Heart failure Flashcards
Heart failure
The inability of the heart to pump enough blood to meet the body’s requirement for oxygen and nutrients
It is characterized by signs and symptoms of congestion (fluid overload) and inadequate tissue perfusion
Etiology
“FAILURE”
- Faulty heart valves (Valvular disease), Stenosis (narrowing of the valves), Infection (endocarditis
- Arrhythmias, Atrial fibrillation or tachycardia
- Infarction, coronary artery disease
- Lineage, Family history
- Uncontrolled hypertension, overtime this can lead to stiffening of the heart walls
- Recreational Drugs
- Envaders (instead of invaders), viruses or infections
Others:
Cardiomyopathy
Systemic pulmonary hypertension
Cardiac output
The amount of blood ejected from the heart each minute.
Dependent on the heart rate and stroke volume (blood pumped out of heart during one heart cycle)
Preload
The filling of the vessels at the end of diastole and the beginning of systole
Afterload
The force that is generated that is needed to eject blood from the ventricles
Cardiac contractility (inotropy)
Ability of the heart muscle to shorten (contract)
Classifications of heart failure
- Right heart failure
- Left heart failure
Pathophysiology
Regardless of the injury that occurs to the heart, that leads to fluid retention, therefore the workload of the heart increases.
As the workload of the heart increases the contractility of the heart increases.
The heart responds by increasing the size of the heart muscle (hypertrophies).
However, overtime it loses it’s contractility.
Left sided heart failure
The left ventricle cannot pump blood from the lungs to the systemic circulation
Blood is then “ backed up in the pulmonary system causing respiratory systems”.
Signs & Symptoms of LHR
“DROWNING” (These patients are literally drowning in their own fluid from the heart’s failure to pump efficiently)
- Difficulty breathing (SoB)
- Rales (crackles) that do not clear with coughing
- Orthopnea (cannot tolerate lying down)
- Weakness (extremely tired and fatigued due to SoB)
- Nocturnal Paroxysmal dyspnea
- Increased heart rate
- Nagging cough especially with exertion (can be frothy or blood-tinged… very bad sign)
- Gaining weight
Right sided heart failure
The heart cannot eject blood from the peripheral circulation
Symptoms include
- gastrointestinal symptoms
- edema to the feet and ankles
Signs & Symptoms of RHR
“SWELLING” (Fluid is backing up in the right side of the heart which causes fluid to back-up in the hepatic veins and peripheral veins)
- Swelling of legs, hands, liver, abdomen
- Weight gain
- Edema (pitting)
- Large neck veins (jugular venous distention)
- Lethargic (weak and very tired)
- Irregular heart rate (atrial fibrillation)
- Nocturia (frequent urination at night)
- Girth of abdomen increased (from swelling of the liver and building up fluid in the abdomen)
Others:
- altered mental status
- pale, cyanotic skins, decreased perfusion to the extremities
- Murmurs
- S3
- Tachycardia
Nursing diagnosis for Heart Failure
- Fluid volume overload
Compensatory mechanism of heart failure that complicate the patient’s condition
Kidneys
- As a result of poor blood perfusion to the kidneys, they retain water and sodium which adds to blood volume and increase the work load of the heart
- The RAAS system is activated, converting Angiotensin I to II which is a powerful vasoconstrictor which retains sodium and water which adds to the blood volume
- However the body is already overloaded with fluid so this leads to more congestion
Sympathetic Nervous System
- The brain starts to release epinephrine and norepinephrine so the heart would pump faster but the heart is failing, it can not work anymore so this increases the workload of the heart.
Diagnostic testing
- ECG
- Echo cardiogram (Direct visualization of the heart)
BLOOD TESTS
- FBC
- BUN (abnormal if kidneys affected)
- Creatinine (abnormal if kidneys affected)
