HEART FAILURE

Heart failure is a chronic condition in which the heart cannot pump enough
blood to meet the body’s needs. This condition can develop when the heart
becomes too weak or stiff to fill and pump blood properly, leading to an
inadequate blood supply to vital organs and tissues.

TYPES:

LEFT-SIDED HEART FAILURE RIGHT-SIDED HEART FAILURE CONGESTIVE HEART FAILURE

The left side of the heart is The right side pumps blood Often used interchangeably
responsible for pumping to the lungs for oxygenation. with heart failure, CHF
oxygen-rich blood to the When this side fails, blood specifically refers to the
body. If the left side weakens, backs up in the veins, leading buildup of fluid in the lungs,
it causes a backup of fluid in to fluid buildup in the legs, liver, abdomen, and
the lungs, leading to abdomen, and other areas. extremities due to poor
shortness of breath. blood circulation.

Systolic Heart Failure: The

heart can’t pump blood
out effectively.
Diastolic Heart Failure:
The heart can’t fill
properly due to stiffness.

Precipitating & Predisposing

LEFT-SIDED HEART RIGHT-SIDED HEART CONGESTIVE HEART
FAILURE FAILURE FAILURE

Predisposing Factors: Predisposing Factors Predisposing Factors

Coronary Artery Disease Left-Sided Heart Failure: Coronary Artery Disease

(CAD): Narrowed arteries Increases lung pressure, (CAD): Narrowed arteries
reduce blood flow to the straining the right ventricle. reduce blood flow,
heart, weakening the left Chronic Lung Disease (e.g., weakening the heart.
ventricle. COPD): Causes low oxygen Hypertension: High blood
Hypertension: High blood levels, leading to pulmonary pressure strains the heart,
pressure strains the heart, hypertension. leading to left ventricular
leading to thickening and Pulmonary Hypertension: thickening.
weakening of the heart Increases pressure on the Diabetes: High blood sugar
muscle. right ventricle. damages blood vessels and
Diabetes: Raises Congenital Heart Disease: heart muscle.
atherosclerosis risk and Structural heart issues raise Valvular Disease: Impaired
damages the heart muscle. pressure in the right heart. valves increase heart
Valvular Disease: Mitral or Valvular Disease (e.g., pressure and workload.
aortic valve issues increase Tricuspid/Pulmonic): Valve Cardiomyopathy: Weakens
left ventricle pressure, disorders increase right the heart’s pumping ability.
weakening it. heart pressure. Obesity: Increases strain on
Cardiomyopathy: Heart Obstructive Sleep Apnea: the heart through related
muscle diseases impair Low oxygen episodes raise conditions.
effective pumping. right-sided heart failure Chronic Lung Disease: Leads
Age and Family History: risk. to pulmonary hypertension,
Advancing age and genetics Age and Genetics: Older straining the right heart.
increase risk. age and family history Age and Family History:
elevate risk. Older age and genetics
Precipitating Factors: raise CHF risk.
Precipitating Factors
Heart Attack: Damages the Precipitating Factors
left ventricle, reducing Pulmonary Embolism:
pumping ability. Sudden lung artery Heart Attack: Weakens
Arrhythmias: Irregular blockage can lead to acute heart muscle, often
heartbeats reduce heart right-sided heart failure. triggering CHF.
efficiency. Infections (e.g., Arrhythmias: Reduce heart
Fluid Overload: Excessive Pneumonia): Worsen lung efficiency.
fluid or salt intake raises function and increase heart Excess Fluid/Salt Intake:
blood volume. workload. Causes fluid retention,
Infections: Increase oxygen Arrhythmias: Irregular worsening CHF.
demand, worsening heart heartbeats strain the heart. Infections: Raise oxygen
function. Heart Attack (Right demand, increasing CHF
Anemia: Low red blood cells Ventricular): Can cause symptoms.
make the heart work right-sided heart failure. Uncontrolled Hypertension:
harder. High Salt/Fluid Intake: Elevates heart workload.
Thyroid Disorders: Leads to fluid retention, Anemia: Increases heart
Hyperthyroidism increases stressing the right heart. strain due to low oxygen.
heart rate and workload. Anemia: Low oxygen in Kidney Dysfunction: Leads
Medication blood increases heart to fluid retention.
Noncompliance: Skipping workload. Thyroid Disorders: Affect
medications causes fluid Medication heart function.
buildup. Noncompliance: Skipping Medication
Stress: Physical or diuretics or other meds Noncompliance: Skipping
emotional stress strains the worsens fluid buildup. meds worsens fluid buildup.
heart. Stress: Sudden stress can Stress: Raises blood
elevate blood pressure and pressure and heart rate,
heart rate, worsening worsening CHF symptoms.
symptoms.

