Definition:

Heart Failure
Is a condition in which the heart cannot pump

enough blood through out the body.

Also known as CARDIAC FAILURE or

CONGESTIVE HEART FAILURE(CHF)

PATHOPHYSIOLOGY
Systolic and diastolic heart failure lead to Decreased amt. Of blood the heart compensate to pump by attempting to force blood out of the ventricle by increasing the size and strength of the ventricular muscle

 and increasing the volume of blood that is pumped by increasing the capacity of the ventricle .

Assessment with clinical manifestations

Holistic approach of gathering data from a health

history. Thorough physical examination. Objectives measurements of various body parts and function. Inquiry should be made about the patients need for use of increasing numbers of pillows. Sleep disturbance

 Inspection and palpation. Auscultation BP,HR, and heart rhythm are assessed. Inspection of the heart failure includes he

pulmonary system . Oxygenation measures, respiratory effort, rate, and depth of respiration.

Diagnostic test
Electrocardiogram(ECG)
Echocardiogram Multiple gated acquisition(MUGA) scan

Chest x-ray(CXR)
Stress test also called treadmill test or exercize

tests. Tracer studies

Laboratory tests
CBC
Fluid and electrolytes levels Urinalysis

Brain natriuretic peptide(BNP)

Thyroid function and iron level tests

Nursing diagnosis
Activity intolerance related to compromised

oxygen transport system secondary to heart failure. Risk for ineffective breathing pattern related to excessive secretions secondary to cardiopulmonary dysfunction. Anxiety related to actual threat to biological integrity secondary to heart failure and death.

Treatment
For mild symptoms:
Controlling volume overload Dietary restriction of salt Fluid intake also be restricted

For acute symptoms; pharmacologic agents: Morphine Diuretics Captopril, enalapril Bisoprolol Carvedilol Vasodilators Nitrates Beta blockers

 Furosemide, torsemide
Hormones Digitalis Aspirin

Surgery: Coronary artery bypass surgery Valve surgery

Heart muscle disease and inflammation dysfunction

Heart muscle Disease
Is a problem with the physical shape of the

muscle It is a serious condition that can lead to heart failure, dysrhythmias, and death

Types: 1. Dilated cardiomyopathy (DCM)

2. Hypertrophic cardiomyopathy 3. Arrhythmogenic right ventricular

cardiomyopathy

4. Restrictive cardiomyopathy

Dilated cardiomyopathy(DCM)
Disease of the heart muscle, result in dilated

heart chamber. Associated with: Coronary heart disease(CHD) HPN Heart valve disease

Risk factors
Family members with DCM History of coxsackie B viral infection

Autoimmune disease
Toxins Pregnancy

Assessment with clinical manifestations

Noting the common signs and symptoms of DCM.

s/sx Shortness of breath Tiredness Palpitations Syncope Chest pain

Nursing diagnosis
Activity intolerance related to compromised

oxygen transport system secondary to heart muscle dysfunction. Risk for ineffective breathing pattern related to decreased respiratory depth secondary to pain. Pain related to friction rub and inflammatory process.

Pharmacology
ACE inhibitors Beta blockers

Diuretics
Anticoagulants Antiarrhythmics

Surgery
Cardioversion Heart transplantation

Pacemaker insertion
defibrillators

Hypertrophic cardiomyopathy(HCM)
Increase in the size and thickness of the heart

muscle.

CAUSE: unknown

Assessment with clinical manifestations

Asymptomatic Shortness of breath Chest pain Palpitations Light- headedness Blackouts Palpably forceful apical pulse and heart murmur

Suspicious signs and symptoms

By findings
Abnormal ECG result

Excessive thickness of the heart muscle as seen

on an echocardiogram

Nursing diagnosis
Activity intolerance related to compromised

oxygen transport secondary to heart muscle dysfunction. Risk fir ineffective breathing pattern related to decreased respiratory depth secondary to pain Pain related to friction rub and inflammatory process.

Pharmacology
Beta blockers Calcium channel blocker

Antiarrhythmics
Diuretics Anticoagulants

Surgery
Myectomy Heart transplantation

Electrical cardioversion
Pacemaker insertion Implantable defibrillator

Arrhythmogenic right ventricular cardiomyopathy (ARVC)

Disease in a cardiac muscle in which the heart

muscle is replaced by fibrous scar and fatty tissue. CAUSE: Unknown

Assessment with clinical manifestations

Asymptomatic patient
Palpitations Light- headedness

Fatigue
Fainting Syncope and Signs and symptoms of heart failure

Diagnostic tests
Patients history ECG

Holter monitor
Exercise test Echocardiogram Blood testing

Other diagnostic tests

MRI

Cardiac catheterization
biopsy

Nursing diagnosis
Activity intolerance related to compromised oxygen

transport system secondary to heart muscle dysfunction. Risk for ineffective breathing pattern related to decreased respiratory depth secondary to pain. Pain related to friction rub and inflammatory process.

