NCM 118

LECTURE / SECOND SEMESTER

Chapter 1
Trans by: Gonzales, Javier, Lopez, Lozano, Macasaet, Mauban, Mendoza, Sevilla, Orbeta

Pathophysiology
HEART FAILURE
● As Heart failure develops, the body activates
DEFINITION neurohormonal compensatory mechanisms.
● Systolic HF results in decreased blood volume being
● Heart Failure is the inability of the heart to pump ejected from the ventricle.
sufficient blood to meet the needs of tissue for oxygen ● The sympathetic nervous system then stimulated to
and nutrients. release epinephrine and norepinephrine.
● Decrease in renal perfusion causes renin release, and
then promotes the formation of angiotensin I.
● Angiotensin I is converted to angiotensin II by ACE
which constricts the blood vessels and stimulates
aldosterone release that causes sodium and fluid
retention.
● There is a reduction in the contractility of the muscle
fibers of the heart as the workload increases.
● Compensation. The heart compensates for the
increased workload by increasing the thickness of the
heart muscle.

● Chest pain, including angina, is not usually caused by

heart failure, but may occur if the heart failure was
caused by a heart attack.
● The severity of the heart failure is mainly decided
based on ejection fraction and also measured by the
Stages of Heart Failure severity of symptoms.
● Other conditions that may have symptoms similar to
Class I heart failure include obesity, kidney failure, liver
● No limitation to physical activity. disease, anemia, and thyroid disease.
● An EF from 41 to 49 percent might be considered too
Class II low.
● Activities of daily living can be completed without ● It does not always indicate that a person is developing
difficulty; however, exertion causes shortness of heart failure, but it could indicate damage, perhaps
breath and some fatigue. from a previous heart attack.
● An ejection fraction measurement under 40 percent
Class III might be evidence of heart failure or
● Difficulty completing activities of daily living without cardiomyopathy.
fatigue, palpitations, or dyspnea. ● In severe cases, EF can be even lower than 40.

Causes
Class IV
● Shortness of breath occurs at rest. ● Coronary artery disease
● Ischemia
● Cardiomyopathy
● Systemic or pulmonary hypertension
NCM 118
LECTURE / SECOND SEMESTER
Chapter 1
Trans by: Gonzales, Javier, Lopez, Lozano, Macasaet, Mauban, Mendoza, Sevilla, Orbeta

● Valvular heart disease ● BUN/creatinine

● Serum albumin/transferrin
Clinical Manifestations of Left-Sided Heart Failure ● Complete blood count (CBC)
● ESR
● “DO CHAP”
Medical Management
D - Dyspnea
● May be precipitated by minimal to moderate activity; ● “DAD BOND CLASH”
also occurs during rest.
D - Digitalis
O - Orthopnea ● increases the force of myocardial contraction and
● Dyspnea that develops in the recumbent position and slows conduction through the atrioventricular node;
is relieved with elevation of the head with pillows. improves contractility, increasing left ventricular
output, and enhances diuresis
C - Cough
● Cough is initially dry and nonproductive. Large A - ACE Inhibitors
volume of frothy sputum, which is sometimes pink, ● promotes vasodilation and diuresis by decreasing
may be produced, usually indicating severe afterload and preload, ultimately decreasing the
pulmonary congestion. workload of the heart

H - Hemoptysis
● Pink or blood-tinged sputum may be produced.
A - Adventitious breath sounds
● May be heard in various areas of the lungs; as failure
worsens, pulmonary congestion increases and
crackles may be auscultated throughout the lung
fields.
P - Pulmonary Congestion
● Sustained high pressure in the pulmonary veins
eventually forces some fluid from the blood into the
surrounding alveoli which transfer oxygen to the
bloodstream.
D - Dobutamine
● IV medication administered to patients with significant
left ventricular dysfunction and hypoperfusion;
stimulates the beta-1-adrenergic receptors
B - Beta Blockers
● Reduces mortality and morbidity in HF by reducing
the adverse effects from constant stimulation of the
sympathetic nervous system
O - Oxygen
● oxygen may be necessary as HF progresses; need is
based on the degree of pulmonary congestion and
resulting hypoxia

