HEART FAILURE

AGNESS LUNGU
INTRODUCTON

 Heart failure, often referred to as congestive heart failure (CHF), is not merely a single
disease entity but a syndrome characterized by the heart's inability to pump blood
efficiently to meet the body's metabolic demands. It represents a culmination of various
cardiovascular disorders, each contributing to the gradual decline in cardiac function.
GENEREAL OBJECTIVE

 At the end of the lesson, the students should be able to demonstrate an understanding of
Heart failure
SPECIFIC OBJECTIVES

At the end of this presentation students should be able to;

 Define Heart failure

 State the types of Heart Failure
 State the stages of Heart Failure
 State the risk factors of heart failure
 Describe the pathophysiology of heart failure
 State the signs and symptoms of Heart failure
 Explain the management of a patient with Heart failure
 State the complications of Heart failure
Definition

 Heart failure is a lifelong condition in which the heart muscle can't pump enough blood to
meet the body’s needs for blood and oxygen. Basically, the heart can’t keep up with its
workload.(American Heart Association)
 Types of Heart Failure

1. Left-sided heart failure

 The heart's pumping action moves oxygen-rich blood from the lungs to the left atrium, then on to the left ventricle, which pumps the blood to
the rest of the body. The left ventricle supplies most of the heart's pumping power, so it's larger than the other chambers and essential for
normal function.
 In left-sided or left ventricular heart failure, the left side must work harder to pump the same amount of blood. The percentage of blood the
heart can pump with each beat is measured by a unit called ejection fraction, or EF. A normal left ventricle ejects about 55% to 60% of the
blood in it.
 There are two types of left-sided heart failure:
 Systolic failure: The left ventricle loses its ability to contract normally. The heart can't pump with enough force to push enough blood into
circulation. This is also known as heart failure with reduced ejection, or HFrEF. When this occurs, the heart is pumping less than or equal to
40% EF.
 Diastolic failure: The left ventricle loses its ability to relax normally because the muscle has become stiff. The heart can't properly fill with
blood during the resting period between each beat. This is also known as heart failure with preserved ejection, or HFpEF. When this occurs,
the heart is pumping greater than or equal to 50%. EF heart failure with mid-range ejection fraction (HFmrEF) is a newer concept. In this type
 Right-sided heart failure

 The heart's pumping action moves "used" blood that no longer has oxygen in it back to the right atrium and on to the
right ventricle. The right ventricle then pumps the blood back out of the heart and into the lungs to be replenished with
oxygen.
 Right-sided or right ventricular heart failure usually occurs as a result of left-sided failure. When the left ventricle fails
and can’t pump enough blood out, increased fluid pressure is transferred back through the lungs. This damages the
heart’s right side. When the right side loses pumping power, blood backs up in the body’s veins
 Stages of Heart Failure

1. Stage A: At risk for heart failure

 • People who are at risk for heart failure but do not yet have symptoms or structural or functional heart disease.
 • No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation or shortness of
breath.

2. Stage B: Pre-heart failure

 • People without current or previous symptoms of heart failure but with either structural heart disease, increased
filling pressures in the heart or other risk factors.
 • Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation,
shortness of breath or chest pain.
Stages of Heart Failure

3. Stage C: Symptomatic heart failure

 People with current or previous symptoms of heart failure
 Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity
causes fatigue, palpitation, shortness of breath or chest pain.
4. Stage D: Advanced heart failure
 People with heart failure symptoms that interfere with daily life functions or lead to
repeated hospitalizations
 • Symptoms of heart failure at rest. Any physical activity causes further
discomfort.
 Risk factors of heart failure

 Coronary heart disease – where the arteries that supply blood to the heart become clogged up with fatty substances
(atherosclerosis), which may cause angina or a heart attack
 High blood pressure – this can put extra strain on the heart, which over time can lead to heart failure
 Conditions affecting the heart muscle (cardiomyopathy)
 Heart rhythm problems (arrhythmias), such as atrial fibrillation
 Damage or other problems with the heart valves
 Congenital heart disease – birth defects that affect the normal workings of the heart
 Obesity, anaemia, drinking too much alcohol, an overactive thyroid or high pressure in the lungs (pulmonary hypertension) can
also lead to heart failure.
 Pathophysiology

 Heart failure is a condition where the heart fails to pump and circulate an adequate supply of blood to meet the requirements of
the body. The muscles of the heart become less efficient and damaged, leading to overload on the heart.
 The muscle contraction of the heart may weaken due to overloading of the ventricle with blood during diastole. In a healthy
individual, an overloading of blood in the ventricle triggers an increases in muscle contraction, to raise the cardiac output. This
is called the Frank-Starling law of the heart. In heart failure, however, this mechanism fails due to weakened cardiac muscles
which results in a failure of the heart to pump an adequate amount of blood.
 To compensate for the lowered cardiac output, the heart rate rises. This makes the condition worse as the heart muscles require
more nutrients to work and the myocardial muscles pump at an increased rate.
 Pathphysiology

