HEART FAILURE End-diastolic volume = 120 mL
End-systolic volume = 50 Ml
- Inability of the heart to pump sufficient blood to meet
the needs of the tissues
ETIOLOGY OF HEART FAILURE
- A clinical syndrome with manifestations of fluid 1. Abnormal preload and afterload conditions
overload/congestion; inadequate tissue perfusion and 2. Abnormal cardiac muscle functions
poor activity tolerance 3. Limited ventricular filling
- Also referred to as Congestive Heart Failure (because of PATHOPHYSIOLOGY:
its associated pulmonary/peripheral congestion) Cardiac ↓C.O.
Decompensation, Cardiac Insufficiency and Ventricular ↓
failure. Activation of Compensatory Mechanism:
By the heart:
• ↑ H.R.
CLASSIFICATIONS OF HEART FAILURE • ↑ Size and strength of ventricular muscle
• LEFT VS RIGHT (according to Location of dysfunction) • ↑ Ventricular filling capacity
Others:
❖ Left-sided Heart Failure – a condition that impairs the • Activation of sympathetic nervous system
left ventricle’s ability to pump blood into the aorta and • Release of catecholamines
the systemic circulation - Pulmonary s/sx predominate • Shunting of blood
• Stimulation of RAAS
❖ Right-sided Heart Failure - Right ventricle fails to pump
• Shifting to Anaerobic metabolism
blood into the pulmonary artery and into the pulmonary
circulation - Systemic s/sx predominate ↓
C.O. not maintained
↓
• BACKWARD VS. FORWARD (according to direction of Left-Sided Heart Failure
blood flow) Failure of the Left Ventricle
❖ Backward Failure - Involves the retrograde flow of
Cannot forcefully Congestion of blood in
blood back to the pulmonary and systemic circulation
contract to eject the left ventricle, then
❖ Forward Failure - Inability of the ventricles to pump blood into the aorta in the left atrium and
finally in the pulmonary
blood forward into the systemic and pulmonary
veins and in the lungs
circulation.
- Decreased CO - Pulmonary edema
- Decreased Organ, - Impaired Gas
• HIGH OUTPUT VS. LOW OUTPUT
Tissue and Cellular Exchange
❖ High Output Failure - Despite normal or high cardiac Perfusion
- CO2 accumulation in
output, the heart cannot cope with the needs of the body the blood
- Pulmonary Congestion
❖ Low Output Failure - Poor ventricular contraction that ↓
leads to decreased cardiac output. C.O. not maintained
↓
Right-Sided Heart Failure
ACUTE VS. CHRONIC Failure of the Right Ventricle
❖ Acute Heart Failure - Sudden change in the heart’s
ability to contract; can cause life threatening symptoms
and pulmonary edema
❖ Chronic Heart Failure - Occurs when other chronic
disorder gradually compromises the heart’s ability to Cannot forcefully Congestion of blood in
pump effectively. contract to eject the right ventricle, then
blood into the in the right atrium, and
pulmonary artery finally in the vena cava
SYSTOLIC AND DIASTOLIC HEART FAILURE (according to
and in the venous
ventricular functioning) systemic vasculature
- Decreased blood
flow to the lungs
❖ Systolic Heart Failure - inability of the ventricles to - Decreased blood to - Systemic congestion
adequately contract and pump blood be oxygenated
❖ Diastolic Heart Failure - inability of ventricles to
completely fill because of stiffening.
✓ Lifestyle changes
• Avoid smoking, alcohol and caffeine
COR PULMONALE
• Sedentary lifestyle
- A condition in which the heart (cor) is affected by lung
• Exercise program
damage (pulmonale)
• Antiembolism stockings
Respiratory Disorders (COPD, Bronchiectasis)
↓ ✓ Drug Therapy
Impaired Gas Exchange • Oxygen administration
↓ • Diuretics
Increased CO2 in the blood • Inotropic Drugs/Cardiac Glycosides
↓ • Sympathomimetics
Constriction of Pulmonary Artery • Vasodilators
↓
Pulmonary Hypertension
✓ Surgical Treatments
↓
- Involves the treatment of the etiologic disease
Increase workload of the right ventricle
↓ • Cardiac resynchronization therapy (CRT)
Right ventricular hypertrophy • Intraaortic Balloon Pump (IABP)
↓ • Ventricular Assist Device
Right-sided heart failure • Heart Transplant ✓ Management of Pulmonary Edema
↓
COR PULMONALE
CARDIAC RESYNCHRONIZATION THERAPY
• Cardiac resynchronization therapy (CRT) is treatment
to help your heart beat with the right rhythm. It uses a
pacemaker to restore the normal timing pattern of the
heartbeat. The CRT pacemaker coordinates how timing
of the upper heart chambers (atria) and the lower heart
LABORATORY/DIAGNOSTICS:
❖ ECG/Stress Test
chambers (ventricles).
❖ Echocardiogram
❖ Radionuclide angiography
❖ Chest X-ray INTRA-AORTIC BALLOON PUMP
❖ Serum electrolytes
❖ Cardiac Catheterization • An intra-aortic balloon pump (IABP) is a mechanical
❖ Myocardial Biopsy device that helps the heart pump blood. This device is
❖ Pulmonary function studies inserted into the aorta, the body's largest artery. It is a
long, thin tube called a catheter with a balloon on the
MEDICAL MANAGEMENT:
Objectives:
1. Eradicate or reduce any etiologic contributory factors
to HF especially those which are modifiable and curable
2. Reduce cardiac workload
3. Prevent further myocardial damage
✓ Dietary modifications
• Low sodium
• Fluid restrictions if with congestion or edema
end of it. If you are hospitalized, your doctor may insert
an IABP.
VENTRICULAR ASSIST DEVICE
• A ventricular assist device (VAD) is a mechanical pump
that's used to support heart function and blood flow in
people who have weakened hearts. The device takes
blood from a lower chamber of the heart and helps
pump it to the body and vital organs, just as a healthy
heart would.
NURSING MANAGEMENT:
1. Provide adequate oxygenation
2. Promote balance between rest and activity
3. Decrease anxiety and stress levels
4. Facilitate fluid and electrolyte balance
5. Provide proper skin care
6. Promote proper nutrition and elimination
7. Facilitate learning through health teachings
8. Administer medications as prescribed and
monitor patient’s response.
9. Assist in medical and surgical diagnosis and
treatment.
[Link] in post-op care after heart transplant
by administering immunosuppressive agents.
After recovery, the patient must remain under medical
supervision and should continue taking digitalis, diuretics
or potassium supplements as needed
