Congestive Heart Failure

Teaching
Nicholette Demarco
Catherine Garcia
Jenna Henshaw
Kayle Augustine
Emily Wyant
 Pathophysiology
• What is heart failure?
o The heart is unable to pump an adequate amount of blood to meet the
body’s metabolic needs

• Decreased cardiac output

• Increased preload
• Increased afterload

• These 3 events result in…

o Decreased contractility
o Decreased stroke volume
Compensatory mechanisms:
Initial
• Decreased cardiac output:
o The SNS is stimulated
• Increased heart rate
• Increased contractility
• Vasoconstriction
• Antidiuretic hormone secretion

• These mechanisms increase cardiac output at first, but eventually..

• Excessive preload and afterload
• Continue to struggle to meet the body’s metabolic needs until
excessive myocardial oxygen demand and preload result in:
o Decreased contractility
o Decompensation
• Decreased cardiac output also leads to:
o Decreased renal perfusion
o Renin- angiotensin- aldosterone system
o This activation further contributes to vasoconstriction and fluid
retention
 Other compensatory
mechanisms
• Ventricular hypertrophy:
• Enlarged myocardium requires more oxygen
• Decreased contractility

• All of these compensatory mechanisms are helpful

at first, but eventually turn into a vicious cycle
 Left-sided Heart Failure
• Result of ineffective left ventricular contractility
o As cardiac output falls, blood that is not being pumped out into
the body backs up first into the left atrium and then in the
pulmonary circulation

• If blood continues to accumulate…

o Pulmonary edema and right- sided heart failure will develop
 Right-sided Heart Failure
• The result of ineffective right ventricular contractility
o Blood does not move appropriately out of the right
ventricle
o Blood will back up into the right atrium at first, then into the
peripheral circulation
• Increased pressure in the peripheral capillary bed
Signs and Symptoms of
Congestive Heart Failure
 Signs & Symptoms of CHF
• SOB
• Fatigue
• Swelling in ankles, legs, abdomen
• Coughing or wheezing
• Recent weight gain or loss
• Confusion or poor ability to concentrate
• Swollen neck vessels
• Fast or irregular pulse
Normal Heart vs CHF Heart
 How is CHF diagnosed?
• Blood tests
• EKG
• Echocardiogram 
• X-ray
• CT
• MRI
• Auscultate lungs for crackling sounds
• Auscultate heart for extra sounds like s3 and s4
 Abnormal Heart Sounds
• S1 and S2 are normal
• Both S3 and S4 are diastolic heart sounds
• S3 is a third heart sound that denotes altered
cardiac function in elderly
• S4 is heard over the apical area
 Discharge planning-
symptom recognition
• Notify your physician or clinic if:
• 1) Your rings begin to feel tighter or shoes become too tight.

• 2) You begin to gain weight. How much weight gain is concerning in

these patients?

• 3) If you no longer can do your normal ADL’s like vacuum or walk up a

flight of stairs, without developing symptoms of SOB or increased fatigue.

• 4) You lose your appetite or experience a full feeling all the time.

• 5) You experience palpitations or a sensation of rapid, irregular heart

action.

• 6) You are requiring more pillows to sleep at night, or awaken with a

sense of air hunger.
Potential Complications
And REMEMBER!!
CHF Diet
 CHF Diet
• What can I eat?
 CHF Diet
• What can’t I eat?
 CHF Diet
• What can I do differently?
• How can I find meals that are okay?
 CHF Diet
• Will I have to give up my favorite foods?

• Will it take long to get used to?

 CHF Diet

• How can I stick with it?

