Definition

By Mayo Clinic staff

Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough
blood to meet your body's needs. Over time, conditions such as narrowed arteries in your heart
(coronary artery disease) or high blood pressure gradually leave your heart too weak or stiff to
fill and pump efficiently.

You can't reverse many conditions that lead to heart failure, but heart failure can often be treated
with good results. Medications can improve the signs and symptoms of heart failure. Lifestyle
changes, such as exercising, reducing the salt in your diet, managing stress, treating depression,
and especially losing excess weight, can improve your quality of life.

The best way to prevent heart failure is to control risk factors and conditions that cause heart
failure, such as coronary artery disease, high blood pressure, high cholesterol, diabetes or
obesity.

(http://www.heartfailure.org/eng_site)

-Heart failure is a progressive disorder in which damage to the heart causes weakening of the
cardiovascular system. It manifests by fluid congestion or inadequate blood flow to tissues. Heart failure
progresses by underlying heart injury or inappropriate responses of the body to heart impairment.

Symptoms and Signs

Swollen Ankles or Legs Shortne

Swollen ankles or legs, known as peripheral edema, may be a result of ss of
right-sided heart failure since fluid cannot be pumped to the lungs at an Breath
efficient rate. In right-sided heart failure, fluid backs up in the veins, Shortne
leaks out of capillaries and accumulates in tissues. Also, a decrease in ss of
blood flow to the kidneys can lead to an increase in fluid retention. breath
Diuretics are often prescribed to get rid of this excess fluid and reduce can be
the strain on the heart. caused
by
In the absence of heart failure, peripheral edema may commonly be congesti
due to obesity or venous insufficiency with stretched venous valves. on in
the
lungs.
This
congesti
on is
known
as
pulmon
ary
edema.
One
sign to
watch
out for
is
whether
your
shortnes
s of
breath
is worse
when
you lay
flat.
Orthopn
ea is the
shortnes
s of
breath
which
occurs
when
blood
kept in
the legs
by
gravity
returns
to the
chest
when
you lay
down.

Shortne
ss of
breath
can also
occur at
night.
Shortne
ss of
breath
that
comes
on
suddenl
y at
night is
known
as
paroxys
mal
(par-ox-
iz-mal)
nocturn
al
dyspnea
.

Fatigue
Fatigue
is often
attribute
d to
getting
old or
being
out of
shape.
Howeve
r, if this
conditio
n
persists
for long
periods
of time,
it may
be the
result of
heart
failure.
Sluggis
hness
may be
the
result of
 your
organs
not
getting
enough
oxygen.
You
may
feel as
tired
after
getting
up in
the
mornin
g as you
did
when
you
went to
bed. Let
your
doctor
know if
this
happens
on a
regular
basis.

Weight Gain or Loss Loss of

Excess fluid in the body may cause an increase in weight. Similarly, Appetit
when excess fluid is excreted, your weight may fall. Weight increases e
by about two pounds for each extra quart of fluid. You may notice that Fluid
your weight has risen before you notice swelling of the ankles or accumu
extremities. Inform your doctor of changes of more than five pounds. lation in
the
Causes of Heart Failure digestiv
e
For heart failure to occur, there must be an unresolved impairment of the heart
organs
that compromises its ability to work as a pump. The source of this can be acan
cutoff
of blood supply, an increase in workload due to high blood pressure causedcause
by
non-functioning valves or a genetic predisposition. Heart failure can be worsened
you to
by a poor diet and lifestyle. Its development follows the scheme below: feel
full.
You
 may
also
feel
bloated.
You
may
want to
try
eating
smaller
more
frequent
meals
instead
of the
traditio
nal
three
large
meals a
day.
Conditions That May Lead To Heart Failure
Coronary Artery Disease (CAD)
This is the most common cause of heart failure in the U.S. today. CAD causing
obstruction to the coronary arteries prevents blood flow and, therefore, oxygen
delivery to the heart. CAD is a manifestation of atherosclerosis, which can affect
any artery of the body. Risk factors for CAD also include smoking, high
cholesterol, hypertension, and diabetes.