 Stroke volume reduces as the systole or diastole contractions start to fail. If the volume of blood in the ventricle at the end of
systole rises, it means less blood is ejected. If the volume at the end of diastole is decreased, it means less blood is entering the
heart during diastole.
 The cardiac reserve may reduce. The heart needs to have the capacity to cope with normal metabolic demands as well as
elevated demands, during exercise or exertion, for example. In heart failure, this reserve is lowered.
 With time, the heart starts to enlarge. This is called hypertrophy. Initially the heart muscle fibres increase in size to improve
contractility but with time they become too stiff and unyielding to be of any benefit. The blood pressure in the arteries fall and
there is reduced blood flow to the kidneys.
 The reduced renal perfusion causes the activation of the renin angiotensin cascade which gives rise to increased blood pressure
and salt and water retention causing edema, increased thirst and dizziness
Signs and Symptoms

 Shortness of breath (also called dyspnea)

 Persistent coughing or wheezing
 Buildup of excess fluid in body tissues (edema)
 Tiredness, fatigue
 Lack of appetite, nausea
 Confusion, impaired thinking
 Weight changes
 Rapid or irregular heartbeat.
 Reduced ability to exercise.
 MEDICAL MANAGEMENT

INVESTIGATIONS
i. Echocardiography: Echocardiography, particularly transthoracic echocardiography (TTE), is a cornerstone in diagnosing heart failure. It
provides real-time imaging of the heart's structure and function, allowing visualization of cardiac chambers, valves, and the pumping ability of
the heart.
ii. Electrocardiography (ECG): An ECG is a simple yet invaluable tool in diagnosing heart failure. It records the heart's electrical activity,
detecting abnormal rhythms, conduction abnormalities, and signs of ischemia or previous myocardial infarction.
iii. Biomarkers: Biomarkers such as B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) play a vital role in diagnosing
heart failure and assessing its severity. Elevated levels of these biomarkers in the blood are indicative of increased ventricular wall stress and
volume overload, characteristic of heart failure. They aid in distinguishing heart failure from other causes of dyspnea and provide valuable
prognostic information.
iv. Chest X-ray: Chest X-ray imaging is routinely used in diagnosing heart failure, primarily to assess for signs of pulmonary congestion and
cardiomegaly.
v. Cardiac MRI and CT: Cardiac magnetic resonance imaging (MRI) and computed tomography (CT) offer advanced imaging modalities for
 TREATMENT

