CONGESTIVE HEART FAILURE

DEFINITION:-

It is a Physiological state in which heart is incapable to pump blood according to metabolic need.
Heart failure is not a disease but group of manifestation in which inadequate pump performance of heart that leads to Pulmonary and systemic congestion.

CAUSES:-

  1. Abnormal loading condition
    During Preload:
    • Arterial septal defect.
    • Congenital defect.
    • Hypervolemia.
    • Pulmonary valve stenosis.
    • Mitral valve stenosis.

  2. During after load:
    • Aortic valve stenosis.
    • Ventricular septal defect.
    • Coronary thrombosis.
    • Size and thickness of ventricles.


  3. Abnormal muscles functions
    • Myocarditis.
    • Cardiomyopathy.
    • Pericarditis.

      • Others:
    • ↑es physical and emotional stress.
    • Dysrhythmia, e.g., Tachycardia, bradycardia.
    • Anaemia.
    • Pregnancy.
    • Thyroid disorder.
    • Hypervolemia.


RISK FACTORS:-

     FAILURE  Signs and Symptoms 
     F  Forgot medication 
     A  Anaemia/Arrhythmia 
     I  Ischemia/Infraction/infection 
     L  life Style 
     U  upgradation of thyroxin 
     R  Renal failure 
     E  Embolism 


PATHOPHYSIOLOGY:-

    Left ventricular hypertrophy
    ↓
    Ventricular hypertrophy leads to ↑es muscles fibers diameter
    ↓
    Decrease contractile function of cardiac muscles fibers
    ↓
    Increase heart work load
    ↓
    When heart fail then compensatory mechanism of heart acts (starts)
    ↓
    If it Fails then residual volume of left ventricle increases
    ↓
    Decrease receiving capacity of heart
    ↓
    Effect shows on left arm
    ↓
    Pulmonary edema
    ↓
    Pressure increase on right ventricles
    ↓
    Right ventricle fail
    ↓
    Systemic congestion


SIGNS AND SYMPTOMS:-

  1. If left ventricular failure
    • Pulmonary edema.
    • back flow of blood into pulmonary artery and vein.
    • Shortness of breath.
    • Dyspnoea and dry coughing.
    • Fatiguability.
    • Insomnia.
    • Restlessness.
    • Tachycardia.


  2. If right ventricular failure
    • Liver Congestion causes abdominal pain.
    • Anorexia (loss of appetite).
    • Nocturia (es urination in night).
    • Weakness.
    • Abnormal body fluid in body cavity.
    • Ankles edema.


      • Others
    • ↑es pulse rate (Tachycardia).
    • Cardiomegaly (enlargement of heart).
    • Pulse utterance (pulse make a sound).


DIAGNOSTIC EVALUATION:-

  • ECG (QRS-large).
  • Chest X-ray (Cardiomegaly).
  • Liver enzyme test.
  • Echocardiography.
  • ABG analysis.


COMPLICATIONS:-

  • Cardiac arrest
  • Myocardial failure
  • Cardiac arrhythmias.


MEDICAL MANAGEMENT:-

  1. Diuretics:
    2. Example;
    • furosemide
    • thiazide.

  2. Positive intropic agent:(increase effectively heart ability)
    3. Example;
    • Digoxin
    • Dopamine.

  3. Vasodilators:
    4. Example;
    • Nitrates.

  4. ACE inhibitors:
    5. Example;
    • Captopril- 15-25 mg TDS.
    • Analapril.


SURGICAL MANAGEMENT:-

  • Heart Transplantation.


NURSING MANAGEMENT:-

NURSING DIAGNOSIS

  • Altered cardiac output related to impaired contractibility of heart.
  • Fluid excess related to sodium and water retention.
  • Activity intolerance related to imbalanced oxygen supply or increase oxygen demand.
  • Knowledge deficit related to disease conditions.

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