HEART FAILURE

OBJECTIVE
• At the end of the session the participants will be able to learn about heart
failure and its Nursing management.
INTRODUCTION

• Heart failure is a chronic progressive condition in which the heart

muscle is unable to pump enough blood to meet the body’s metabolic
needs .

• Heart failure, or congestive heart failure, is a long-term condition that

gets worse over time.

• Heart failure means that the heart is unable to pump blood around the
body properly. It usually happens because the heart has become too
weak or stiff.
DEFINATION
• HF is a complex clinical syndrome with symptoms and signs that result
from any structural or functional impairment of ventricular filling or
ejection of blood.
RISK FACTORS

• Coronary artery disease

• Heart attack
• Heart valve disease
• High blood pressure.
• Irregular heartbeats.
• Congenital heart disease.
RISK FACTORS

• Diabetes
• Alcohol use
• Smoking or using tobacco.
• Obesity
• Viruses
• some medications
TYPES OF HEART FAILURE

• Heart failure with reduced ejection fraction (HFrEF) (systolic

failure):

The left ventricle loses its ability to contract normally. The heart can't
pump with enough force to push enough blood into circulation.
TYPES OF HEART FAILURE

• Heart failure with preserved ejection fraction (HFpEF)/diastolic

failure (or diastolic dysfunction):

The left ventricle loses its ability to relax normally (because the muscle
has become stiff). The heart can't properly fill with blood during the
resting period between each beat.
Mechanism Of The Heart Failure

When heart failure happens acutely the body has little

time to make compensatory change but if the heart
fails over a period of time
• cardiac muscle fibers enlarge/increase in number
• which makes the walls of the chambers thicker
Changes are likely to occur in an attempt to maintain
cardiac output and tissues perfusion specially a vital
organs.
Mechanism cont..
• The heart chambers enlarge.

• Decreased renal blood flow activates the renin angiotensin

aldosterone system which leads to salt and water retention .

• This increase blood volume and cardiac work load

Mechanism of heart failure
SIGNS AND SYMPTOMS
• Shortness of breath with activity or when lying down
• Fatigue and weakness
• Swelling in the legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
SIGN AND SYMPTOMS
• Persistent cough or wheezing with white or pink blood-tinged mucus
• Swelling of the belly area (abdomen)
• Very rapid weight gain from fluid buildup
• Nausea and lack of appetite
• Difficulty concentrating or decreased alertness
• Chest pain if heart failure is caused by a heart attack
Investigations
• Chest x-ray
whether the heart is enlarged, whether there is congestion
in the lungs.
• ECG
low voltage, evidence of chamber enlargement, ST, T
changes and arrhythmias.
• Echo
LV ejection fraction, valvular lesions, wall motion
abnormalities.
NT-proBNP ( N-terminal prohormone of B-type
natriuretic peptide)
 Management of the Heart Failure
• Position
• Oxygen
• Diuretics
• Morphine
• Digitalis
• ACE inhibitor
• Vasodilators (nitrates)
• Dopamine or Dobutamine
Management cont..

• Potassium supplements to prevent digitalis toxicity and hypokalemia

• Diet: low sodium (small frequent ) to limit fluid retention and promote
fluid excretion

• Paracentesis if ascites exist and causing respiratory distress

• Cardiac Resynchronization Therapy: use of right and left

ventricular pace makers to synchronize contraction and improve cardiac
output
Nursing Management
• Keep the patient in comfortable position in semi/high fowler’s
position(propped up orthopneic position ).

• Administer oxygen and check oxygen saturation.

• Monitor vital signs, neurological status ( report changes in heart and

respiratory rate/patterns and LOC).

• Change position slowly and frequently

• Monitor intake and output

Cont……..
• Daily electrolyte monitoring

• Restrict fluid as ordered

• Collaborate with client to establish balance schedule of rest and

activities.

• Administer medications and assess the patient’s response

• Weight the patient daily at the same time in the same scale, usually in
the morning after the patient urinates.
 Cont..

• Maintain calm and quiet environment.

• Monitor for increased crackles, Ronchi or pulmonary congestion.

• Identify and evaluate the severity of edema ( pitting edema)

• Determine the degree of jugular vein distension.

• Monitor the presence of ascites.

• Evaluate electrolyte levels (Na, K and creatinine)

• Assess the level of pain

Cont……..

• Assess degree of discomfort associated with activity.

• Monitor for restless, anxious behavior and promote self care
participation.
• Provide high nutritional diet with low salt and animal protein.
• Give passive exercise for prevention of venous thrombosis in leg, chest
infection and bedsore.
• Reassure the patient and the relatives to reduce emotional stress .
Complications

• Irregular heartbeat.
• Sudden cardiac arrest.
• Heart valve problems.
• A collection of fluid in lungs.
• Pulmonary hypertension.
• Kidney damage.
• Liver damage.
• Malnutrition
Introduction(CRT/ CRT-P)

Cardiac resynchronization therapy (CRT) is a device called a

biventricular pacemaker (cardiac resynchronization device) which sends
electrical signals to both lower chambers of heart (ventricles).

The signals trigger ventricles to contract in a more coordinated way,

which improves the pumping of blood out of the heart.
Cardiac resynchronization therapy
• Is a small device inserted into the interior chest wall.

• Insertion of electrodes in the left and right ventricles of the heart and the
right atrium to treat heart failure by coordinating the function of the left
and right ventricles via a pacemaker.
CRT cont..

• Also incorporate the additional function of an implantable cardioverter-

defibrillator (ICD)

• To quickly terminate an abnormally fast, life-threatening heart rhythm.

CRT and CRT-D

• CRT and CRT-D have become increasingly important

therapeutic options for patients with moderate and severe heart
failure.

• CRT with pacemaker only is often termed "CRT-P" to help

distinguish it from CRT with defibrillator (CRT-D).
Indication

• A low ejection fraction (typically <35%)

• Heart failure
• Compromised electrical activity - prolonged QRS duration to
>120 ms.
• Left bundle branch block (LBBB)
• Heart failure (class II or III heart failure)

With current guidelines indicating CRT is inappropriate for class IV

heart failure
Indication(CRT)

• Treatment for heart failure - ventricles don't contract in a coordinated

fashion.

• In heart failure, heart muscle is weakened and may not be able to pump
out enough blood to support the body. This can be worsened if heart's
chambers aren't in sync with each other.

• May reduce the symptoms of heart failure and lower risk of heart failure
complications, including death.
Procedure

• The insertion of electrodes into the ventricles is done under local

anesthetic.

• With access to the ventricles most commonly via the subclavian vein.

• Although access may be conferred from the axillary or cephalic veins.

• Right ventricular access is direct

• While left ventricular access is conferred via the coronary sinus(CS).

Complications

• Infection

• Injury to a blood vessel

• Collapsed lung (pneumothorax)

• Compression of the heart due to fluid buildup in the sac

surrounding the heart (cardiac tamponade)

• Failure of the device

LVAD (Left ventricular assist device)
LIFE STYLE CHANGES TO PREVENT HEART
FAILURE

• Not smoking
• Controlling high blood pressure and diabetes
• Staying physically active
• Eating healthy foods
• Maintaining a healthy weight
• Reducing and managing stress