1. Angiotensin-Converting Enzyme Inhibitors (ACE Inhibitors):

 Examples: Enalapril, Lisinopril, Ramipril
 Dosages: Starting doses may vary, but typical doses range from 2.5 mg to 20 mg orally once or twice daily, depending on the specific agent and patient
factors. Titration may be guided by blood pressure and renal function.
2. Angiotensin Receptor Blockers (ARBs):
 Examples: Losartan, Valsartan, Candesartan
 Dosages: Initial doses vary, but common starting doses range from 25 mg to 50 mg orally once daily. Titration may be necessary based on patient response
and tolerability.
3. Beta-Blockers:
 Examples: Carvedilol, Metoprolol succinate, Bisoprolol
 Dosages: Initiation often involves low doses to minimize the risk of worsening heart failure symptoms. Starting doses may range from 3.125 mg to 12.5
4. Mineralocorticoid Receptor Antagonists (MRAs):
 Examples: Spironolactone, Eplerenone
 Dosages: Starting doses may vary; for spironolactone, typical starting doses range from 12.5 mg to 25 mg orally once daily. For eplerenone,
starting doses range from 25 mg to 50 mg orally once daily. Renal function and potassium levels should be monitored, and doses adjusted
accordingly.
5. Diuretics:
 Loop Diuretics (e.g., Furosemide): Dosages are highly variable and depend on the degree of congestion and renal function. Typical initial
doses range from 20 mg to 40 mg orally once or twice daily, with adjustments based on response.
 Thiazide Diuretics (e.g., Hydrochlorothiazide): Used adjunctively in some cases. Dosages vary but may range from 12.5 mg to 50 mg orally
once daily.
6. Sacutrilbi/Valsartan (ARNI):
 Example: Sacubitril/valsartan
 Dosages: Starting dose is typically 49 mg/51 mg orally twice daily. If tolerated, the dose may be increased to the target maintenance dose of 97
 NURSING CARE
USING SELF CARE MODEL OF
NURSING
 The self-care model of nursing, developed by Dorothea Orem, emphasizes the patient's ability and responsibility to perform self-care
activities to maintain health and well-being. When applying this model to the nursing care of a patient with heart failure, the focus is on
empowering the patient to actively participate in their own care while providing support and guidance as needed.
 Assessment of Self-Care Abilities: The nursing process begins with a comprehensive assessment of the patient's self-care abilities,
including their knowledge of heart failure, understanding of medication regimens, ability to recognize and manage symptoms, and
willingness to adhere to lifestyle modifications. This assessment helps identify areas where the patient may need assistance or education.
 Promotion of Self-Care Independence: Nurses work collaboratively with patients to develop individualized care plans that promote self-
care independence. This may involve teaching patients about their condition, including the importance of medication adherence, dietary
restrictions (e.g., sodium restriction), fluid intake monitoring, and regular exercise. Nurses empower patients to make informed decisions
about their health and encourage them to take an active role in managing their condition.
 Education and Skill Development: Patient education is a cornerstone of nursing care in heart failure management. Nurses provide clear,
concise, and culturally sensitive education to patients and their families about the nature of heart failure, signs and symptoms of
exacerbation, self-monitoring techniques (e.g., daily weight monitoring, recognizing fluid retention), and when to seek medical attention.
Additionally, nurses teach patients about medication management, including the purpose, dosage, side effects, and importance of adherence.
 Supportive Counseling and Emotional Care: Living with heart failure can be emotionally challenging for patients and their
families. Nurses offer emotional support and counseling to help patients cope with the psychological impact of their diagnosis,
address fears and concerns, and promote positive coping strategies. Encouragement and reassurance are provided to boost the
patient's confidence in managing their condition effectively.
 Collaboration with Healthcare Team: Nurses collaborate with other members of the healthcare team, including physicians,
pharmacists, dietitians, and physical therapists, to ensure comprehensive care for patients with heart failure. This
interdisciplinary approach facilitates continuity of care, promotes adherence to treatment plans, and addresses the multifaceted
needs of patients.
 Evaluation and Adjustment of Care Plans: Regular evaluation of the patient's self-care abilities and adherence to the care
plan is essential for optimizing outcomes. Nurses monitor the patient's progress, assess for any barriers to self-care, and make
adjustments to the care plan as needed. This ongoing evaluation ensures that the patient's evolving needs are met and supports
their journey toward improved health and well-being.
 Complications of Heart Failure

 Fluid Retention and Congestion: Heart failure leads to impaired cardiac function, resulting in inadequate blood circulation and
fluid retention. This can cause symptoms such as peripheral edema, pulmonary congestion (congestive heart failure), and ascites.
 Acute Decompensated Heart Failure (ADHF): Episodes of acute decompensation can occur, characterized by worsening
symptoms such as severe dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and fluid overload. ADHF often necessitates
hospitalization and may be triggered by factors such as medication non-adherence, infection, or myocardial ischemia.
 Arrhythmias: Heart failure predisposes patients to various arrhythmias, including atrial fibrillation, atrial flutter, ventricular
tachycardia, and ventricular fibrillation. Arrhythmias can exacerbate heart failure symptoms, increase the risk of stroke, and
contribute to sudden cardiac death.
 Cardiogenic Shock: In severe cases of heart failure, particularly with reduced ejection fraction, inadequate cardiac output can lead
to cardiogenic shock. This life-threatening condition results in systemic hypoperfusion and organ dysfunction, requiring immediate
intervention with vasopressors, inotropic agents, and mechanical circulatory support.
 Pulmonary Embolism: Heart failure patients are at increased risk of developing pulmonary embolism due to stasis of blood in the
pulmonary circulation, endothelial dysfunction, and hypercoagulability. Pulmonary embolism can further exacerbate respiratory
symptoms and compromise cardiopulmonary function.
 Renal Dysfunction: Heart failure can impair renal perfusion and function, leading to cardiorenal syndrome. Reduced cardiac
output, neurohormonal activation, and venous congestion contribute to renal hypoperfusion, sodium and water retention, and
worsening renal function. Chronic kidney disease is both a cause and consequence of heart failure, forming a vicious cycle of
organ dysfunction.
 Hepatic Congestion and Cirrhosis: Venous congestion in the hepatic circulation can lead to hepatic congestion and impaired
liver function, resulting in elevated liver enzymes, hepatomegaly, and eventually hepatic fibrosis and cirrhosis.
 Cachexia and Malnutrition: Chronic heart failure is often accompanied by cachexia, a wasting syndrome characterized by
unintentional weight loss, muscle wasting, and weakness. Reduced appetite, increased metabolic demand, and altered nutrient
utilization contribute to malnutrition and sarcopenia in heart failure patients.
 Depression and Anxiety: Living with chronic heart failure can take a toll on a patient's mental health, leading to depression,
anxiety, and decreased quality of life. Psychological distress may worsen heart failure symptoms and impair self-care
behaviors, highlighting the importance of addressing mental health needs in heart failure management.