Brent Evans, MSN, RN, CNE
Definition: Inability of heart to meet circulatory needs.
Compensatory mechanisms increase cardiac output (CO).
Over time, weakened heart is unable to maintain CO.
Compensation can exacerbate heart failure (HF).
Fluid backs up, leading to decreased oxygenation of tissues.
Decreased quality of heart pump results in tachycardia, further decreasing CO and increasing myocardial oxygen demand.
Coronary Artery Disease: Most common cause, often leading to myocardial infraction (MI).
Hypertension: Contributes significantly to HF.
Valvular Disease: Affects heart function.
Cardiomyopathy: Disease of heart muscle leading to heart failure.
Orthopnea: Difficulty breathing when lying flat.
Anxiety: Secondary to shortness of breath (SHOB).
Tachycardia: Increased heart rate to compensate.
Weak Pulses: Indicating decreased cardiac output.
Cough: Fluid backing up into lungs.
Jugular Venous Distension (JVD): Observed when not lying flat.
Hepatomegaly: Liver enlargement due to fluid back-up.
Edema: Fluid retention in body tissues.
Nocturia: Increased urination at night due to fluid dynamics.
Exertional Dyspnea: Shortness of breath on exertion.
Primary goal: Reduce workload on heart and/or improve heart's ability to increase output.
Beta Blockers:
Reduce heart rate and force of contractions.
Examples: Metoprolol, Atenolol, Propranolol.
Block beta-1 receptors, leading to decreased heart workload.
Monitor heart rate (HR) and blood pressure (BP) before administration.
ACE Inhibitors:
Examples: Lisinopril, Captopril.
Block angiotensin II to reduce afterload and decrease cardiac remodeling.
Monitor BP before administration.
Diuretics:
Reduce fluid overload and improve symptoms (covered separately).
Digoxin:
Cardiac glycoside that increases force of contraction (positive inotrope) and decreases heart rate (negative chronotrope).
Parameters: Check apical pulse for 60 seconds before administration.
Narrow therapeutic range (0.5-0.8 ng/mL).
Monitor for toxicity: dysrhythmias, nausea, visual disturbances, etc.
Dobutamine: A beta-1 agonist, improving cardiac output and lowering BP.
Milrinone: A phosphodiesterase inhibitor, enhancing cardiac function and decreasing afterload.
Ivabradine: An HCN blocker that lowers heart rate without affecting contractility.
SGLT2 Inhibitors (e.g., Dapagliflozin): Promote fluid and sugar excretion.
Monitor:
Heart Rate (HR) and Blood Pressure (BP)
Level of consciousness (LOC)
Exertion tolerance
Urine output (UOP)
Capillary refill and peripheral pulses
Lung sounds and daily weights
Electrolytes and Brain Natriuretic Peptide (BNP) levels
Improved functional status.
Antiplatelets:
Examples: Aspirin, Clopidogrel (Plavix).
Stop platelets from aggregating; used primarily for arterial clots.
Often prescribed in dual therapy.
Thrombolytics:
Examples: Urokinase, Alteplase.
Used to dissolve existing clots; high risk of bleeding.
Anticoagulants:
Indicated for prevention of blood clots, e.g., in DVT, PE, atrial fibrillation.
Treatment involves parenteral drugs like heparin.
Administered subcutaneously or intravenously.
Monitor Partial Thromboplastin Time (PTT), aiming for specific therapeutic ranges.
Risk of complications, including bleeding and thrombocytopenia.
Example: Enoxaparin (Lovenox).
More expensive, longer half-life, and can be given at home post-surgery.
Oral anticoagulant, requiring monitoring of INR (ideal range typically 2-3).
Many drug interactions, vitamin K is essential in management.
Apixaban, Dabigatran have more rapid onset and less monitoring requirements.
Patient Monitoring:
Signs of active bleeding or upcoming invasive procedures are critical.
Contextualize anticoagulation therapy in relation to patient’s overall health and treatment plan.
Heart Failure readings: Pages 211-241 for background; pages 255-256 for nursing process; pages 265-271 for digoxin and nitrates; pages 288-302 for anticoagulants.