Pathogenesis
LEFT-SIDED HEART FAILURE RIGHT-SIDED HEART FAILURE CONGESTIVE HEART FAILURE

Initial Injury: Conditions like Initial Injury or Stress: Initial Injury or Stress:
coronary artery disease, Conditions like left-sided heart Conditions like coronary artery
hypertension, or heart attacks failure, COPD, or pulmonary disease and hypertension
damage the heart muscle or hypertension increase pressure damage the heart or increase its
increase the left ventricle's on the right ventricle. workload.
workload.
Right Ventricular Dysfunction: Heart Dysfunction: The heart's
Left Ventricular Dysfunction: Strain or damage impairs the pumping ability decreases due
Strain on the left ventricle right ventricle's ability to pump to reduced contraction strength
impairs its ability to contract blood into the lungs, reducing or improper filling.
(systolic dysfunction) or fill cardiac output.
(diastolic dysfunction), reducing Increased Pressure: The heart

pumping capacity. Increased Right Heart Pressure: struggles, leading to pressure

The right ventricle's struggle buildup in the heart chambers
Increased Pressure: Difficulty in causes pressure to build in the and lungs.
pumping causes pressure right atrium and systemic
buildup in the heart and lungs, venous circulation. Fluid Accumulation: Elevated
pressure causes fluid leakage
leading to pulmonary
congestion and shortness of Fluid Back-Up: Elevated pressure into the lungs (pulmonary
leads to fluid leakage into congestion) and other tissues
breath.
surrounding tissues, causing (edema), resulting in shortness
Fluid Accumulation: Elevated peripheral edema (swelling) and of breath and swelling.
pulmonary pressure results in possibly ascites (abdominal fluid
Compensatory Mechanisms: The
fluid leaking into the lungs accumulation).
(pulmonary edema), worsening body increases heart rate and
Compensatory Mechanisms: The fluid retention to maintain
gas exchange and respiratory
symptoms. body compensates for reduced blood flow, but these can
output with increased heart rate worsen heart failure.
Compensatory Mechanisms: The and fluid retention, further
Progression: Untreated causes
body compensates for reduced straining the heart.
cardiac output with increased can lead to worsening
Progression: Without treatment congestive heart failure,
heart rate, fluid retention, and
heart enlargement of underlying causes, right-sided resulting in more severe

(hypertrophy), but these often heart failure can worsen, symptoms and complications.
resulting in severe symptoms
exacerbate the condition.
and complications.
Progression: If underlying causes
remain unaddressed, left-sided
heart failure can worsen, leading
to more severe symptoms and
complications.

Signs & Symptoms

LEFT-SIDED HEART FAILURE RIGHT-SIDED HEART FAILURE CONGESTIVE HEART FAILURE

“DO CHAP” “AW HEAD” “FRESH COWS”

D- DYSPNEA A- ANOREXIA & NAUSEA F- FATIGUE & WEAKNESS

O- ORTHPNEA W- WEIGHT GAIN R- RAPID OR IRREGULAR HEART

BEAT
C- COUGH H- HEPATOMEGALY
E- EDEMA
H- HEMOPTYSIS E- EEDEMA (BIPEDAL)
S- SHORTNESS OF BREATH
A- ADVENTITIOUS BREATH A- ASCITES
SOUNDS H- HEART (PALPITATIONS)
D- DISTENDED NECK VAIN
P- PULMONARY CONGESTION C- CONFUSION OR IMPAIRED
THINKING

O- OUTPUT (NOCTURIA)

W- WEIGHT GAIN

S- SKIN (COOL, PALE SKIN)

 DIAGNOSTIC TEST

1. Physical Examination

Clinical Signs: The healthcare provider will check for signs of heart failure, such as swelling in the legs
or abdomen, jugular vein distension, abnormal lung sounds (rales), and elevated blood pressure.

2. Blood Tests

B-type Natriuretic Peptide (BNP) Test: Measures levels of BNP, a hormone released by the heart in
response to stretching from fluid overload. Elevated levels suggest heart failure.
Complete Blood Count (CBC): Helps assess for anemia or infection that may contribute to heart
symptoms.
Electrolytes and Kidney Function Tests: Evaluates sodium, potassium, creatinine, and other markers
to assess overall health and kidney function.

3. Electrocardiogram (ECG)

ECG: Records the electrical activity of the heart, helping to identify arrhythmias, previous heart
attacks, or other cardiac abnormalities.

4. Chest X-ray

Chest X-ray: Provides images of the heart and lungs to check for fluid buildup in the lungs and assess
heart size and shape.

5. Echocardiogram

Echocardiography: A key test that uses ultrasound to visualize heart structures and function,
assessing ejection fraction, wall motion, and heart chamber sizes. It helps determine whether heart
failure is due to systolic or diastolic dysfunction.

6. Stress Test

Exercise or Pharmacological Stress Test: Evaluates how the heart responds to physical stress. It helps
assess exercise capacity and the presence of ischemic heart disease.

7. Cardiac MRI

Cardiac Magnetic Resonance Imaging (MRI): Provides detailed images of the heart’s structure and
function, useful for assessing cardiomyopathy and other structural heart diseases.

8. Coronary Angiography

Coronary Angiography: A procedure that uses dye and X-rays to visualize blood flow through the
coronary arteries, identifying blockages that may contribute to heart failure.

9. Holter Monitor

24-hour Holter Monitoring: A portable ECG device worn for a day or more to detect irregular heart
rhythms that may contribute to heart failure symptoms.

