Cardiovascular Diseases

Management & Nursing

Care
 Heart failure is a condition in
which the heart can’t pump
enough blood throughout the
body.
 Heart failure does not mean that
your heart has stopped or is about
to stop working. It means that
your heart is not able to pump
blood the way that it should.
 The heart can’t fill with enough
blood or pump with enough force,
or both.
Heart failure develops over time
as the pumping action of the heart
grows weaker.
It can affect the left side, the right
side, or both sides of the heart.
Most cases involve the left side
where the heart can’t pump
enough oxygen-rich blood to the
rest of the body.
With right-sided failure, the heart
can’t effectively pump blood to the
lungs where the blood picks up
oxygen.
The weakening of the heart’s pumping
ability causes:

1-Build up Blood and fluid to "back

up" into the lungs.

2- The build up of fluid in the feet,

ankles, and legs.

3- Tiredness and shortness of

breath
Other names for heart failure

Congestive heart failure (when

the poor pumping function
results in symptoms)
Left-sided heart failure
Right-sided heart failure
Systolic heart failure
Diastolic heart failure
The major causes of CHF may be divided in
to two subgroups
1- underlying diseases e.g.
Coronary artery disease
Hypertensive heart disease
Congenital heart disease
Acute myocardial infarction
Pulmonary emboli
2- Precipitating causes e.g.
Anemia
Infection
Bacterial endocarditic
Pulmonary embolism
Hypervolemia
Nutritional deficiencies
Precipitating causes : often
increase the workload of the
ventricles, causing a decompen -
sated condition that leads to
decreased myocardial function.
Pathology of ventricular failure
Heart failure can be described as
systolic or diastolic :

Systolic failure , the most common

cause of CHF, results from an
inability of the heart to pump blood .
It is a defect in the ability of the
ventricles to contract (pump) the
left ventricle loses its ability to
generate enough pressure to
eject blood forward through the
high pressure aorta.
Systolic failure is caused by

impaired contractile ( e.g.,

myocardial infarction ) , increased
after load (e.g., hypertension ),
cardiomyopathy, and mechanical
abnormalities ( e.g., valvular heart
disease ) .
Diastolic failure is an
impaired ability of the ventricles
to fill during diastole.
 Decreased filling of the
ventricles will result in
decreased stroke volume.
In diastolic failure there is
normal systolic function .
It is characterized by high filling
pressures and the resultant
venous engorgement in both the
pulmonary and systemic vascular
.
It is usually the result of left
ventricular hypertrophy from
chronic systemic hypertension,
aortic stenosis, or hypertrophic
cardiomyopathy .
Mixed systolic and diastolic failure

Systolic and diastolic failure of

mixed origin is seen in disease
states such as dilated
cardiomyopathy, a condition in
which poor systolic function is
further compromised by
dilated left ventricular walls that
are unable to relax.
This patient often has extremely
poor ejection fractions , high
pulmonary pressures , and
biventricular failure ( both
ventricles may be dilated and
have poor filling and emptying
capacity ) .
Types of congestive heart failure

Left- sided failure

 results from left ventricle
dysfunction, which causes blood
to back up through the left
atrium and into the pulmonary
veins .
Right – sided failure
Causes back ward blood flow to
the right atrium and venous
circulation
 venous congestion in the
systemic circulation result in
peripheral edema, hepatomegaly,
splenomegaly vascular
congestion of the GT.
What Causes Heart Failure?

Heart failure is caused by other

diseases or conditions that
damage or overwork the heart
muscle.
Over time, the heart muscle
weakens and is not able to pump
blood as well as it should.
The leading causes of heart failure are:
 High Coronary artery disease
(CAD)
CAD, including angina and heart
attack is the most common
underlying cause of heart failure.
• People who have a heart attack are
at high risk of developing heart
failure.
 Diabetes
 High blood pressure
Most people with heart failure
also have high Blood pressure,
and about one in three has
diabetes.
Other Causes of Heart Failure
1- Cardiomyopathy (a disease of
the heart muscle)
2- Diseases of the heart valves
3- Abnormal heartbeats or
arrhythmias
4- Congenital heart defects (a
heart defect or problem you are
born with)
Other conditions that may injure the heart
muscle and lead to heart failure include:

Treatments for cancer, such as

radiation and certain chemotherapy
drugs

Thyroid disorders (having either too

much or too little thyroid hormone in
the body)
Alcohol abuse

HIV/AIDS

Cocaine and other illegal drug

use
Who Is At Risk for Heart Failure?

• People 65 years of age and older

Men have a higher rate of heart
failure than women.
Children with congenital heart
defects can also have heart
failure..
 Clinical manifestations of congestive
heart failure

Fatigue
 Is one of the earliest symptoms
of chronic CHF.
Dyspnea
Is a common manifestation of
chronic CHF. It is caused by
increased pulmonary pressures
secondary to interstitial and
alveolar edema.
Tachycardia
May be the first clinical
manifestation of CHF. One of the
body's' first mechanisms to
compensate for a failing
ventricle is the increase the
heart rate.
Edema
It may occur in the legs, liver,
abdominal cavity, lungs .
Nocturia
When the person lies down at night.
Fluid movement from interstitial
spaces back into the circulatory
system is enhanced . this causes
increased renal blood flow and
diuresis. The patient may complain
of having to void six or seven times
during the night .
Skin changes
Because tissue capillary oxygen
extraction is increased in a
person with CHF, the skin may
appear dusky, may be cool to the
touch from diaphoresis .
Behavioral changes

