LEFT-SIDED HEART FAILURE

Definition

life-threatening condition in which the

left side of the heart cannot pump
enough blood to the body
Diagnostic criteria

1. New York Heart Association Functional

Classification:

Class I: no limitation is experienced in any

activities; there are no symptoms from ordinary
activities.
Class II: slight, mild limitation of activity; the
patient is comfortable at rest or with mild
exertion.
Class III: marked limitation of any activity; the
patient is comfortable only at rest.
Class IV: any physical activity brings on
discomfort and symptoms occur at rest.
2. The American College of Cardiology/American Heart
Association four stages of heart failure:

Stage A: a high risk HF in the future but no structural

heart disorder;
Stage B: a structural heart disorder but no symptoms at
any stage;
Stage C: previous or current symptoms of heart failure
in the context of an underlying structural heart problem,
but managed with medical treatment;
Stage D: advanced disease requiring hospital-based
support, a heart transplant or palliative care.
Causes, incidence, and risk factors:

Heart attack
Chronic blockages of the heart arteries
High blood pressure
Excessive alcohol consumption
Leaking or narrow heart valves
Hypothyroidism
Heart muscle infections
Any other disease that damages the heart
muscle
Signs and Symptoms
Shortness of breath/dyspnea
Pulmonary Edema
Adventitious breath sounds
S3 heard upon auscultation
Cough (produces frothy or blood-tinged mucus)
Difficulty lying down; need to sleep with the head elevated to avoid
shortness of breath
Paroxysmal nocturnal dyspnea (PND)
Sensation of feeling the heartbeat (palpitations)
Irregular or rapid pulse
Fatigue, weakness, faintness
Weight gain from fluid retention
Decreased urine production (oliguria)
Increased blood pressure
Nocturia
Skin appears pale and feels cool and clammy
Infants may have poor feeding, weight loss, and failure to thrive
Exams and Tests

Electrocardiogram (ECG)
Chest X-ray
Ultrasound of the heart
(echocardiogram)
Laboratory studies
Exercise testing or cardiac
catheterization
Coronary angiography
Medical management
Specific objectives:
Eliminate or reduce any etiologic contributory
factors, especially those that may be reversible
(e.g. atrial fibrillation, excessive alcohol
consumption
Reduce the workload on the heart by reducing
afterload and preload
Optimize all therapeutic regimens
Prevent exacerbation of heart failure
Lifestyle changes such as stopping drinking
alcohol.
Persons with heart failure should eat less salt,
avoid alcohol, and exercise moderately.
Medicines
Angiotensin-converting enzyme (ACE)
inhibitors
Angiotensin II receptors blockers
Hydralazine and Isosorbide Dinitrate
Diuretics
Beta blockers and ACE inhibitors
Digoxin
Calcium Channel Blockers
Intravenous Infusions such as Nesiritide
and Milrinone and dobutamine
Surgical Interventions

Coronary artery revascularization with

percutaneous coronary intervention
or coronary artery bypass
Implantable cardioverter defibrillator
(ICD)
Cardiac resynchronization therapy
(CRT)
Cardiac transplantation
Nursing Management

Administering medications and assessing the patients

response to the pharmacologic regimen
Assessing fluid balance, including intake and output, with a
goal of optimizing volume status
Weighing the patient daily at the same time and on the same
scale, usually in the morning after urination; monitoring fro a
2-3 lbs gain in a week
Auscultating lung sounds to detect an increase or decrease
pulmonary crackles
Determining the degree of Jugular Venous Distention(JVD)
Identifying and evaluating the severity of dependent edema
Monitoring pulse rate and blood pressure; checking for
postural hypotension due to dehydration
Examining skin turgor and mucous membranes for signs of
dehydration
Assessing for symptoms of fluid overload (e.g. orthopnea,
PNE, DOE)