 Heart Medications
- ACE Inhibitors
- Beta-Blockers
- Diuretics
- Digoxin
- Antiarrhythmic
- Blood Thinners
- Calcium Channel Blockers
- Vasodilators
- ARBs
• ACE Inhibitors
o Inhibits the formation of ang. 2 and blocks the release of aldosterone
• Aldosterone promotes Na retention and K excretion
o benazepril (Lostensin), captopril (Capoten), Lisinopril (Prinivil), etc
o Know your patient
• African Americans and older adults
• Should not be given in pregnancy
• Patients with renal problems
o Signs and Symptoms:
• nausea, vomiting, diarrhea, fatigue, potassium excess, tachycardia,
constant, irritating cough
• Patients with lung problems/asthma  ARB
• Make sure your patient reports any problems
• Beta-Blockers
o cardiac output by diminishing the SNS response
• decrease basal sympathetic tone
• heart rate, contractility and renin release
o Different BB’s for different patients
o Nonselective beta blockers: carvedilol (Corgeg), propranolol (Inderal)
• Slows heart rate with bronchoconstriction
o Cardioselective beta blockers: (Acebutolol (Sectral), atenolol
(Tenormon), betaxolol (Kerlone)
• Do not cause bronchoconstriction
o Signs and Symptoms
• pulse and BP, worsening of asthma symptoms( non-selective), sexual
dysfunction, fatigue and dizziness
o Teach patient to get up slowly
o Diabetic patients and hypoglycemia
• Diuretics
o Sodium and water loss
o Treat edema associated with heart failure
o How different diuretics affect you
• Thiazide diuretics
o sodium, potassium and magnesium: calcium
o Examples: Chlorothiazide (Diuril), hydrochlorothiazide (Esidrix)
o Watch calcium intake
• signs of nausea, abdominal pain, decreased appetite,
constipation
o Hyperglycemia can occur
• diabetic patients: signs of hyperglycemia: increased thirst,
appetite and urination
• Loop diuretics act the loop of Henle
o Sodium, water, potassium, calcium and magnesium = potent
o Examples: Furosemide (Lasix), bumetanide (Bumex)
o Patients risk of low electrolytes
o Patients taking digoxin, toxicity is more likely to occur
o Patients need to understand the importance of their diet when on
loop diuretics
• Spironolactone
o A potassium-sparing diuretic
o Aldactone, Elpleronone (Inspra)
• Blocks the production of aldosterone
o Aldosterone can cause sodium and water retention
o Recommended dose of 12.5-25mg/day
o Signs and Symptoms: Fatigue or weakness, a feeling of numbness or tingling,
nausea or vomiting, problems breathing, chest pain, palpitations or skipped
heartbeats.
• Have patient report any of these
• Hyperkalemia (too much potassium): rare
o Teach patient about foods to avoid
o Renal problems: risk of hyperkalemia
• Lanoxin(digoxin)
o Cardiac glycoside
o Pharmacodynamics: myocardial contraction = cardiac output
Conduction of AV node = heart rate

o Therapeutic level is 0.8 to 2 ng/ml

o Digitalis Toxicity: drug accumulation
• Signs and Symptoms  diarrhea, nausea, vomiting, bradycardia (<60 bpm), headaches,
malaise, blurred vision, cardiac dysrhythmias, confusion and visual illusions
(white/green/yellow halos around objects)
• Digoxin immune Fab (ovine, Digibind) for digitalis toxicity
o Drug interactions
• Potent diuretics that promotes potassium loss  hypokalemia
o Patients at risk should consume foods rich in potassium/potassium
supplements and avoid certain foods (ex. Licorice)
• OTC Medications can decrease digoxin absorption
• Know what herbs your patient may be taking (ex. Ginseng, St. John’s wort)
• Antiarrhythmic
o Used to treat abnormal heart rhythms in people with or without heart
failure.
o Examples:
• aminodarone (Cordarone)
• sotalol (Betapace)
• dofetilide (Tikosyn)
o Notify your doctor if you experience:
• Worsening arrhythmias
• Blurred vision
• Shortness of breath
• Abnormally fast or slow heartbeat
• Dizziness of lightheadedness
• Cough
• Bitter or metallic taste or change in taste
• Loss of appetite
• Increased sensitivity to sunlight
• Diarrhea or constipation
• Blood Thinners
• Prevent blood clots
• Antiplatelet drugs: keep blood cells from sticking together in the veins and
arteries
o Examples: Aspirin, clopidogrel (Plavix), ticlopine (Ticlid)
o Anticoagulants: prevent blood clots by increasing the amount of time it takes
for the blood to clot
• Examples: warfarin (Coumadin)
o Talk to your doctor before taking any herbal supplements
o Side effects:
• Excessive bleeding, dizziness, muscle weakness, hair loss, rashes
o Certain foods can increase or decrease clotting
• Example: cabbage, lettuce, collard greens decrease effectiveness of
warfarin
• Example: garlic, ginger, peanut butter are natural anticoagulants
• Calcium Channel Blockers
• Increase blood supply and oxygen to the heart; reduces workload of the
heart
• Example: amlodipine (Norvasc)
o Should be taken with food or milk
o Side effects:
• Drowsiness
• Increased appetite
• Sweating
o Contact your doctor with any of these side effects:
• Weight gain
• Breathing difficulty
• Coughing or wheezing
o Should avoid grapefruit
o Alcohol may increase the side effects
• Vasodilators
• Widen/dilate blood vessels; reduces blood pressure
• Examples: Hydralazibe, isosorbide dinitrate, nitrates
o May help relieve symptoms and lower the risk of early death
o Side effects:
• Dizziness or lightheadedness
• Headaches
• Flushing or feeling warm
• Nausea
• Swelling from fluid backup
o Do not use erection enhancing medications
• Such as Viagra, Cialis, or Levitra
• Can cause very low blood pressure
• Angiotensin II Receptor Blockers
o Expand blood vessels, lowers blood pressure, makes it easier for the heart to
pump blood
o Examples:
• candesartan (Atacand)
• irbesartan (Avapro)
• losartan (Cozaar)
• valsartan (Diovan)
o Can be taken on an empty or full stomach
o Side effects:
• Dizziness, lightheadedness, or fainting upon rising
• Diarrhea
• Muscle cramps or weakness
• Insomnia
o Call your doctor if you experience:
• irregular, or fast or slow heart beat
• Confusion
o Do not use salt substitutes
• Can cause retention of potassium