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Heart Failure Study Notes

Course Overview

  • Course Title: Adult Health One
  • Instructor: Trudylee Chandler DNP, APRN

Objectives

  • Etiology, Pathophysiology, and Clinical Manifestations of Heart Failure
    • Differentiate between Left vs. Right Heart Failure and Chronic heart failure.
  • Nursing Process Framework
    • Apply the Clinical Judgement Model in the care of heart failure patients.
  • Develop Comprehensive Nursing Care Plan
    • Including fluid management, medication administration, and activity tolerance for patients with acute decompensated heart failure.
  • Recognize Potential Complications
    • Understand complications that arise from heart failure.
  • Use Nursing Process for Pulmonary Edema Care

Definition of Heart Failure

  • Heart Failure (HF):
    • Definition: Inability of the heart to pump sufficient blood to meet the tissue needs for oxygen and nutrients.
    • Characteristic Features:
    • Fluid overload or inadequate tissue perfusion.
    • Indicates myocardial disease with issues in contraction (systolic failure) or filling (diastolic failure).
    • Some cases can be reversible, while most are progressive lifelong disorders managed through lifestyle changes and medications.

Risk Factors for Heart Failure

  • Coronary Artery Disease (e.g., Right coronary artery involvement)
  • Hypertension
  • Diabetes Mellitus
  • Obesity
  • Age:
    • Increased incidence with age, prevalent in older adults.

Compensatory Mechanisms in Heart Failure

  • Nervous System: Responds through increased heart rate and contractility.
  • Hormonal Systems:
    • Activation of renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system.
  • Cardiac Compensations:
    • Increased Heart Rate (HR), Stroke Volume (SV)
    • Ventricular dilation and myocardial hypertrophy.

Types of Heart Failure

  • Systolic Heart Failure (Systolic Dysfunction):
    • Impaired contractility, resulting from weakened heart muscle.
    • Ejection Fraction (EF): Less than 40%.
    • Common etiologies:
    • Ischemic heart disease, chronic hypertension, dilated cardiomyopathy, myocarditis.
  • Diastolic Heart Failure (Diastolic Dysfunction):
    • Impaired filling and relaxation due to stiff heart muscle.
    • Ejection Fraction: Greater than or equal to 50%.
    • Commonly associated with hypertension leading to left ventricular hypertrophy, and increasing among older women with a history of hypertension.

Clinical Manifestations of Left-Sided Heart Failure

  • Pulmonary Symptoms:
    • Crackles, cough, dyspnea, orthopnea, paroxysmal nocturnal dyspnea.
  • Cardiac Symptoms:
    • Tachycardia, palpitations, S3 gallop, confusion, lightheadedness, anxiety.

Clinical Manifestations of Right-Sided Heart Failure

  • Systemic Congestion Symptoms:
    • Peripheral edema, jugular venous distention, hepatomegaly, ascites.
    • Anorexia, nausea, abdominal pain, weight gain, weakness.

Chronic Heart Failure Statistics

  • Approx. 6 million people in the U.S. have heart failure.
  • 870,000 new cases diagnosed each year.
  • Most common hospitalization reason for individuals over 65.
  • Approx. 20% readmission within 30 days; nearly 50% within 6 months post-discharge.

Patient Assessment for Heart Failure

  • Focus Areas:
    • Therapy effectiveness, self-management, signs and symptoms of increased heart failure, emotional/psychosocial response.
  • Health History and Physical Exam:
    • Mental status, lung sounds, heart sounds (S3 gallop), fluid status, daily weight, intake and output, medication responses, urine output.

ACC/AHA Stages of Heart Failure

  • Stage A:
    • At high risk for heart failure but without structural changes or symptoms.
    • Examples: Hypertensive patients, atherosclerotic disease.
  • Stage B:
    • Structural heart disease without symptoms of HF.
    • Examples: Patients with diabetes, previous myocardial infarction (MI).
  • Stage C:
    • Structural heart disease with prior or current symptoms of HF.
  • Stage D:
    • Refractory heart failure requiring specialized interventions.

Diagnostics for Heart Failure

  • Key Tests Include:
    • B-type natriuretic peptide (BNP) levels (> 100 indicates heart failure).
    • Electrolytes, BUN/Creatinine, Liver function tests, CBC, Thyroid tests, ABGs, Chest X-ray, EKG, Echocardiogram, Stress test.

Nursing Interventions for Heart Failure

  • Improve activity tolerance, manage fluid volume, control anxiety, and minimize powerlessness.
  • Provide education for patient and family regarding heart failure and management.

Heart Failure Management Strategies

  • Lifestyle Modifications:
    • Limit salt and fluid intake, restrict or avoid alcohol, stop smoking, reduce saturated fat, promote mild exercise, manage weight, elevate extremities.
  • Medication Management:
    • Educate on diuretics, ACE inhibitors, beta-blockers, and more.

Heart Failure Medications

  • Diuretics:
    • Used to alleviate fluid overload.
  • ACE Inhibitors (e.g., Lisinopril):
    • Monitor hypotension, hyperkalemia, renal alterations.
  • ARBs:
  • Beta Blockers:
  • Ivabradine:
  • Hydralazine & Isosorbide Dinitrate:
  • Digitalis:
  • Dopamine, Dobutamine, Milrinone:
    • Positive inotropes for acute heart failure management.

Complications of Heart Failure

  • Common Complications Include:
    • Pleural effusion, dysrhythmias, left ventricular thrombus, hepatomegaly, renal failure, pulmonary edema, cardiogenic shock, thromboembolism, pericardial effusion, cardiac tamponade, and cardiac arrest.

Management of Pulmonary Edema

  • Prevention and Early Recognition:
    • Monitor lung sounds, recognize decreased activity tolerance, manage fluid retention, place patient upright, minimize exertion.
  • Interventions:
    • Oxygen therapy, diuretics (e.g., furosemide).

Surgical Interventions in Heart Failure

  • Options Include:
    • Percutaneous Coronary Angioplasty (PTCA), Coronary Artery Bypass Grafting (CABG), Biventricular pacemaker, Implantable Cardioverter Defibrillator (ICD), Left Ventricular Assist Device (LVAD), Intra-aortic Balloon Pump, Heart transplant.

Other Interventions and Technologies

  • Cardiac Resynchronization Therapy:
    • Bi-ventricular pacemaker for patients with EF < 35%, optimizes cardiac output and slows ventricular remodeling.
  • Left Ventricular Assist Device (LVAD):
    • Can be used short or long-term; functions as a bridge to recovery or transplant.

Case Study Example

  • A patients prescribed:
    • Oxygen at 4 L/min, furosemide (Lasix), spironolactone (Aldactone), and lisinopril (Prinivil).
  • Best Evaluation Assessment:
    • Auscultate lung sounds to determine fluid status and response to medication.