Acute decompensating heart failure

Acute decompensating heart failure or heart failure is a condition in which the

heart cannot pump enough blood to the bodys other organs. Heart failure results from
changes in systolic or diastolic function of the left ventricle. When heart is not working
properly, cardiac output decrease and making it difficult to circulate the blood to all parts
of the body. Decreased cardiac output activates the renin angiotensin aldosterone system,
which regulates blood pressure and fluid balance. With the time, the myocardium starts to
enlarge; this causes cellular dysfunction and potential functional loss and symptoms of
fluid volume overload arise, and HF worsens.

Heart failure is not a disease itself, instead, it is characterized by manifestations of

volume overload, inadequate tissue perfusion, decrease level of consciousness, renal
dysfunction and poor exercise tolerance.

There are many underlying causes, which affects the heart in many ways
influencing both cardiac preload and after load and causing coronary artery vasculature
changes; such as heart valve disorders, exposure to toxins, viral infection, hypertension,
coronary artery disease, congenital heart diseases, life style, and diabetes mellitus.

Nurse should review the patients history and physical exam to identify
contributing factors to the development of Heart failure. Nurse should administer

medications as ordered by MD and obtain lab and diagnostic work as ordered. Assess
patients breath sounds such as dyspnea, cough, and extended expiration, wheezing.
Check for symptoms related to decreased cardiac output, such as chest pain, dyspnea,
orthopnea, dependent edema, JVD, fluid overload. Continuously monitor fluid intake and
output. Monitor for symptoms of fluid overload such as edema, shortness of breathe,
dyspnea, bounding pulses. Encourage activity as tolerated, rest as needed. Teach the
patient to avoid smoking, importance of healthy food and exercise.

The use of angiotensin converting enzyme (ACE) inhibitors is considered firstline treatment for heart failure. ACE inhibitor shown improved cardiac function,
improved symptoms, and better test results. Though, ACE inhibitors decrease some
visible symptoms and contribute slowing effect but they do not seem to stop the disease
progression. The choice of drugs for CHF is Captopril, Enalapril, and Fosinopril. Betablockers are often prescribed in combination with ACE inhibitors such as Bisoprolol and
Carvedilo. Diuretics are almost inevitably prescribed with heart failure at some point,
because they treat the fluid congestion (edema). The goal of diuretics is to reduce filling
pressures in the heart by causing the patient to eliminate excess fluid.