Hypertension
This is more commonly known as high blood pressure. It is a condition that is
treatable and simple to diagnose with a blood pressure cuff. Although most
individuals will not have symptoms, hypertension is detected by a simple
measurement with a blood pressure cuff and stethoscope. It is also a risk factor for
CAD, stroke, peripheral vascular disease, or kidney impairment.

Valvular Heart Disease

A condition that occurs when the valves between the chambers of the heart are
faulty, either due to birth defect or injury.

Cardiomyopathy
A disease of the heart muscle. This can be one of many varieties. It can arise
because of genetic causes, a viral infection, or consumption of toxins (lead,
alcohol, etc.). In peripartum cardiomyopathy, women who have recently given
birth can develop heart muscle impairment. In many cases, the condition is called
"idiopathic", which means it has occurred of uncertain origin or cause.

In addition to those causes above, the following factors also can play a role in
determining if heart failure will affect you:

1. family history of heart failure

2. diabetes
3. marked obesity
4. heavy consumption of alcohol, or drug abuse
5. failure to take medications
6. large salt intake in diet
7. sustained rapid heart rhythms

Many other conditions can actually simulate heart failure symptoms - it is

important to seek evaluation from a medical professional for a definitive
diagnosis. Some of these are:

1. lung impairment
2. anemia
3. kidney impairment
4. pericardial disease (rare)

Heart Failure and Your Circulation

Two important causes of heart failure are Coronary Artery Disease and
Hypertension.

Coronary Artery Disease (also known as CAD)

Cause
Coronary Artery Disease is a condition
where fatty deposits and cell-
proliferation build-up in the arteries
supplying the heart muscle. These
plaques form commonly in a condition
called atherosclerosis. Genetic factors
or a diet of foods high in cholesterol or
saturated fat that result in high blood
cholesterol can increase your risk for
this disease. Fatty deposits form
silently; no symptoms arise until they
are large enough to significantly
restrict blood flow to an area of heart
muscle. When this occurs, angina
pectoris (chest tightness or discomfort)
usually results. Normally a 70% or
greater blockage in the diameter of a
coronary artery will cause symptoms of
chest discomfort or pain with exercise.

An abrupt closure of a coronary artery

due to a blood clot forming (associated
with a fissure of a plaque) can cause a
heart attack (or myocardial infarction).

Symptoms
Angina Pectoris - A constricting chest
discomfort or pressure that can radiate
outward in the torso, left arm, neck and
jaw. Sustained symptoms at rest could
represent a heart attack.
Diagnosis
Screening tests for CAD are treadmill
testing, stress echocardiograms and
tracer studies. Coronary arteriography
is the gold standard for diagnosing
CAD. In this procedure a catheter is
inserted into the leg or arm and guided
toward the opening of the blood vessels
that supply the heart. A dye is then
injected directly into the coronary
arteries while x-ray movies are
recorded.
Treatment
Medical management includes:
 drugs to reduce the heart's need
for oxygen
 drugs to lower blood pressure
 drugs that dilate the coronary
arteries
 drugs to reduce the amount of
cholesterol in the body
Other alternatives are coronary
angioplasty and stent implantation or
coronary artery bypass grafts.

Hypertension (High Blood Pressure)

Cause
Blood pressure refers to the pressure of
blood against the walls of arteries and
is measured in units of millimeters of
mercury (mmHg), which is a reference
to the fluid historically used with blood
pressure cuffs. Blood pressure is
always measured by two numbers on
Symptoms
Usually none, but headaches and
flushing are sometimes evident.
Diagnosis
Blood pressure cuff
(sphygmomanometer), Chest X-ray and
echocardiogram (to observe
this scale. The range of the first
number is usually 100-140 mmHg,
which is referred to as systolic (the
peak pressure in the arteries after the
heart contracts). The range of the
second number is usually 60-90 mmHg
and is referred to as diastolic (the
minimum pressure reached in the
arteries when the heart relaxes just
before the next contraction). The usual
cause of hypertension is not known -
the brain's "set-point" for a usual BP
increases. Uncommonly, renal artery
stenosis (a blockage of the arteries)
going to the kidneys or hormone
producing tumors can also be causes.
For a more thorough explanation, click
here!
hypertrophy).
Treatment
Hypertension is managed with a
combination of hygienic approaches
and medication. A low salt diet,
exercise, weight loss when obesity is
present, and stress reduction may all
help. Most individuals also require
medication to maintain a blood
pressure lower than 140/90. If the
blood pressure has caused cardiac
remodeling (see diagram) reducing
blood pressure can encourage the heart
to return to its former shape and
function.

