KL

Heart Failure-lecture 4

Cardiac Lecture: Heart Failure

Objectives

  • Compare the etiology and pathophysiology of heart failure.

  • Understand clinical manifestations, assessment, diagnostic tests, medical management, nursing interventions, and prognosis for heart failure patients.

  • Highlight specific patient teaching and the importance of compliance in home care for heart failure.

Definition of Heart Failure

  • Heart failure is not the cessation of heart function but rather a condition where the heart fails to pump effectively to meet the body's needs.

  • It is a chronic condition leading to:

    • Inadequate cardiac output

    • Myocardial hypertrophy

    • Pulmonary systemic congestion

Types of Heart Failure

  • Heart failure is classified into various types based on different criteria:

    • Left-sided heart failure

    • Right-sided heart failure

    • Systolic heart failure

    • Diastolic heart failure

Pathophysiology of Heart Failure

  • Heart failure results from:

    • Weak or damaged ventricular walls leading to ineffective blood ejection.

    • Stiff, thickened ventricular walls causing inadequate filling of the heart.

  • In left-sided heart failure:

    • The left ventricle cannot effectively deliver oxygen-rich blood to the body.

    • Increased pressure in blood vessels between the lungs and left ventricle leads to fluid leakage into lung tissues.

  • In right-sided heart failure:

    • The right ventricle fails to contract strongly enough to push blood into the lungs, leading to blood buildup and edema.

    • Each side's failure ultimately weakens and enlarges ventricles, resulting in a vicious cycle.

  • Continuous release of stress hormones by the nervous system to compensate worsens heart failure and damages muscle cells.

Causes of Heart Failure

  • Most common cause: Coronary artery disease.

  • Other contributing factors include:

    • High blood pressure

    • Diabetes

    • Heart valve diseases

    • Damaged/diseased heart muscle

    • Arrhythmias

    • Heart defects

    • Substance abuse

    • Lung diseases

    • Obstructive sleep apnea

Epidemiology

  • Heart disease is the leading cause of death.

  • Statistics:

    • 5.7 million cases (2009-2012).

    • 6.5 million cases (2011-2014).

    • Projected 46% increase in heart failure cases by 2030.

    • Leading cause of hospitalizations in individuals over 65, costing over $70 billion in healthcare.

    • Kentucky has high incidences of heart disease.

Prevention and Health Promotion

  • Key prevention strategies include:

    • Maintaining a regular exercise routine (consult with healthcare provider).

    • Smoking cessation: Smoking narrows and stiffens blood vessels, increases inflammation, and weakens the heart muscle.

    • Adhering to medication regimens as prescribed.

    • Following a low-sodium diet: Recommended limit of 2,300 mg sodium daily, with an optimal goal of 1,500 mg.

Classifications of Heart Failure

  1. Class 1 (Minimal): No limitations on ordinary physical activity;

  2. Class 2 (Mild): Slight limitations in physical activity with fatigue, palpitations, dyspnea, or chest pain.

  3. Class 3 (Moderate): Limited physical activity; comfortable at rest but experience symptoms during ordinary activities.

  4. Class 4 (Severe): Inability to perform any physical activity without discomfort; symptoms may develop at rest.

Staging of Heart Failure (ACC)

  1. Stage A: High risk for developing heart failure without structural heart disorders.

  2. Stage B: Structural heart issues without symptoms of heart failure.

  3. Stage C: Presence of current symptoms with positive therapy responses.

  4. Stage D: Severe end-stage disease requiring advanced treatment options like mechanical support or heart transplant.

Systolic vs Diastolic Heart Failure

  • Systolic Heart Failure:

    • Weakened myocardial cells resulting in reduced contraction and cardiac output; reduced ejection fraction.

  • Diastolic Heart Failure:

    • Myocardial cells fail to stretch effectively during blood filling; normal ejection fraction but decreased output due to inadequate filling.

Left-sided Heart Failure

  • Symptoms: Dyspnea, pulmonary congestion, cough with frothy sputum, orthopnea, and pulmonary crackles.

  • Common causes: Coronary artery disease, hypertension, heart valve disease.

  • Blood backs up into lungs, causing congestion and difficulty breathing.

Right-sided Heart Failure

  • Symptoms: Distended jugular veins, anorexia, nausea, vomiting, liver enlargement, abdominal distension, and peripheral edema.

  • Most commonly results from left-sided failure.

  • Fluid backs up into the venous system, causing organ swelling.

Nursing Assessment

  • Monitor for signs of decreased cardiac output, including:

    • Fatigue

    • Anginal pain

    • Anxiety

    • Poor skin conditions (pale, cool skin)

    • Weight gain

  • Use of pitting edema as a measure of fluid accumulation.

Diagnostic Tests for Heart Failure

  • Routine lab tests include:

    • CBC (Complete Blood Count)

    • BUN (Blood Urea Nitrogen)

    • Creatinine

    • Liver function tests (ALT)

    • BNP: Should be < 100; higher values indicate worsening heart failure.

    • Electrolytes (sodium, calcium, potassium)

  • Additional diagnostic procedures:

    • Hemodynamic monitoring

    • Echocardiograms to assess heart structure and function.

    • Chest X-rays for visualizing pleural effusions or cardiomegaly.

Nursing Interventions

  • Daily weight monitoring: Critical for assessing fluid retention. Report any gain of 1-2 pounds immediately.

  • Strict I&Os: Control liquid intake to prevent overload.

  • Vital signs assessment: Closely monitor respiratory function due to dyspnea.

  • Positioning: Use High Fowler's position for optimal breathing.

  • Dietary management: Encourage adherence to sodium and fluid restrictions.

  • Teaching strategies should involve family members for better home compliance and support.

Medications for Heart Failure Management

  1. Diuretics (e.g., Furosemide): To decrease preload and fluid retention.

  2. Afterload reducers (e.g., Lisinopril, Losartan): To lower the pressure against which the heart must pump.

  3. Inotropic agents (e.g., Digoxin): Increase contractility to improve cardiac output.

  4. Beta-blockers: Slow heart rate and lower blood pressure, improving relaxation.

  5. Vasodilators (e.g., Nitroglycerin): Reduce myocardial oxygen demand.

  6. Anticoagulants (e.g., Warfarin): To prevent clot formation.

Complications of Heart Failure

  1. Pulmonary Edema: Medical emergency, characterized by severe shortness of breath and frothy sputum; immediate treatment includes oxygen administration and diuretics.

  2. Cardiogenic Shock: Severe pump failure often after an MI; requires close monitoring and possible mechanical intervention.

  3. Pericardial Tamponade: Fluid in the pericardial sac compresses the heart; requires emergency treatment including potential pericardiocentesis.

Summary

  • Heart failure is a prevalent and critical health issue necessitating comprehensive patient education, adherence to prescribed therapies, and regular health monitoring to manage symptoms effectively and improve the patient's quality of life.

  • Emphasize the necessity of ongoing patient education and compliance to manage heart failure effectively, particularly regarding medication adherence and dietary restrictions.

  • Engage patients and their families in understanding the disease, risk factors, and management strategies for better health outcomes.