EART FAILUR

Heart
Failure
- Inability of the heart to pump sufficient
blood to meet the needs of the tissues
- A clinical syndrome with manifestations of
fluid overload/congestion; inadequate tissue
perfusion and poor activity tolerance
- Also referred to as Congestive Heart
Failure (because of its associated
pulmonary/peripheral congestion) Cardiac
Decompensation, Cardiac Insufficiency and
Ventricular failure
 Classifications of Heart Failure
• Left vs Right (according to Location of
dysfunction)
 Left-sided Heart Failure – a condition
that impairs the left ventricle’s ability to
pump blood into the aorta and the
systemic circulation
- Pulmonary s/sx predominate
 Right-sided Heart Failure
- Right ventricle fails to pump blood into
the pulmonary artery and into the
pulmonary circulation
- Systemic s/sx predominate
• Backward vs. Forward (according to
direction of blood flow)
 Backward Failure
- Involves the retrograde flow of
blood back to the pulmonary and
systemic circulation
 Forward Failure
- Inability of the ventricles to pump
blood forward into the systemic
and pulmonary circulation
• High Output vs. Low Output
 High Output Failure
- Despite normal or high cardiac output, the
heart cannot cope with the needs of the
body
 Low Output Failure
- Poor ventricular contraction that leads to
decreased cardiac output
Acute vs. Chronic
 Acute Heart Failure
- Sudden change in the heart’s ability
to contract; can cause life threatening
symptoms and pulmonary edema

 Chronic Heart Failure

- Occurs when other chronic disorder
gradually compromises the heart’s
ability to pump effectively
Systolic and Diastolic Heart Failure (according
to ventricular functioning)
 Systolic Heart Failure
- inability of the ventricles to adequately
contract and pump blood

 Diastolic Heart Failure

- inability of ventricles to completely fill
because of stiffening
End-diastolic volume = 120 mL
End-systolic volume = 50 Ml
Etiology of Heart Failure
1. Abnormal preload and afterload conditions
2. Abnormal cardiac muscle functions
3. Limited ventricular filling
PATHOPHYSIOLOGY:
↓C.O.
↓
Activation of Compensatory Mechanism:
By the heart:
• ↑ H.R.
• ↑ Size and strength of ventricular muscle
• ↑ Ventricular filling capacity
Others:
• Activation of sympathetic nervous system
• Release of catecholamines
• Shunting of blood
• Stimulation of RAAS
• Shifting to Anaerobic metabolism
 ↓
C.O. not maintained
↓
Left-Sided Heart Failure
Failure of the Left Ventricle

Congestion of blood in the left

Cannot forcefully ventricle, then in the left
contract to eject atrium and finally in the
blood into the aorta pulmonary veins
↓ and in the lungs
- Decreased CO ↓
- Decreased Organ, - Pulmonary edema
Tissue and Cellular - Impaired Gas Exchange
Perfusion - CO2 accumulation in the blood
  - Pulmonary Congestion
 ↓
C.O. not maintained
↓
Right-Sided Heart Failure
Failure of the Right Ventricle

Cannot forcefully contract Congestion of blood in the

to eject blood into the right ventricle, then in the
pulmonary artery right atrium, and finally in
↓ the vena cava and in the
- Decreased blood flow to venous systemic vasculature
the lungs ↓
- Decreased blood to be - Systemic congestion
oxygenated
   
 COR PULMONALE
- A condition in which the heart (cor) is affected by lung damage (pulmonale)

 Respiratory Disorders (COPD, Bronchiectasis)

↓
Impaired Gas Exchange
↓
Increased CO2 in the blood
↓
Constriction of Pulmonary Artery
↓
Pulmonary Hypertension
↓
Increase workload of the right ventricle
↓
Right ventricular hypertrophy
↓
Right-sided heart failure
↓
COR PULMONALE
 Clinical Manifestations
Right-sided Heart Failure Left-sided Heart Failure
- Peripheral edema - Pulmonary Edema
- Ascites - Dyspnea
- Pericardial effusion - Rales/Crackles
- Hepatomegaly - Wheezing
- Hepatojugular reflux - Blood-tinged frothy sputum
- Jugular vein distention - Orthopnea
- Increased ICP - Restlessness
- Irritability and confusion - Anxiety
- Fatigue
- Weakness
- ↓U.O.
Laboratory/Diagnostics:
 ECG/Stress Test
 Echocardiogram
 Radionuclide angiography
 Chest X-ray
 Serum electrolytes
 Cardiac Catheterization
 Myocardial Biopsy
 Pulmonary function studies
A B

C
Medical Management:
Objectives:
1. Eradicate or reduce any etiologic contributory
factors to HF especially those which are
modifiable and curable
2. Reduce cardiac workload
3. Prevent further myocardial damage
 Dietary modifications
• Low sodium
• Fluid restrictions if with congestion or edema
 
 Lifestyle changes
• Avoid smoking, alcohol and caffeine
• Sedentary lifestyle
• Exercise program
• Antiembolism stockings
 Drug Therapy
• Oxygen administration
• Diuretics
• Inotropic Drugs/Cardiac Glycosides
• Sympathomimetics
• Vasodilators
 Surgical Treatments
- Involves the treatment of the etiologic
disease
• Cardiac resynchronization therapy (CRT) 
• Intraaortic Balloon Pump (IABP) 
• Ventricular Assist Device 
• Heart Transplant
 Management of Pulmonary Edema
Nursing Management:
1. Provide adequate oxygenation
2. Promote balance between rest and activity
3. Decrease anxiety and stress levels
4. Facilitate fluid and electrolyte balance
5. Provide proper skin care
6. Promote proper nutrition and elimination
7. Facilitate learning through health teachings
8. Administer medications as prescribed and
monitor patient’s response.
9. Assist in medical and surgical diagnosis and
treatment.
 After recovery, the patient must
remain under medical supervision and
should continue taking digitalis,
diuretics or potassium supplements
as needed.