Heart Failure

Heart Failure

This indicates that there is a problem with contraction of the heart (systolic dysfunction) or filling of the heart (diastolic dysfunction) that may or may not cause pulmonary or systemic congestion.

It is the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients.

1. Systolic Heart Failure (weakened heart muscle; problem with contraction)

2. Diastolic Heart Failure (stiff and noncompliant heart muscle, making it difficult for the ventricle to fill)

2 types of HF by assessment of left ventricular functioning

Assessment on the Ejection Fraction

It is performed to assist in determining the type of HF.

amount of blood present in the left ventricle at the END OF SYSTOLE – amount of blood present at the END OF DIASTOLE

Ejection Fraction computation

Normal; Severely Reduced

The EF is ______ in diastolic HF and _____ in systolic HF.

Systolic HF

Which is more common among the two: Systolic HF or Diastolic HF?

• Ordinary physical activity does not cause undue fatigue, dyspnea, palpitations, or chest pain

• No pulmonary congestion or peripheral hypotension

• Patient is considered asymptomatic

• Usually no limitations of activities of daily living (ADLs)

Prognosis: Good

According to the New York Heart Association (NYHA) in the Classification of Heart Failure, what are the signs and symptoms of HF Class I?

• Slight limitation on ADLs

• Patient reports no symptoms at rest but increased physical activity will cause symptoms

• Basilar crackles and S3 murmur may be detected

Prognosis: Good

According to the New York Heart Association (NYHA) in the Classification of Heart Failure, what are the signs and symptoms of HF Class II?

• Marked limitation on ADL

• Patient feels comfortable at rest but less than ordinary activity will cause symptoms

Prognosis: Fair

According to the New York Heart Association (NYHA) in the Classification of Heart Failure, what are the signs and symptoms of HF Class III?

Symptoms of cardiac insufficiency at rest

Prognosis: Poor

According to the New York Heart Association (NYHA) in the Classification of Heart Failure, what are the signs and symptoms of HF Class IV?

Patients at high risk for developing left ventricular dysfunction but without structural heart disease or symptoms of heart failure

According to the American Heart Association (AHA), what are the structural changes and progression of patients with HF Stage A?

Patients with left ventricular dysfunction or structural heart disease who have not developed symptoms of heart failure

According to the American Heart Association (AHA), what are the structural changes and progression of patients with HF Stage B?

Patients with left ventricular dysfunction or structural heart disease with current or prior symptoms of heart failure

According to the American Heart Association (AHA), what are the structural changes and progression of patients with HF Stage C?

Patients with refractory end-stage heart failure requiring specialized interventions

According to the American Heart Association (AHA), what are the structural changes and progression of patients with HF Stage C?

1. Left-sided heart failure (left ventricular failure)

2. Right heart failure (right ventricular failure)

The signs and symptoms of HF can be related to which ventricle is affected. What are the 2 types of HF in terms of the ventricular chambers affected?

Left-Sided Heart Failure

The blood volume and pressure in the left atrium increases, which decreases blood flow from the pulmonary vessels. Pulmonary venous blood volume and pressure increase, forcing fluid from the pulmonary capillaries into the pulmonary tissues and alveoli, causing pulmonary interstitial edema and impaired gas exchange.

It is when the left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation causing Pulmonary Congestion.

1. Dyspnea

2. Decrease O2 Saturation

3. Crackles

4. Dry Cough

5. S3 heart sound

What are the clinical manifestations of Left-sided Heart Failure?

Paroxysmal Nocturnal Dyspnea (PND)

It is the sudden attacks of dyspnea at night.

Right-sided Heart Failure

It is when the right side of the heart cannot eject blood and cannot accommodate all the blood that normally returns to it from the venous circulation causing Systemic Congestion.

1. Jugular Vein Distention

2. Hepatomegaly

3. Ascites

4. Edema in the Lower Extremities (Dependent Edema)

5. Anorexia and Nausea

6. Weakness (d/t reduced cardiac output, impaired circulation, inadequate removal of catabolic waste products)

7. Weight Gain (d/t accumulation of fluid)

Clinical manifestations of Right-sided Heart Failure

1. Echocardiogram

• ultrasound of the heart

• checks the ejection fraction of the heart

2. BNP (B-type Natriuretic Peptide)

• ventricular stretch marker

• to evaluate the treatment

3. Hemodynamic Monitoring

• for decompensated/acute HF

• Measures: Central Venous Pressure (RHF) & Pulmonary Artery Wedge Pressure (LSHF)

Diagnostic Tests for Heart Failure

Echocardiogram

Confirmatory Diagnostic Test for HF

BNP

It is a ventricular stretch marker. The purpose of this test is to evaluate treatment.

<100 pg/mL

Normal BNP Level

Central Venous Pressure

It measures the pressure of the vena cava, which reflects the pressure in the right side of the heart.

Femoral Vein

Where is the CVP inserted?

Phlebostatic Axis (4th ICS mid-axillary line)

What is the landmark of the femoral vein?

0.8 mmHg/3-8 cmH2O

Normal CVP level

Pulmonary Artery Wedge Pressure (PAWP)

It reflects the pressure in the left side of the heart.

Echocardiogram

It checks for the ejection fraction of the heart.

Can be inserted via:

• Femoral Vein or

• Subclavian Vein

When is the PAWP inserted?

4.5-13 mmHg

Normal PAWP level

1. To prevent RAAS

• ACE inhibitors (first line)

• ARBS (second line)

2. To prevent SNS

• Beta-Blockers (first line) use carvedilol

• Calcium Channel Blockers (second line)

What is the management to prevent remodeling patient with HF?

1. Digoxin (to increase cardiac output)

• Monitor digoxin level & potassium level

2. Diuretics (to decrease edema)

• Mild - use K-sparing

• Moderate - use Thiazide

• Severe - use Loop

3. Diet

• ⬇ sodium

• ⬆ potassium

• Restrict Fluids

What is the management to relieve symptoms for patients with HF?

1. Heart Transplant

2. Continuous inotrope

3. Intra-aortic balloon pump

What are the special interventions for patients experience HF in stage D/Class IV?