Heart failure is the inability of the heart to pump sufficient blood to meet the

needs of the tissues for oxygen and nutrients

o A syndrome characterized by fluid overload or inadequate tissue
perfusion
o The term heart failure indicates myocardial disease in which there is a
problem with the contraction of the heart (SYSTOLIC FAILURE) or filling
of the heart (DIASTOLIC FAILURE)
o Some cases are reversible
o Most heart failure is progressive, lifelong disorder managed with
lifestyle changes and medications
Causes:
o Necrotic damage from MI
o Valvular dysfunction
o Infection
o Cardiomyopathy
o Uncontrolled HTN
May occur 2/2 known clinical syndrome
Decreased exercise tolerance
Fluid retention
o Most reliable clinical sign is jugular venous distention (+JVD)
Diagnosis:
o Imaging tests
o Laboratory tests
Classification of heart failure
o NYHA
Classification I, II, III, IV

ACC/AHA classification
Stages A, B, C, D
o Treatment guidelines are in place for each stage/classification
HF compensatory mechanisms
o Sympathetic nervous system
o RAAS
o

o Ventricular hypertrophy
o Ventricular remodeling
HF complications
o Pulmonary complications
SOB
Pulmonary edema (especially with L-sided)
Arterial blood gases of
o Cardiogenic versus noncardiogenic pulmonary edema
Cardiogenic HF, cardiomyopathies, CAD, HTN
Noncardiogenic ARDS, high altitudes, lung injury
o Dysrhythmias
Medical management of HF
o Eliminate or reduce etiologic or contributory factors
o Reduce the workload of the heart by reducing afterload and preload
o Optimize all therapeutic regimens
o Prevent exacerbations of HF
o Medications are routinely prescribed for HF
ACE inhibitors (captopril, enalapril)
Dilate venules and arterioles
Improve renal blood flow
Relieve symptoms of HF
Play a pivotal role in the management of heart failure due
to systolic dysfunction
Angiotensin II receptor blockers (losartan, valsartan)
Promote reverse remodeling
Decrease morbidity and mortality
Beta-blockers (metoprolol) used in chronic HF only
Promote reverse remodeling
Decrease afterload
Inhibit SNS
Decrease morbidity and mortality
Diuretics (furosemide [loop], hydrochlorthiazide [thiazide],
spironolactone [K sparing]
Decrease fluid volume
Decrease preload
Decreased pulmonary venous pressure
Relieve symptoms of HF like edema
Digitalis
Increase contractility of the heart (+ inotropic efect)
Increase CO
Decrease HR (because the proper amount of blood is
being pumped out to the body and the heart wont try to
compensate by beating faster to get more blood out)
Goal of medical management
o Relief of symptoms
o Enhancement of cardiac performance

o Correct precipitating causes

o Palliative care for end-stage HF
Nursing Management
o Optimize cardiopulmonary function
o Promote comfort and emotional support
o Pharmacologic therapy
o Nutritional intake
o Patient and family education