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Congestive heart failure

Dr. Walaa Nasr Lecturer of Adult Nursing Second year

Congestive heart failure


Definition Causes and pathophysiology Types of heart failure Compensatory mechanism failure Clinical manifestations Classification of heart failure Diagnostic evaluation Medical management Nursing management



Congestive heart failure


Heart failure describes the clinical syndrome that develops when the heart cannot maintain an adequate cardiac output. The heart pumps blood inadequately, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and other changes that may further weaken the heart.

Causes of congestive heart failure


artery disease Heart attack High blood pressure Heart valves disorders

of Heart muscle (myocarditis, cardiomyopathy)

Causes of congestive heart failure (cont)


lung disease ( pulmonary hypertension) Severe anemia Overactive thyroid gland (hyperthyroidism) Underactive thyroid gland (hypothyroidism) Abnormal heart rhythms ( atrial fibrillation) Kidney failure

Congestive heart failure



heart failure

There are two types of leftsided heart failure Systolic dysfunction Diastolic dysfunction Right-sided heart failure

Congestive heart failure

Compensatory Mechanisms of heart failure

Renin-angiotensin-aldosterone system Sympathetic nervous system Enlargement of the muscular walls of the ventricles (ventricular hypertrophy).

Congestive heart failure

Clinical manifestations
Symptoms (back up of blood and fluid) Dyspnea Orthopnea Reduced exercise tolerance, lethargy, fatigue Nocturnal cough Wheeze Ankle swelling Anorexia

Congestive heart failure

Clinical manifestations ( cont)

Cachexia and muscle wasting Tachycardia Pulsus alternans Elevated jugular venous pressure Crepitations or wheeze Third heart sound Oedema Hepatomegaly (tender) Ascites

Congestive heart failure

Classification of heart failure
New York Heart Association (NYHA) Functional Classification


% of patients
35% 35% 25% 5%

No symptoms or limitations in ordinary physical activity Mild symptoms and slight limitation during ordinary activity Marked limitation in activity even during minimal activity. Comfortable only at rest Severe limitation. Experiences symptoms even at rest

Congestive heart failure

Diagnostic evaluation

Patient history Physical examination Diagnostic studies 1. Electrocardiography (ejection fraction) 2. Radionuclide 3. magnetic resonance 4. computed tomography imaging 5. cardiac catheterization with angiography 6. a biopsy of heart muscle is needed

Congestive heart failure


lifestyle change



Salt restriction Exercises Smoking and alcoholism Body weight (daily weight) Supportive stockings

Congestive heart failure

Treatment (cont)

Drug management Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers Beta-blockers Other vasodilators ( nitroglycerin) Cardiac glycosides (digoxin) Aldosterone receptor blockers (spironolactone) Loop diuretics

Congestive heart failure

Treatment (cont)

Potassium-sparing diuretics Thiazide and thiazide-like diuretics Anticoagulants (heparine) Opioids (morphine) to relieve anxiety Positive inotropic drugs (drugs that make muscle contract more forcefully) (dopamine)

Oxygen for pulmonary edema is required

Congestive heart failure

Treatment (cont)

Non pharmacological management of heart failure (surgical intervention)

Coronary artery bypass grafting (


Percutaneous coronary intervention

Valve replacement Biventricular pacemaker

Heart transplantation Left ventricular assist device (LVAD)

Nursing care of patients with congestive heart failure Maintain the patient in high fowler's position Elevate extremities except when the patient is in acute distress Frequently monitor vital signs Change position frequently Monitor intake and output and daily weight

Nursing care of patients with congestive heart failure (cont)

Restrict fluids as ordered

Teach the patient and family and provide emotional support (life style change)
Explain the side effect of diuretic medications for additional actions ( side effects of diuretics include electrolyte imbalance, symptomatic hypotension Use aseptic procedures invasive lines when caring for