Heart Failure and Your Neuroendocrine System

Paradoxically, activity of the neuroendocrine (body regulation) system, that

normally functions to maintain the circulation, can actually worsen heart failure if
sustained over time. By following the feedback control it is programmed to, it
inadvertently adds strain to the heart. Examine the scenario below where the body
is entering the early stages of heart failure due to blocked heart arteries. Click here
to see a quick overview of the neuroendocrine system, if necessary.
With time, the heart failure becomes worse and worse. High blood volumes and
remodeling increase heart size over time, which further impacts its ability to
adequately eject blood. In this way, a system designed to support our heart has
caused it to fail when attempting to compensate for heart injury.

Why would the body do this to itself? Consider that the design of this system has
evolved in such a way as to protect our body not from heart damage, but from
exterior threats. For example, if one suffers an injury where blood is being lost
(see example), survival is dependent on maintaining an adequate blood pressure to
all vital organs. If blood is lost, then blood pressure in our arteries will drop
accordingly. Fluid retention serves to keep high blood volumes to buffer the loss
due to injury. By constricting our arteries as shown before, the remaining blood
gets mobilized more efficiently to tissues at an adequate pressure. Therefore,
possibly the situation shown in the chart isn't so much an error in design of the
neuroendocrine system so much as a misapplication of a control mechanism
initiated by initial heart and circulatory impairment.

Heart Failure and Your Heart

Once the heart has been injured, the body will attempt to compensate for reduced
blood flow. Unfortunately, many of the countermeasures actually increase strain
on the heart and further the development of heart failure.

The heart, after suffering damage or being placed under physical stress by high
blood pressure, will begin to change its own shape. This deforming of the
ventricles' shape is known as remodeling or hypertrophy. This remodeling occurs
in two primary patterns - concentric and dilated (as shown below):

 Key
 h = Thickness  c = Concentric
 r = Radius  n = Normal
 d = Dilated
These diagrams represent cross-sections of the left ventricle, the chamber that
supplies the body with oxygenated blood flow. The triangular notches are cut into
each ventricle to demonstrate how the wall has changed in shape and thickness.

For comparative terms, the normal heart essentially looks like a football. When
the wall thickens in concentric circles (lower left), The heart works less
effectively and takes on the shape of a large fist. This may be caused by
hypertension, a blocked aortic valve, or underlying genetics. Dilation of the
ventricle walls (lower right) gives the weakened heart a beach-ball shape and an
inefficient contraction. This prohibits blood from leaving the heart as it normally
would. This remodeling pattern follows damage from a heart attack, sustained
hypertension, viral infection, or genetic causes.

Heart failure occurs when the heart can't pump blood to the body as quickly as
needed. Blood returning to the heart faster than the heart can eject it congests the
system behind it. Decreased blood flow to organs, such as the kidneys, causes the
body to retain more fluid which complicates the problem further. The relationship
between the heart and other organs can be a delicate one - once one is injured, it
can send off a cascade of events that damage other organs and worsens heart
failure.

Medical Tests and Findings

Chest X-ray More on Heart Failure

Your doctor can use an x-ray to look at your heart, lungs, and blood vessels. He or
she can see if your heart is enlarged or if there is fluid around your lungs. What are the
Pulmonary congestion shows up as cloudy areas on the x-ray. A chest x-ray symptoms and
requires only a brief exposure to x-rays and is generally considered safe. signs of heart
failure?

