Proyecto de investigación del sistema cardiovascular N°1

Título del texto Chronic heart failure part 1:pathophysiology, signs and symptoms

Nombres y Apellidos Rebecca Brake, Ian David Jones

del Autor

Año de la publicación 2017

Referencia Brake, Rebecca & Jones, Ian. (2017). Chronic heart failure part 1: pathophysiology, signs and
Bibliográfica symptoms. Nursing Standard. Available at:
<https://www.researchgate.net/publication/312081769_Chronic_heart_failure_part_1_pathophys
iology_signs_and_symptoms> (Accessed 16 August 2020).

Palabras Claves breathlessness, cardiology, chronic heart failure, heart failure, left ventricular systolic
dysfunction.

Resumen del texto The abstract presented in the article mentions the definition of heart failure which is a syndrome
that alters the relaxation or contraction of the heart, presents the possible symptoms that may be
experienced during heart failure such as fatigue, pain, and peripheral edema considering the lack
of air as the most debilitating, this being the first of two articles to be published on chronic heart
diseases in which he describes the pathophysiology, causes, and evaluation of signs and
symptoms.

Contenido This article begins by highlighting its objective which is to develop a physiological
understanding, signs and symptoms of chronic heart failure in the nurse, it is contemplated that
after reading and performing activities the nurse will be able to define heart failure, identify the
most common causes and summarize the signs and symptoms of heart failure.

In the introduction it mentions that chronic heart failure is common in the UK where
approximately 900,000 suffered from it according to the (National Institute for Excellence in
Health and Care (NICE) 2010). Its prevalence of presenting this condition has been increasing in
the elderly population although it has had higher survival rates from ischemic heart disease and
aging in the population (Mosterd and Hoes 2007, Haydock and Cowie 2010).

Moving on from the introduction, the physiology of the heart is explained in which they describe
the heart pumping which drives the blood through the circulatory system, the uniform
contraction of the atria and ventricles are fundamental in the whole process, it is mentioned that
a healthy heart Deoxygenated blood flows from the superior vena cava and the inferior vena
cava into the right atrium. This increases the pressure in the right atrium, which causes the
tricuspid valve to allow the passage of blood to the right ventricle.

Once the pulmonary tricuspid valve has closed and the lunate open, allowing the right ventricle
to contract, the blood passes into the pulmonary arteries later in the pulmonary capillaries where
the gaseous change occurs, once the blood is oxygenated it is entered into the atrium left through
the pulmonary veins generating an increase in the pressure of the left atrium causing the mitral
valve to open allowing passage to the left ventricle causing the semilunar valve to have been
allowing the left ventricle to contract, passing oxygenated blood to the aorta where it will be
transported to the circulatory system.

Once the normal functioning of the heart is explained, they explain the pathophysiology of heart
failure which is caused by the loss of functional myocardial cells and this is due to the reduction
in cardiac output which can result from the deterioration of contractibility or release.
compensatory means are initiated by reducing perfusion in the organs, this includes the
activation of the sympathetic nerves and the initiation of the renin angiotensin aldosterone
system as a compensatory means.

The renin-angiotensin-system to control blood pressure and electrolyte balance and plasma
volume. Renal perfusion decreases when cardiac output or circulating blood volume is reduced.
This reduction in renal perfusion stimulates the release of renin by the kidneys. Renin interacts
with circulating angiotensinogen and converts it to angiotensin I. Angiotensin converting
enzyme converts inactive angiotensin I to active angiotensin II, which has the ability to produce
vasoconstriction and fluid retention. Angiotensin II stimulates the release of aldosterone, which
causes increased fluid retention and causes an increase in blood pressure.()

Once the sympathetic nerve is stimulated, it releases norepinephrine, stimulating beta-adrenergic

cells, producing vasoconstriction in smooth muscle, increasing heart rate and peripheral vascular
resistance. Being a compensatory mechanism in which it is sought to increase cardiac output,
these being beneficial when there is a hemorrhage but in heart failure it can be maladaptive and
cause further deterioration.However, in the chronic heart, the renin-angiotensin-aldosterone
system can be misfit and cause further deterioration. Increased intracardiac pressures can lead to
edema, while volume expansion, increased venous return, and fluid displacement in interstitial
spaces can result in peripheral edema.

Types of Chronic Heart Failure Chronic heart failure can be defined in several ways. This article
discusses chronic heart failure in relation to the abnormalities that occur during the systolic and
diastolic phases of the cardiac cycle - left ventricular systolic dysfunction with reduced ejection
fraction and heart failure with preserved ejection fraction.
Left ventricular systolic dysfunction with reduced ejection fraction, there is an alteration in the
contraction of the left ventricle in the systolic phase in which the ejection fraction of the
ventricle is lower, being insufficient to be able to pump the whole blood.
Heart failure with preserved ejection fraction this is due to an alteration in the relaxation of the
left ventricle is known as diastolic dysfunction or relaxation phase in the cardiac cycle, this can
be due to causes such as hypertension or age.

Past the types of heart failure, this article mentions the causes of heart failure in the United
 Kingdom which are ischemia, myocardial infarction, and as other causes are hypertension, aortic
or mitral heart valve disease, atrial fibrillation, heart block, hypothyroidism, toxins such as
chemotherapy and alcohol and infectious such as human immunodeficiency virus, bacteria,
puerperium.

The article mentions that in order to determine heart failure, laboratories of (NT-proBNP) must
be taken, it is a neurohormone that is released into the bloodstream when the ventricles are under
stress and an echocardiography since abnormalities in the cardiac structure and function can be
observed using this imaging modality, and the type of chronic heart failure can be identified.

Signs and symptoms are generally the result of decreased cardiac output and fluid accumulation
such as dyspnea, paroxysmal orthopnea, nocturnal dyspnea, and peripheral edema, but it should
be clarified that there are symptoms that are not exclusive to chronic heart failure.

Specific signs in these include laterally displaced apex beat, elevated jugular venous pressure,
third heart sound, and hepatojugular reflex. The following signs are less specific but may present
as tachycardia, irregular pulse, murmur, narrow pulse pressure, tachypnea, bibasal lung crackles,
reduced air intake and lack of brightness, percussion at the lung bases (pleural effusion)
peripheral edema, hepatomegaly, ascites, cold extremities and oliguria.

Symptoms Typically the person may experience shortness of breath, orthopnea, paroxysmal
nocturnal dyspnea, reduced exercise tolerance, fatigue and swelling of the ankles. Among the
less common but which can occur are night cough, wheezing, bloating, loss of appetite,
confusion, depression, palpitations, dizziness, syncope and pain.

At the end of the article, he presents his conclusion, which mentions that chronic heart failure is
a complex condition which is associated with high rates of mortality and morbidity, which are
due to the reduction in cardiac output and the accumulation of fluid normally, which is why
Nurses must ensure adequate support for patients and report on health conditions.

Fecha elaboración 16/080/2020

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