Pharmacology
ACE inhibitors Diuretics

Anticoagulants
Prophylactic antibiotics

Surgery
Cardioversion Ablation theraphy

Heart transplantation
Pacemaker insertion Implantable defibrillators

Restrictive cardiomyopathy (RCM)

Disease of the ventricular heart muscles in which

the muscle walls become stiff but not necessary thickened. CAUSE:Unknown

Pathophysiology
The stiffness of the heart wall muscles causes a

resistance against which the atria have to pump blood.

Blood may back up into the lungs and major veins

of the neck and liver.

Assessment and clinical manifestations

Asymptomatic and symptomatic

Symptomatic patient: Crackles on pulmonary auscultation Jugular vein distension

 Pitting edema of dependent body parts

Enlarged liver
Fatigue Shortness of breath

Inflammation dysfunction
Inflammation of the heart muscle

Types: 1. Endocarditis 2. Myocarditis 3. pericarditis

Endocarditis
Inflammation of the inner layer of the heart (the

endocardium)

Bacterial endocarditis Is an infection of the hearts inner lining or the heart valves.

Rheumatic endocarditis
Type of bacterial endocarditis Streptococcal infection is a causative agent in

rheumatic endocarditis.

surgery: Bronchoscope

Assessment with clinical findings

Signs and symptoms of infection including Malaise Anorexia Weight loss Cough Back pain Joint pain

 Auscultation of the heart

Janeway lesions

The lesions appear Flat Painless Red to bluish- red spots on the palms and sole Eye examination petechiae

Diagnostic tests
Blood culture

Pharmacology: Antibiotic therapy Surgery Surgical valve repair

Myocarditis
Inflammation of the myocardium
1. May result from an infections agent virus, bacteria, or fungus

2. Parasitic agents parasites, protozoa, or spirochetes 3. Toxin agents Poisons, allergens, or immunosuppressants

Assessment and clinical manifestations

Absence of symptoms or

With symptoms such as

Fatigue Dyspnea

 Palpitations

Chest discomfort
Abdominal discomfort Heart murmur

Irregular rhythm

Pericarditis
Is an inflammation of the pericardium

causes: Viral Bacterial Fungal infection

 Parasitic organisms Idiopathic

Autoimmune diseases
hypothyroidism Renal failure

MI
Neoplasm from nearby tumor in the lungs,breast,

or the blood

 Irradiation

Drugs
Injury Trauma

surgery

Diagnostic tests
CBC
Erythrocyte sedimentation rate CRP

Blood urea nitrogen(BUN)

Creatinine Cardiac enzymes Blood culture

 Rheumatoid factors Antinuclear antibodies Tuberculin testing CXR Echocardiography Computed tomography MRI ECG

Valvular dysfunction and disease

Mitral valves prolapse(MVP)
Condition in which the mitral valve leaflets

stretch into the atria during systole.

Assessment with clinical manifestations

Auscultation of the heart Transesophageal echocardiography

Nursing diagnosis
Excess fluid related to decreased cardiac output

secondary to valvular disease. Activity intolerance related to compromised oxygen transport system secondary to valvular disease. Risk for infection related to compromised host defenses. Fear related to present status and unknown future.

Mitral regurgitation
Is a disorder of the mitral heart valve in which

blood is erroneously pumped from the left ventricle into the left atrium during systole.

Assessment with clinical manifestations

Often results in the patient remaining

asymptomatic. When symptoms occur it is often vague and nonspecific and can present as: Fatigue Generalized weakness Dyspnea with or without exertion Palpitations and cough

Mitral stenosis
Narrowing or constriction of the diameter of the

mitral valve opening.

Assessment with clinical manifestations: May reveal no symptoms or may reveal a) Dyspnea on exertion b) Fatigue and cough with hemoptysis


a) b) c) a) b) c) d)

History Chest pain Rheumatic fever Dysphasia Inspection Prominent wave in the jugular venous pulse Signs of peripheral edema Enlarged liver Ascites and mitral facies

Aortic regurgitation
Inflammatory disease of the heart or congenital

conditions Assessment with clinical manifestations Asymptomatic Increased dyspnea on exertion Fatigue Paroxysmal nocturnal dyspnea