Prevention N - Nitrates
● Causes venous dilation, which reduces the amount of
● Healthy diet blood return to the heart and lowers preload.
● Engaging in cardiovascular exercises
● Smoking cessation D - Digitalis
● Maintain a healthy weight ● to remove excess extracellular fluid by increasing the
● Reduce and manage stress rate of urine produced in patients with fluid overload
● Take medicines as directed
C - Calcium Channel Blockers
Assessment and Diagnostic Findings ● causes vasodilation, reducing systemic vascular
resistance
● ECG L - Lifestyle Changes
● Chest X-ray ● restriction of dietary sodium, avoidance of excess fluid
● Sonograms (echocardiography, Doppler, and intake, weight reduction, and regular exercise
transesophageal echocardiography)
● Exercise or pharmacological stress myocardial A - Angiotensin II Receptor Blockers
perfusion ● ARBs block the effects of angiotensin II at its receptor;
● PET scan have similar hemodynamic effects as of ACE
● Cardiac catheterization inhibitors
● Liver enzymes ● serves as alternative for patients who cannot tolerate
● Bleeding and clotting times ACE inhibitors
● Electrolytes
● Pulse oximetry
● Arterial blood gases (ABGs)
NCM 118
LECTURE / SECOND SEMESTER
Chapter 1
Trans by: Gonzales, Javier, Lopez, Lozano, Macasaet, Mauban, Mendoza, Sevilla, Orbeta

S - Sodium Restriction Nursing Management

● a low-sodium diet (2 to 3g/day) diet and avoidance of
drinking excess amounts of fluid is recommended ● Repeat the importance of lifestyle modifications
● Advise on activity
H - Hydralazine ● Keeps a healthy weight
● lowers systemic vascular resistance and left ● Promote patient adherence to treatment
ventricular afterload ● Decrease stress
● Prevent fluid accumulation
Pharmacologic Therapy ● Teach the patient when to seek medical attention
● Follow up with the cardiologist
● ACE inhibitors ● Emphasize the use of medical identification
● Angiotensin II receptor blockers
● Beta blockers ACUTE MYOCARDIAL INFARCTION
● Diuretics
● Calcium channel blockers DEFINITION
Nutritional Therapy ● A myocardial infarction (MI), commonly known as a
heart attack, occurs when blood flow decreases or
● Sodium restriction stops in the coronary artery of the heart, causing
● Patient compliance damage to the heart muscle.

Treating Congestive Heart Failure

● “UNLOAD FAST”
● Upright position
● Nitrates
● Lasix
● Oxygen
● ACE Inhibitors
● Digoxin
● Fluids (decrease)
● Afterload (decrease)
● Sodium restriction
● Test (Dig Level, ABGs, Potassium level)

● Depending on the case, an implanted device such as

a pacemaker or implantable cardiac defibrillator may
sometimes be recommended.
● In some moderate or more severe cases, cardiac
resynchronization therapy (CRT) or cardiac
contractility modulation may be beneficial.
● In severe disease that persists despite all other
measures, a cardiac assist device ventricular assist
device, or, occasionally, heart transplantation may be
recommended.

Cardiac Resynchronization Therapy

Signs and Symptoms

● The most common symptom is chest pain or

discomfort which may travel into the shoulder, arm,
back, neck or jaw.
● Often it occurs in the center or left side of the chest
and lasts for more than a few minutes.
NCM 118
LECTURE / SECOND SEMESTER
Chapter 1
Trans by: Gonzales, Javier, Lopez, Lozano, Macasaet, Mauban, Mendoza, Sevilla, Orbeta

3 Areas of Damage After a Myocardial Infarction