Congestive Hearth Failure

Definition

¨       A physiologic state in which the hearth is unable to pump enough blood the meet the metabolic needs of the body at rest or during exercise even though filling pressure are adequate ( Medical Surgical Unit Cardiovascular Disorder )

¨       Pathology condition of heart to pump enough blood to meet metabolic and this is only with increase pump left ventricle (Braunward )

Etiology

Congestive heart failure caused by:

1.      Abnormal loading condition

2.      Abnormal muscle function (myocardium dysfunction )

3.      Condition/disease that precipite/exacerbate heart failure:

·         Physical or emotional stress

·         Dysritmia

·         Infection

·         Anemia

·         Thyroid disorder

·         Pregnancy

·         Paget’s disease

·         Nutritional deficiency

·         Pulmonary disease

Patophysiology

 

Systemic vascular resistance

Peripheral artery

   constriction                                                   force LV contraction                                                             

                                                                                                                    coronary artery constriction

Ephinephrine release                     

                                                               LV oxygen demand

                               

LV hypoxia

                                                                                                                       Oxygen supply

     Systemic blood pressure               Force of LV contraction

 

ADH         renal blood flow

LV EDP

                        renin

LV preload

                  angiotensin

LA preload

                   aldosteron

Pulmonary edema

Sodium water & retention

           Pulmonary vascular resistance

§  Peripheral edema

§  Hepatomegaly                                      RV failure

§  Ascites

§  Weir of jugularis venous                     RV preload

§  Gastro intestine disorder

Clinical manifestation

Heart failure maybe categories as :

¨       Left versus right ventricular

¨       Backward versus forward

¨       High versus low output

¨       Systolic versus diastolic

¨       Left versus right ventricular failure

Left ventricular failure                                     Right ventricular failure

-          Weakness                                                  -   weight gain

-          Fatigue                                                       -   ankle or pretibial swelling and

-          mental  confusion                                           pigmentation

-          insomnia                                                    -   abdominal distention

-          anorexia                                                     -   anorexia,nausea,gastric distress

-          diaphoresis                                                -   edema

-          anxiety                                                       -   ascites

-          breathleness                                               -   jugular vein distention

-          cough                                                         -  hepatomegaly

-          orthopnea                                                  -   increase central venous pressure

-          tachicardia

-          gallop S₃,S₄

-          pulmonary cracles

-          pulsus alternans

¨       backward versus forward failure

backward failure is the term used to refer to the venous congestion arising from damming of blood behind filling chamber.This is can caused mental confusion etc. Forward failure refers to the problem of inadequate perfusion

¨       high versus low output failure

the causes of high output failure include sepsis,pagets disease anemia etc.low output failure including congenital,valvular rhematic coronary etc

¨       systolic versus diastolic failure

-          systolic heart failure refers to a decrease in the ability of the ventricle to contracy force fully and maintain and adequate forward cardiac output atherosklerosis

-          diastolic heart failure occurs when ventricular relaxation is incomplete and the chamber is unable to accept sufficient blood like injured or ischemic myocardium

Complication

¨       acute pulmonary edema

¨       refractory  heart failure

Prognosis

The prognosis for the client with congestive heart failure depend on:

1.      the degree of cardiac hypertrophy

2.      the amount of cardiac reserve

3.      the presence of other heart of associated disorder

Diagnostic assessment

¨       data from client’s health history

¨       chest radiography

¨       arterial blood gases

¨       liver enzymes

¨       ECG

¨       Echocardiography

Medical management

Client with acute congestive heart failure are usually admited to an intensive care unit. Where they reserve continous assessment and intervention

¨       Positioning

¨       Oxygen administration

Pharmacologic management

¨       Digitalis :Fargoxin,digoxin

¨       Dopamine and dobutamine : amrinone

¨       Diuretic to reduce preload

¨       Nitroglycerine/isosorbidedinirate is to venous dilators

¨       Hidralazine is to arteriolar dilator

¨       Combine is use sodium nitroprusside

¨       Prazosin

¨       ACE (angiotensin converting enzyme)

¨       Betablocker or betaadrenergic

Dietary management

¨       Diet low salt (sodium diet)

¨       Low fat (for obesitas)

¨       Excessive water intake

Surgical management

¨       Veno arterial bypass

¨       Conterpulsation

Nursing management

a.        Cardiac output decrease R/T heart failure or dysrhitmia

b.       Fluid volume excess R/T reduce glorurol filtration , decrease cardiac output , intake antidiuretic production sodium water retention

c.        Gas exchange impared R/T fluid in alveoli

d.       Peripheral tissue perfusion , high risk for decrease R/T decreased   cardiac output and vaso contriction

e.        Activity intolerance , high risk for R/T to decrease cardiac output , hypoxia fear of death or serious consequence

f.        Colaborative problem

High risk for digitalis toxicity R/T impaired drug excretion from hepatic and renal involvement

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