 Cerebral circulation may be

impaired with chronic CHF
secondary to decreased CO.
 The patient may report usually
behavior, including restlessness,
confusion and decreased attention
span or memory .
Chest pain
Because of decreased coronary
perfusion from decreased CO
and increased myocardial work.
Weight changes
Many factors contribute weight
changes .Initially there may be a
progressive weight gain from
fluid retention. Abdominal
fullness from ascites and
hepatomegaly frequently cases
anorexia and nausea .
The actual weight loss may be
apparent until after the edema
subsides .
Complications of congestive heart failure

-pleural effusion
- Arrhythmias
- Left ventricular thrombus
- Hepatomegaly
Nursing and collaborative management:
A- For acute congestive heart
failure.
Goal:
1- Decreasing intravascular volume.

2- Decreasing venous return.

3- Decreasing after load.

4- Improving gas exchange and
oxygenation.

5- Improving cardiac function.

6- Reducing anxiety.

B-For chronic congestive heart
failure:
The main goal in the treatment of
CHF is to:
 1-Treat the underlying cause and
contributing factors maximize CO.
2- Provide treatment to alleviate
symptoms .
-Non pharmacologic therapy:
New technique is the utilization
of biventricular pacing;. Cardiac
resynchronization therapy
coordinated right and lifts
ventricle contractility through
biventricular pacing.
- Cardiac transplantation:
Is often the treatment of choice.
However the lack of donor
hearts
and the challenges of care make
it an option for only a small
number of patients with CHF.
Drug therapy :
1- Angiogenesis – converting
enzyme inhibitors:
Inhibitors are useful in both
systolic and diastolic heart
failure. and they are the first
treatment of CHF e.g., captopril
, enalapril .
2- Diuretics are used in heart
failure to mobilize edematous
fluid ,reduce pulmonary venous
pressure and reduce preload
- e.g., loop diuretics (lasix )

- potassium –
sparing diuretic
(alductone ) .
3- Inotropic drugs: To
improving cardiac contractility
to increase CO, decrease LV
diastolic pressure and decrease
systemic vascular resistance
 Examples:
- Digoxin (lanoxin).
- B- adrenergic agonists.
(Dopamine, dobutamine)
- Calcium sensitizers (simdax).
- Vasodilator drugs .
e.g.,
nitroprusside, nitroglycerin
- B- adrenergic
blockers

e.g., carvedilol.
Nutritional therapy:
Diet education and weight
management:
Are critical to the patient
Control of chronic CHF. The
nurse should obtain
detailed diet history, determine
not only what but also the
sociocultural value of food.
Nursing care plan for Congestive heart
failure
 Nursing diagnosis
1. Activity intolerance related to
fatigue secondary to cardiac
insufficiency and pulmonary
congestion as manifested by
dyspnea, shortness of breath ,
weakness.
Nursing interventions:-

- Encourage alternate rest and

activity periods to reduce cardiac
workload

- Provide emotional and physical

rest to reduce oxygen consumption
and to relieve dyspnea and fatigue
.
- Monitor cardio respiratory
response to activity to determine
level of activity that can be
performed

- Teach patient techniques of self

care to minimize oxygen
consumption .
 Nursing-2
diagnosis

Excess fluid volume related

to cardiac failure as
manifested by edema,
dyspnea on exertion,
increased weight gain .
Nursing interventions:-

- Weigh daily and monitor

trends to monitor fluid retention
and weight reduction

-Monitor respiratory pattern for

symptoms of respiratory
difficulty.
- Monitor fluid intake and fluid
output

- Monitor for therapeutic effect of

diuretic to assess response to
treatment .
- Monitor for serum electrolyte
levels to assess as a response to
treatment
 Nursing diagnosis -3

Disturbed sleep pattern

related to nocturnal dyspnea,
nocturia as manifested by
inability to sleep through the
night .
Nursing interventions:-

- Determine patients / activity

pattern to establish routine .

-Encourage patient to establish

a bedtime routine to facilitate
transition from wakefulness to
sleep.
-Adjust environment to promote
sleep adjust medication
administration schedule to
support patients' sleep cycle

- Monitor patients' sleep pattern

and number of sleep hours to
determine hours of sleep .
Nursing diagnosis-4

Impaired gas exchange

related to increased preload ,
mechanical failure, or
immobility manifested
respiratory rate, dyspnea,
shortness of breath .
Nursing interventions:-

- Monitor rate, depth, and effort

of respirations

- Monitor for dyspnea and

events that improve and worsen
it .
- Administer oxygen
supplemental as ordered to
maintain oxygen levels .

- position to alleviate
dyspnea( semi-fowler position )

- Monitor the effectiveness of

oxygen therapy by measuring
oxygen saturation .
Nursing diagnosis-5
Anxiety related to dyspnea or
perceived threat of death

Nursing interventions:-

-Explain all procedures, to

promote sense of security .
- Instruct patient on the use of
relaxation techniques to help
alleviate anxiety

- Create an atmosphere to
facilitate trust (e.g., make
frequent checks )
Nursing diagnosis-6

Deficient knowledge related

to disease process as
manifested by questions
about the disease .
 Nursing interventions:-

- Assess the patients' current

level of knowledge about his
condition

- Describe common signs

and symptoms of the disease
-Instruct the patient on
measures to prevent/minimize
side effects of treatment for the
disease

-Include family or significant

others in teaching to provide
support for the patient