Congestive Heart Failure (CHF)

Reported By: Chanel Kate B. Galleta

 Defintion

Congestive heart
failure (CHF) is a condition in
which the heart's function as
a pump is inadequate to
meet the body's needs.
 What are the functional
classifications of heart failure?
Class I - Patients without limitation of
physical activity.
Class II - Patients with slight limitation
of physical capacity, in which marked
increase in physical activity leads
to fatigue, palpitations, dyspnea, or
angina pain; they are comfortable at
rest.
Class III - Patients with marked limitation of
physical activity in which minimal ordinary
activity results in fatigue, palpitation,
dyspnea, or angina pain; they are
comfortable at rest.
Class IV - Patients who are not only unable
to carry on any physical activity without
discomfort but who also have symptoms of
heart failure or the angina syndrome even
at rest; the patient's discomfort increases if
any physical activity is undertaken.
 Etiology/Cause
Coronary Artery Disease (CAD)
Myocardial Infarction (Heart Attack)
High blood pressure (hypertension)
Longstanding alcohol abuse
Heart Valve Disease (e.g. Aortic
Stenosis)
 Risk Factor

History of Coronary Diabetes

Artery Disease (CAD) Heart Valve Disease
History of Myocardial (e.g. Aortic Stenosis)
Infarction (Heart Cardiomyopathy
Attack) (Heart Muscle
Cigarette Smoking Disease)
Hypertension Sedentary Lifestyle
Obesity
Anatomy & Physiology
 Pathophysiology
Heart failure results from a variety of cardiovascular
conditions, including
chronic hypertension, coronary artery disease, and
valvular disease.
As HF develops, the body activates neurohormonal
compensatory mechanisms.
Systolic HF results in decreased blood volume being
ejected from the ventricle.
The sympathetic nervous system is then stimulated
to release epinephrine and norepinephrine.
 Decrease in renal perfusion causes renin release,
and then promotes the formation of angiotensin
I.
Angiotensin I is converted to angiotensin II by
ACE which constricts the blood vessels and
stimulates aldosterone release that
causes sodium and fluid retention.
There is a reduction in the contractility of
the muscle fibers of the heart as the workload
increases.
Compensation. The heart compensates for the
increased workload by increasing the thickness
of the heart muscle.
Clinical Manifestation
 D: Dyspnea
May be precipitated by minimal to moderate
activity; also occurs during rest.
O: Orthopnea
Dyspnea that develops in the recumbent
position and is relieved with elevation of the
head with pillows.
C: Cough
Cough is initially dry and nonproductive. Large
volume of frothy sputum, which is sometimes
pink, may be produced, usually indicating severe
pulmonary congestion.
H: Hemoptysis
Pink or blood-tinged sputum may be produced.
A: Adventitious breath sounds
May be heard in various areas of the lungs;
as failure worsen, pulmonary congestion
increases and crackles may be auscultated
throughout the lung fields.
P: Pulmonary congestion (crackles/rales)
Sustained high pressure in the pulmonary
veins eventually forces some fluid from
the blood into the surrounding
microscopic air sacs (alveoli), which
transfer oxygen to the bloodstream.
A: Anorexia and nausea
Results from the venous engorgement and
venous stasis within the abdominal organs.
W: Weight gain
Due to retention of fluid.
H: Hepatomegaly
Results from the venous engorgement of
the liver; increased pressure may interfere
with the livers ability to function.
E: Edema (Bipedal)
Edema usually affects the feet and ankles
and worsens when the patient stands or
sits for a long period.
A: Ascites
Is the accumulation of fluid in the
peritoneal cavity; increased pressure within
the portal vessels forces fluid into the
abdominal cavity.
D: Distended neck vein
Increased venous pressure leads to
distended neck veins.
 Laboratory Finding

ECG
B-type natriuretic peptide (BNP)
Chest X-ray
Complete blood count (CBC)
BUN/Creatinine
PET scan
CT scan
 Medical Management
Pharmacologic Therapy
ACE Inhibitors. ACE inhibitors slow the progression of HF,
improve exercise tolerance, decrease the number of
hospitalizations for HF, and promote vasodilation and
diuresis by decreasing afterload and preload.
Angiotensin II Receptor Blockers. ARBs block the
conversion of angiotensin I at the angiotensin II receptor
and cause decreased blood pressure, decreased systemic
vascular resistance, and improved cardiac output.
Beta Blockers. Beta blockers reduce the adverse effects
from the constant stimulation of the sympathetic nervous
system.
 Diuretics. Diuretics are prescribed to
remove excess extracellular fluid by increasing the rate
of urine produced in patients with signs and symptoms of
fluid overload.
Calcium Channel Blockers. CCBs cause vasodilation,
reducing systemic vascular resistance but contraindicated in
patients with systolic HF.
Nutritional Therapy
Sodium restriction. A low sodium diet of 2 to
3g/day reduces fluid retention and the symptoms of
peripheral and pulmonary congestion, and decrease the
amount of circulating blood volume, which decreases
myocardial work.
 Patient compliance. Patient compliance is important
because dietary indiscretions may result in severe
exacerbations of HF requiring hospitalizations.
Additional Therapy
Supplemental Oxygen. The need for supplemental oxygen
is based on the degree of pulmonary congestion and
resulting hypoxia.
Cardiac Resynchronization Therapy. CRT involves the use of
a biventricular pacemaker to treat electrical conduction
defects.
Ultrafiltration. Ultrafiltration is an alternative intervention
for patients with severe fluid overload.
Cardiac Transplant. For some patients with end-stage heart
failure, cardiac transplant is the only option for long term
survival.
Surgical Management
 Nursing Management
Promoting activity tolerance. A total of 30
minutes of physical activity every day should be
encouraged, and the nurse and the physician
should collaborate to develop a schedule that
promotes pacing and prioritization of activities.
Managing fluid volume. The patients fluid status
should be monitored closely, auscultating
the lungs, monitoring daily body weight, and
assisting the patient to adhere to a
low sodium diet.
 Controlling anxiety. When the patient exhibits
anxiety, the nurse should promote physical comfort
and provide psychological support, and begin
teaching ways to control anxiety and avoid anxiety-
provoking situations.
Minimizing powerlessness. Encourage the patient
to verbalize their concerns and provide the patient
with decision-making opportunities
Patient education. Teach the patient and
their families about medication
management, low-sodium diets, activity
and exercise recommendations, smoking
cessation, and learning to recognize the
signs and symptoms of worsening HF.
Encourage the patient and their families to
ask questions so that information can be
clarified and understanding enhanced.
 Nursing Diagnosis
Activity intolerance related to decrease CO.
Excess fluid volume related to the HF
syndrome.
Anxiety related to breathlessness from
inadequate oxygenation.
Powerlessness related to chronic illness and
hospitalizations.
Ineffective therapeutic regimen
management related to lack of knowledge.