10. Cardiac Catheterization

Cardiac Catheterization: An invasive procedure that measures pressures within the heart chambers
and assesses coronary artery disease.

MANAGEMENT
Medical Management

Monitoring: Regular checks of vital signs, weight, and symptoms to assess heart function and fluid status.
Lifestyle Modifications:
Low sodium diet, moderate exercise, smoking cessation, and alcohol moderation.
Education: Inform patients about heart failure, symptoms of worsening condition, and treatment
adherence.

Pharmacological Management

Diuretics: Reduce fluid overload (e.g., furosemide).

ACE Inhibitors: Relax blood vessels and reduce heart workload (e.g., lisinopril).
Beta-Blockers: Improve heart function and lower heart rate (e.g., carvedilol).
Aldosterone Antagonists: Decrease fluid retention (e.g., spironolactone).
ARNIs: Combination therapy to enhance heart function (e.g., sacubitril/valsartan).
Digoxin: Enhances contractility and controls heart rate.
Anticoagulants: For thromboembolism risk (e.g., warfarin).

Surgical Management

ICD: For patients at risk of cardiac arrest due to arrhythmias.

Biventricular Pacemaker: Improves heart synchronization in severe cases.
Heart Valve Surgery: Repair or replacement of valves.
CABG: Improves blood flow in coronary artery disease.
Heart Transplantation: For end-stage heart failure.

Nursing Care Management

Assessment: Regular evaluation of vital signs, lung sounds, heart sounds, and daily weight.
Patient Education: Teach about medication adherence, dietary restrictions, and recognizing worsening
symptoms.
Promoting Activity: Encourage gradual increase in physical activity.
Fluid Management: Educate on fluid restrictions and monitor intake/output.
Emotional Support: Provide resources for coping with chronic illness.
Collaboration: Work with a multidisciplinary team for comprehensive care.
Palliative Care: Offer comfort care and facilitate end-of-life discussions for advanced cases.
IF TREATED IF NOT TREATED

Improved Symptoms: Patients often experience Worsening Symptoms: Shortness of breath, fatigue,
reduced shortness of breath, fatigue, and swelling, and swelling may become more severe, affecting
enhancing quality of life. quality of life.

Enhanced Exercise Tolerance: Effective management Decreased Heart Function: The heart’s pumping
allows for increased physical activity with less ability can decline, leading to worsening heart failure.
discomfort and improved stamina.
Frequent Hospitalizations: Increased acute heart
Reduced Hospitalizations: Proper treatment failure episodes may lead to more hospital visits and
decreases acute heart failure episodes, leading to higher healthcare costs.
fewer health crises and lower medical costs.
Organ Damage: Poor blood flow can damage vital
Better Heart Function: Medications and lifestyle organs, potentially resulting in organ failure.
changes can enhance heart efficiency, stabilizing or
reversing some symptoms. Arrhythmias: The risk of life-threatening abnormal
heart rhythms increases.
Decreased Mortality Risk: Appropriate treatment
lowers the risk of complications and death from Pulmonary Edema: Fluid accumulation in the lungs

cardiovascular events. can cause severe respiratory distress and require

emergency care.
Improved Psychological Well-Being: As symptoms
improve, patients experience better emotional health Increased Mortality Risk: Without treatment, the risk
of death from cardiovascular events rises
and reduced anxiety.
significantly.
Longer Life Expectancy: Effective heart failure
management can lead to a longer, healthier life by Impaired Quality of Life: Patients may face reduced
activity, social isolation, and emotional distress.
controlling symptoms and slowing disease
progression.
Potential for End-Stage Heart Failure: Untreated
heart failure can progress to end-stage, requiring
advanced treatments or resulting in a poor prognosis.

NCP
1. Fluid Volume Excess related to impaired cardiac function
Monitor Fluid Balance: Record daily weights, intake, and output to detect fluid
retention early.
Administer Diuretics as Prescribed: Give diuretics as ordered and observe for
effectiveness and potential side effects.
Educate on Fluid Restriction: Teach patients about the importance of adhering to fluid
restrictions and low-sodium diets to manage fluid retention.
2. Activity Intolerance related to decreased cardiac output
Assess Tolerance to Activities: Monitor the patient's response to activities (e.g., vital
signs, fatigue, and dyspnea) to prevent overexertion.
Encourage Gradual Activity: Promote gradual, low-impact activities and rest periods to
build tolerance without excessive strain.
Teach Energy Conservation Techniques: Educate the patient on spacing activities, taking
breaks, and avoiding prolonged exertion to reduce fatigue.
3. Risk for Impaired Gas Exchange related to pulmonary congestion
Monitor Respiratory Status: Frequently assess respiratory rate, lung sounds, and oxygen
saturation for signs of worsening congestion.
Position for Optimal Breathing: Position the patient in a semi-Fowler's or high-Fowler's
position to facilitate lung expansion and reduce dyspnea.
Administer Oxygen as Prescribed: Provide supplemental oxygen as ordered to maintain
adequate oxygen levels and support breathing.