Fluid leakage in
the lungs

Prevalent causes
heart failure

Heart failure and

your circulation

Heart control an
the neuroendocr
system
Echocardiogram
The echocardiogram is a procedure used to visualize the pumping action of the How does the he
heart. It is an ultrasound examination of the heart that can also measure blood flow respond to heart
into and out of the heart. failure?
What tests are u
Electrocardiogram to diagnose hear
This test also known as an "ECG" or "EKG", measures the electrical activity of failure?
the heart. An electrocardiogram can check the heart's rhythm, evidence of
enlargement, and the presence of a prior or recent heart attack. Electrical wires
with adhesive ends are attached to the skin on your chest, arms, and legs. The
electrical activity of the heart is then recorded on a piece of paper.

Tracer Studies
Radioactive tracers given through a hand or arm IV are another tool used in the
diagnosis of heart failure. Radioactivity is detected as the blood moves through the
heart. In this way, doctors can outline the chambers of the heart, measure the
ejection fraction, and assess blood flow to regions of the heart muscle.

Treadmill Test
This test is known as a "stress test" because your heart's activity is being
monitored with an electrocardiogram during exercise. By walking on a treadmill
for specific intervals of time at differing intensity levels, your doctor can see if
your symptoms are brought on by exertion and if they correlate with patterns on
an electrocardiogram.

Stress tests can be done using radioactive tracers such as thallium, Sesta MIBI,
and Myoview. First, the tracer is injected into an IV tube in the arm before and
during exercise on the treadmill. After exercise, pictures of the heart can be taken
to see where the tracer has been deposited, telling the doctor which areas are
getting enough blood and which are not.

Alternatively, stress testing can be done without exercise. The effects of stress on
heart blood flow can be simulated through the use of an IV drug such as adenosine
or persantine that dilates heart blood vessels, or dobutamine that increases heart
rate and function.

Catheterization
Doctors can insert a catheter, or small tube, into a leg (femoral) artery via a needle
stick and direct it to a region of the heart with x-ray guidance. Once in place, the
catheter can measure pressures in the heart and direct a dye used to visualize heart
chambers or blood vessels. This visualization technique is called angiography. The
x-rays show areas of narrowing or blockage. Catheters are also used to open
blocked heart arteries with angioplasty and stenting.

FROM MOSBY:

NURSING CARE OF CLIENTS WITH HEART FAILURE:

ASSESSMENT:

1. Baseline vital signs, breath sounds

2. Daily weight; circumference of edematous extremities; abdominal girth
3. Hemodynamic status (CVP, PAWP)
4. Electrolytes levels ( sodium, chloride, potassium)
5. Intake and output
B. ANALYSIS/ NURSING DIAGNOSES:

1. Decreased cardiac output related to impaired cardiac function.

2. Excess fluid volume related to impaired excretion of sodium and water.
3. Impaired gas exchange related to excessive fluid in interstitial space.

C. PLANNING/ IMPLETATION:

1. Maintain the client in high- Fowler’s position.

2. Elevate extremities except when the client is in acute distress.
3. Frequently monitor vital signs.
4. Change position frequently.
5. Monitor intake and output and daily weight.
6. Restrict fluid as ordered.
7. Monitor invasive lines.
8. Refer to cardiac glycosides, antihypertensives, and diuretics for additional nursing actions.

D. EVALUATION/ OUTCOMES:

1. Maintains adequate tissue perfusion.

2. Reduces peripheral edema/ ascites.
3. Verbalizes understanding of pharmacologic and diet therapy.

 Coronary computed tomography angiography (CTA) is a heart imaging test that helps determine
if fatty or calcium deposits have narrowed a patient’s coronary arteries. Coronary CTA is a
special type of x-ray examination. Patients undergoing a coronary CTA scan receive an iodine-
containing contrast material as an intravenous (IV) injection to ensure the best possible images.

“There are many things in life that will catch your eye, but only a few will catch your heart..pursue
those.”

“the heart is the only broken instrument that works”