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Definition Causes and pathophysiology Types of heart failure Compensatory mechanism failure Clinical manifestations Classification of heart failure Diagnostic evaluation Medical management Nursing management
of
heart
Heart failure describes the clinical syndrome that develops when the heart cannot maintain an adequate cardiac output. The heart pumps blood inadequately, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and other changes that may further weaken the heart.
artery disease Heart attack High blood pressure Heart valves disorders
Inflammation
lung disease ( pulmonary hypertension) Severe anemia Overactive thyroid gland (hyperthyroidism) Underactive thyroid gland (hypothyroidism) Abnormal heart rhythms ( atrial fibrillation) Kidney failure
Types
Left-sided
heart failure
There are two types of leftsided heart failure Systolic dysfunction Diastolic dysfunction Right-sided heart failure
Renin-angiotensin-aldosterone system Sympathetic nervous system Enlargement of the muscular walls of the ventricles (ventricular hypertrophy).
Signs
Cachexia and muscle wasting Tachycardia Pulsus alternans Elevated jugular venous pressure Crepitations or wheeze Third heart sound Oedema Hepatomegaly (tender) Ascites
Class
I II III IV
% of patients
35% 35% 25% 5%
Symptoms
No symptoms or limitations in ordinary physical activity Mild symptoms and slight limitation during ordinary activity Marked limitation in activity even during minimal activity. Comfortable only at rest Severe limitation. Experiences symptoms even at rest
Patient history Physical examination Diagnostic studies 1. Electrocardiography (ejection fraction) 2. Radionuclide 3. magnetic resonance 4. computed tomography imaging 5. cardiac catheterization with angiography 6. a biopsy of heart muscle is needed
Treatment
lifestyle change
1.
2.
3.
4.
5.
Salt restriction Exercises Smoking and alcoholism Body weight (daily weight) Supportive stockings
Treatment (cont)
Drug management Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers Beta-blockers Other vasodilators ( nitroglycerin) Cardiac glycosides (digoxin) Aldosterone receptor blockers (spironolactone) Loop diuretics
Treatment (cont)
Potassium-sparing diuretics Thiazide and thiazide-like diuretics Anticoagulants (heparine) Opioids (morphine) to relieve anxiety Positive inotropic drugs (drugs that make muscle contract more forcefully) (dopamine)
Treatment (cont)
Nursing care of patients with congestive heart failure Maintain the patient in high fowler's position Elevate extremities except when the patient is in acute distress Frequently monitor vital signs Change position frequently Monitor intake and output and daily weight
Teach the patient and family and provide emotional support (life style change)
Explain the side effect of diuretic medications for additional actions ( side effects of diuretics include electrolyte imbalance, symptomatic hypotension Use aseptic procedures invasive lines when caring for