Congestive heart failure CHF

HEART FAILURE ( CONGESTIVE

HEART FAILURE) ANILKUMAR BR

MSC.NLECTURER (MSN)

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

•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.

• 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.

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.

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.

Clinical manifestations

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

Cardiovascular

•Apical pulse •Third heart sounds •Cardiac murmurs •Tachycardia • Increase JVD

Cerbro vascular

•Light headness •Dizziness • confusion

GIT

•Nausea and Anorexia •Hepatomegally •Ascites

Renal

•Decreased urinary frequency during the day •Nocturia

Respiratory

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

Assessment and diagnostic findings

• History and physical examination •Echocardiography and ECG• Chest x-ray • 12 lead ECG • Cardiac catheterization

Laboratory investigation

• serum electrolytes •BUN •TSH •BNP (B-type natriuretic peptide)• urine analysis

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.

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.

• 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

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

• 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.

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

Pharmacologic therapy

• ACE inhibitors •Beta – blockers • Diuretic • Digitals • Calcium channel blockers

Complications

• cardiogenic shock • Dysrhythmias • Thromboembolism • Pericardial effusion

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)

Nutritional therapy

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

Additional therapy

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

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

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• 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)

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

Complications

• cardiogenic shock •Dysrhythmias •Thromboembolism •Pericardial effusion

Nursing interventions

• Promoting activity tolerance •Managing fluid volume • controlling anxiety •Minimizing powerlessness