ ‫إعداد‬
‫الحمداني‬ ‫نزار‬ ‫صالح‬
Congestive Heart Failure

2. Congestive heart failure
Definition
(The heart does not pump efficiently with fluid
collect around the heart)
Organs in the body do not get enough oxygen rich
blood that they need to work well

3. Causes of Heart Failure
♥ Coronary Artery Disease
♥ Untreated High Blood Pressure (neglected)
♥ Defect Heart Valves
♥ Cardiomyopathy
♥ Lung Disease
♥ Diabetes
♥ Infections
♥ (Bad life Style) eg. Smoking & Alcohol
♥ Toxic Drugs

4. Ischemia (myocardial dysfunction)
Hypoxia and acidosis (accumulation of lactic acid)
Myocardial infarction (muscle necrosis)
Loss of contractility
Heart Failure

5. Coronary Artery Disease
It is a condition where fatty deposits and
cell-proliferation build-up in the arteries’ wall
supplying the heart muscle
Genetic factors or a diet high in cholesterol
or saturated fat that result in high blood
cholesterol can increase the risk for this disease
Fatty deposits form silently; no symptoms arise
until they are large enough to significantly restrict
blood flow to an area of heart muscle

6. When this occurs, angina pectoris
(chest tightness or discomfort) usually results.
70% or greater blockage in the diameter
of a coronary artery will cause symptoms of chest
discomfort or pain with exercise
An sudden closure of a coronary artery due to a blood
clot forming can cause a heart attack
(myocardial infarction)

7. Hypertension (High Blood Pressure)
Increases afterload (resistance to ejection)
Increases the workload of the heart
Hypertrophy of myocardial
HF

8. Heart Failure and Lungs
As the left ventricle's abilities are diminished, blood tends to pool and back-up
behind it in the pulmonary circulation
(lung)
This back-up under increased pressure,
as the right side of the heart
is still pumping into pulmonary circulation
This result in fluid leakage into the lungs
(a condition called pulmonary edema)
This situation translates into shortness of breath

9. Heart Failure and Lungs

10. Congestive heart failure
Classification of heart failure
New York Heart Association (NYHA) Functional Classification
Symptoms% of patientsClass
No symptoms or limitations
in ordinary physical activity35%I
Mild symptoms and slight
limitation during ordinary
activity
35%II
Marked limitation in activity
even during minimal
activity. Comfortable only at
rest
25%III
Severe limitation.
Experiences symptoms even
at rest
5%IV

11. Types
1 Left-side heart failure
Two types of left-side heart failure
a Systolic dysfunction
b Diastolic dysfunction
2 Right-sided heart failure
3 Congestive heart failure

13. Congestive heart failure
Clinical manifestations
Signs
Cachexia and muscle wasting
Tachycardia
Increased jugular venous distention
(JVD)
Bilateral crackles that (do not clear with
cough)
Third heart sound (S3)
Murmurs (with valvular dysfunction)
Edema
Hepatomegaly (tender)
Ascites
Cardiomegaly
Symptoms
Dyspnea
Orthopnea
Reduced exercise tolerance,
lethargy, fatigue
Nocturnal cough
Wheeze
Ankle swelling
Anorexia

14. (B) When the pressure is
released, an indentation
remains in the edematous tissue
(A) Example of pitting edema. The
nurse applies finger
pressure to an area near the
ankle

15. Diagnostic Evaluation
Patient history
Physical examination
Laboratory Investigations
Electrocardiography ECG
Echocardiogram(ejection fraction) & US
Magnetic resonance
Computed tomography imaging
Cardiac catheterization with angiography
A biopsy of heart muscle is needed
Treadmill Test

16. Treatment
♥ Medications management
♥ Oxygen
♥ Angiotensin-converting enzyme (ACE) inhibitors
♥ Beta-blockers
♥ vasodilators
♥ Cardiac glycosides (digoxin)
♥ Diuretics
♥ Anticoagulants (heparin)
♥ Opioids (morphine) to relieve anxiety
♥ Positive inotropic drugs (drugs that make muscle contract more
forcefully) (dopamine)

17. Non pharmacological management
Non pharmacological management of heart failure
(surgical intervention)
♥ Coronary artery bypass grafting ( revascularization)
♥ Percutaneous coronary intervention (Angioplasty) PCI
♥ Valve replacement
♥ Biventricular pacemaker
♥ Heart transplantation
♥ Left ventricular assist device
(LVAD)

18. Nursing care of patients
with congestive heart failure
♥ High fowler's position
♥ Oxygen supply
♥ Elevate extremities except when the patient is in acute distress
♥ Frequently monitor vital signs
♥ Change position frequently
♥ Monitor Fluids intake and output
♥ Daily weight
♥ Restrict salt and fluids as ordered
♥ Teach the patient and family and provide emotional support (life
style change)
♥ Explain the side effect of medications like ( side effects of diuretics
include electrolyte imbalance, symptomatic hypotension)
♥ Use aseptic procedures when caring for invasive lines

19. Thank you for listening