Congestive Heart Failure (Circulatory Pathologies)

Question 1

Whaat is Congestive Heart Failure?

Answer 1

It’s the heart’s inability to pump sufficient blood to supply the body’s needs

This condition can be acute or chronic

It may be secondary to heart disease, chronic high blood pressure, valvular disease and other conditions that place excessive stress on the heart, as well as viral infection and alcoholism

There are often systolic and diastolic dysfunctions relating to

Usually, about ⅔ of the blood volume in the heart is ejected with ventricle contraction. With heart failure, the volume of blood ejected becomes progressively less. In severe cases, this volume may be as low as ¼-⅕ the volume of the blood in the heart. The remaining fluid causes the dilation of the faulty ventricle and passive congestion of the organs proximal to it

Left ventricle problems cause lung congestion
Right ventricle difficulties cause congestion in the liver and limbs
Secondary to ventricular enlargement is the fact that the heart must work harder to eli

Circulation will become sluggish

Early decreases in heart function often go undetected because of the system’s ability to compensate for the problems

Question 2

Risk Factors of Chronic Congestive Heart Failure

Answer 2

Pre-existing heart disease

Exacerbating factors such as physical and emotional stress, dysrhythmia, fever, infection, anemia, thyroid disorders, pregnancy Paget’s disease, poor renal function or medications such as steroids

Question 3

Symptoms of Left Ventricular Failure

Answer 3

Characterized by pulmonary congestion and edema

Another primary symptom is dyspnea (labored or difficult breathing)

Orthopnea (advanced dyspnea) and paroxysmal nocturnal dyspnea (PN), the feeling of suffocation when lying supine, may be experienced semiflower

Orthopnea is relieved in time (up to 30 mins) when the person is placed in an upright position

With PND, a semi-supine position is necessary with the trunk and head elevated by pillows during sleep

Pulmonary edema may cause feelings of anxiety, tachypnea (rapid breathing), noisy, wet breathing and profuse sweating

Accessory breathing muscles may be engaged, resulting in muscular hypertension and trigger points

A hacking cough with frothy, bloody sputum can be the result of the irritating nature of the fluid in the lungs

Fatigue, drowsiness and muscular weakness are caused by tissue hypoxia. These symptoms progress as the day wears on and there is a decrease in tolerance of exercise

In advanced cases, a decrease in blood supply to the brain results in cerebral hypoxia which causes anxiety, irritability, restlessness, confusion, loss of concentration, impaired memory and insomnia

Question 4

Symptoms of Right Ventricular Failure

Answer 4

There is generalized edema, distal to the heart, including ascites (edema in the peritoneal cavity) and weight gain

Breathing is less affected than with left ventricular failure

Edema is most marked in the lower limbs beginning at the ankles, the sacral area and the backs of the thighs. Chronic and pitted edema develop

Liver function may be impaired and the spleen enlarged
Abdominal pain, intestinal problems and anorexia are secondary to ascites

With severe right-sided failure, distension of the jugular veins is observable when the person is standing

Question 5

Medical Treatment of Congestive Heart Failure

Answer 5

Dietary modifications such as reductions in the intake of salt and water

Regular progressive physical activity, which may stabilize or even reverse the process

Rest after a meal or after physical activity

Stress reduction techniques to control anxiety

Question 6

Contraindications

Answer 6

With chronic congestive heart failure, full body lymphatic drainage techniques are avoided as is elevation of the limbs above the level of the heart

Lymphatic drainage is absolutely CI’d with cardiac edema, since a sudden increase in the volume of lymphatic fluid or venous return through compromised tissues and organs has potentially serious results

Question 7

Massage

Answer 7

Permission should be obtained from the client’s physician before performing massage

The client’s sleeping position is a good guide for positioning during massage. Likely seated or semi-seated and supported by pillows will be most comfortable

A relaxation massage is performed

It may be advised to only massage the head, neck and limbs, avoiding the trunk

Short, segmental strokes are used