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Congestive Hearth Failure

Definition

A physiologic state in which the hearth is unable to pump enough blood the meet the

metabolic needs of the body at rest or during exercise even though filling pressure are

adequate ( Medical Surgical Unit Cardiovascular Disorder )

Pathology condition of heart to pump enough blood to meet metabolic and this is only

with increase pump left ventricle (Braunward )

Etiology

Congestive heart failure caused by:

1. Abnormal loading condition

2. Abnormal muscle function (myocardium dysfunction )

3. Condition/disease that precipite/exacerbate heart failure:

Physical or emotional stress

Dysritmia

Infection

Anemia

Thyroid disorder

Pregnancy

Pagets disease

Nutritional deficiency

Pulmonary disease

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Patophysiology

Systemic vascular resistancePeripheral artery

constriction force LV contraction

coronary artery constriction

Ephinephrine release

LV oxygen demand

LV hypoxia

Oxygen supply

Systemic blood pressure Force of LV contraction

ADH renal blood flow

LV EDP

renin

LV preload

angiotensin

LA preload

aldosteron

Pulmonary edema

Sodium water & retention

Pulmonary vascular resistance

Peripheral edema

Hepatomegaly RV failure

Ascites

Weir of jugularis venous RV preload

Gastro intestine disorder

Clinical manifestation

Heart failure maybe categories as :

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Left versus right ventricular

Backward versus forward

High versus low output

Systolic versus diastolic

Left versus right ventricular failure

Left ventricular failure Right ventricular failure

- Weakness - weight gain

- Fatigue - ankle or pretibial swelling and

- mental confusion pigmentation

-

insomnia - abdominal distention- anorexia - anorexia,nausea,gastric distress

- diaphoresis - edema

- anxiety - ascites

- breathleness - jugular vein distention

- cough - hepatomegaly

- orthopnea - increase central venous pressure

- tachicardia

- gallop S3,S4

- pulmonary cracles

- pulsus alternans

backward versus forward failure

backward failure is the term used to refer to the venous congestion arising from damming

of blood behind filling chamber.This is can caused mental confusion etc. Forward failure

refers to the problem of inadequate perfusion

high versus low output failure

the causes of high output failure include sepsis,pagets disease anemia etc.low output

failure including congenital,valvular rhematic coronary etc

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systolic versus diastolic failure

- systolic heart failure refers to a decrease in the ability of the ventricle to contracy

force fully and maintain and adequate forward cardiac output atherosklerosis

- diastolic heart failure occurs when ventricular relaxation is incomplete and the

chamber is unable to accept sufficient blood like injured or ischemic myocardium

Complication

acute pulmonary edema

refractory heart failure

Prognosis

The prognosis for the client with congestive heart failure depend on:

1. the degree of cardiac hypertrophy

2. the amount of cardiac reserve

3. the presence of other heart of associated disorder

Diagnostic assessment

data from clients health history

chest radiography

arterial blood gases

liver enzymes

ECG

Echocardiography

Medical management

Client with acute congestive heart failure are usually admited to an intensive care unit. Wherethey reserve continous assessment and intervention

Positioning

Oxygen administration

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Pharmacologic management

Digitalis :Fargoxin,digoxin

Dopamine and dobutamine : amrinone

Diuretic to reduce preload

Nitroglycerine/isosorbidedinirate is to venous dilators

Hidralazine is to arteriolar dilator

Combine is use sodium nitroprusside

Prazosin

ACE (angiotensin converting enzyme)

Betablocker or betaadrenergic

Dietary management

Diet low salt (sodium diet)

Low fat (for obesitas)

Excessive water intake

Surgical management

Veno arterial bypass

Conterpulsation

Nursing management

a. Cardiac output decrease R/T heart failure or dysrhitmia

b. Fluid volume excess R/T reduce glorurol filtration , decrease cardiac output , intake

antidiuretic production sodium water retention

c. Gas exchange impared R/T fluid in alveoli

d. Peripheral tissue perfusion , high risk for decrease R/T decreased cardiac output

and vaso contriction

e. Activity intolerance , high risk for R/T to decrease cardiac output , hypoxia fear of

death or serious consequence

f. Colaborative problem

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High risk for digitalis toxicity R/T impaired drug excretion from hepatic and renal

involvement

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