1. Congestive heart failure
Dr. Walaa Nasr
Lecturer of Adult Nursing
Second year

2. Congestive heart failure
outlines
Definition
Causes and pathophysiology
Types of heart failure
Compensatory mechanism of heart failure
Clinical manifestations
Classification of heart failure
Diagnostic evaluation
Medical management
Nursing management

3. Congestive heart failure Definition
Heart failure describes the clinical syndrome that develops when the heart cannot maintain an adequate cardiac output. The heart pumps blood inadequately, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and other changes that may further weaken the heart.

4. Causes of congestive heart failure
Coronary artery disease
Heart attack
High blood pressure
Heart valves disorders
Inflammation of Heart muscle (myocarditis, cardiomyopathy)

5. Causes of congestive heart failure (cont…)
Severe lung disease ( pulmonary hypertension)
Severe anemia
Overactive thyroid gland (hyperthyroidism)
Underactive thyroid gland (hypothyroidism)
Abnormal heart rhythms ( atrial fibrillation)
Kidney failure

6. Congestive heart failure Types
Left-sided heart failure
There are two types of left-sided heart failure
Systolic dysfunction
Diastolic dysfunction
Right-sided heart failure

8. Congestive heart failure Compensatory Mechanisms of heart failure
Renin-angiotensin-aldosterone system
Sympathetic nervous system
Enlargement of the muscular walls of the ventricles (ventricular hypertrophy).

9. Congestive heart failure Clinical manifestations
Symptoms (back up of blood and fluid)
Dyspnea
Orthopnea
Reduced exercise tolerance, lethargy, fatigue
Nocturnal cough
Wheeze
Ankle swelling
Anorexia

10. Congestive heart failure Clinical manifestations ( cont…)
Signs
Cachexia and muscle wasting
Tachycardia
Pulsus alternans
Elevated jugular venous pressure
Crepitations or wheeze
Third heart sound
Oedema
Hepatomegaly (tender)
Ascites

11. Congestive heart failure Classification of heart failure New York Heart Association (NYHA) Functional Classification
Symptoms
% of patients
Class
No symptoms or limitations in ordinary physical activity
35% I
Mild symptoms and slight limitation during ordinary activity II
Marked limitation in activity even during minimal activity. Comfortable only at rest
25%
III
Severe limitation. Experiences symptoms even at rest 5% IV

12. Congestive heart failure Diagnostic evaluation
Patient history
Physical examination
Diagnostic studies
Electrocardiography (ejection fraction)
Radionuclide
magnetic resonance
computed tomography imaging
cardiac catheterization with angiography
a biopsy of heart muscle is needed

13. Congestive heart failure Treatment
lifestyle change
Salt restriction
Exercises
Smoking and alcoholism
Body weight (daily weight)
Supportive stockings

14. Congestive heart failure Treatment (cont…)
Drug management
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Beta-blockers
Other vasodilators ( nitroglycerin)
Cardiac glycosides (digoxin)
Aldosterone receptor blockers (spironolactone)
Loop diuretics

15. Congestive heart failure Treatment (cont…)
Potassium-sparing diuretics
Thiazide and thiazide-like diuretics
Anticoagulants (heparine)
Opioids (morphine) to relieve anxiety
Positive inotropic drugs (drugs that make muscle contract more forcefully) (dopamine)
Oxygen for pulmonary edema is required

16. Congestive heart failure Treatment (cont…)
Non pharmacological management of heart failure (surgical intervention)
Coronary artery bypass grafting ( revascularization)
Percutaneous coronary intervention (Angioplasty)
Valve replacement
Biventricular pacemaker
Heart transplantation
Left ventricular assist device (LVAD)

18. Nursing care of patients with congestive heart failure
Maintain the patient in high fowler's position
Elevate extremities except when the patient is in acute distress
Frequently monitor vital signs
Change position frequently
Monitor intake and output and daily weight

19. Nursing care of patients with congestive heart failure (cont…)
Restrict fluids as ordered
Teach the patient and family and provide emotional support (life style change)
Explain the side effect of diuretic medications for additional actions ( side effects of diuretics include electrolyte imbalance, symptomatic hypotension
Use aseptic procedures when caring for invasive lines