- complex syndrome resulting from cardiac disorders that impair the ability of the ventricles to fill with and effectively pump blood
- can be acute or chronic
- heart is unable to pump enough blood to meet the metabolic demands of the body
- is the end result of many conditions
heart failure
- abnormal accumulation of fluid in the interstitial tissue and alveoli of lungs
- both cardiac and non-cardiac disorders can cause this
pulmonary edema
- pulmonary edema due to increased capillary hydrostatic pressure secondary to elevated pulmonary venous pressure
- accumulation of fluid in the lung interstitium and alveoli as a result of cardiac dysfunction
cardiogenic pulmonary edema
what are the primary compensatory mechanisms when the heart begins to fail?
- frank-starling mechanism
- neuroendocrine responses
- myocardial hypertrophy
- the greater the stretch of cardiac muscle fibers, the greater the force of the contraction
- increased contractile force leads to increased cardiac output
- increases myocardial O2 demand
- limited by overstretching
frank-starling mechanism
-decreased cardiac output stimulates the:
*sympathetic nervous system and catecholamine release
*stimulates RAAs (with decreased renal perfusion)
-atrial and brain natriuretic peptide are released
-blood flow is redistributed to vital organs
-vasodilation and vasoconstriction, increased HR and BP, salt and water retention etc…
>attempt to balance out system but in long run it is ineffective
neuroendocrine response
- increased cardiac workload causes myocardial muscles to hypertrophy and ventricles to dilate
- increased contractile force to maintain cardiac output
- increased O2 demand, cellular enlargement
ventricular hypertrophy
what is the leading cause of heart failure?
ischemic heart disease aka coronary heart disease
what are some risk factors for heart failure?
- CAD and HTN
- family hx
- cardiotoxic drugs
- smoking
- obesity
- alcohol abuse
- DM
what are the clinical manifestation of left sided heart failure?
- fatigue, activity intolerance
- dizziness, syncope, dyspnea
- S3 gallop
- rales and wheezes
what are the clinical manifestation of right sided heart failure?
- edema of feet, legs, sacrum
- anorexia, nausea
- RUQ pain
- neck vein distension
what respiratory complications can occur with heart failure?
- dyspnea on exertion
- shortness of breath
- tacypnea
- orthopnea
- dry cough
- rales in lung bases
what gastrointestinal complications can occur with heart failure?
- anorexia, nausea
- abdominal distension
- liver enlargement
- right upper quadrant pain
what muskuloskeletal complications can occur with heart failure?
-fatigue, weakness
what neurologic complications can occur with heart failure?
- confusion
- impaired memory
- anxiety, restlessness
- insomnia
what cardiovascular complications can occur with heart failure?
- activity intolerance
- tachycardia
- palpitations
- S3, S4 heart sounds
- elevated central venous pressure
- neck vein distension
- hepatojugular reflux
- splenomegaly
what genitourinary complications can occur with heart failure?
- decreased urine output
- nocturia
what integumentary complications can occur with heart failure?
- pallor or cyanosis
- cool, clammy skin
- diaphoresis
what metabolic complications can occur with heart failure?
- peripheral edema
- weight gain
what are the main goals for care of a client in heart failure?
- slow progression of disease
- reduce cardiac workload
- improve cardiac function
- control fluid retention
what diagnostic tests are available for heart failure?
- blood tests to detect atrial and brain natriuretic peptides
- serum electrolytes
- urinalysis, BUN, serum creatinine
- liver function
- thyroid function
- ABGs
- CXR
- ECG
- echocardiogram
- study of forces involved in blood cirdulation
- used to assess cardiovascular function in clients who are critically ill or unstable
hemodynamics
what are some of the pharmacological therapies available for heart failure?
- ACE inhibitors (angiotensin converting enzyme)
- angiotensin II receptor blockers
- beta blockers
- diuretics
- vasodilators
- digitalis
- antidysrrythmias
what devices are available for circulatory assistance in heart failure clients?
- intra-aortic balloon pump
- left ventricular assist device
