AN-Najah National University

Faculty of Nursing
Cardiovascular Diseases
Management & Nursing Care

Prepared by : Masoudeh Assaira
Fadia qasim
Supervised by: Miss Shurouq qadose
2006

Heart failure is a condition in which the heart cant
pump enough blood throughout the body. Heart
failure does not mean that your heart has
stopped or is about to stop working. It means
that your heart is not able to pump blood the
way that it should. The heart cant fill with
enough blood or pump with enough force, or
both.
Heart failure develops over time as the pumping
action of the heart grows weaker. It can affect the
left side, the right side, or both sides of the heart.
Most cases involve the left side where the heart
cant pump enough oxygen-rich blood to the rest
of the body. With right-sided failure, the heart
cant effectively pump blood to the lungs where
the blood picks up oxygen.
The weakening of the hearts pumping
ability causes:

1- Buildup Blood and fluid to "back up" into the
lungs

2- The buildup of fluid in the feet, ankles, and legs

3- Tiredness and shortness of breath
Heart failure is a serious condition. About 5
million people in the United States have heart
failure, and the number is growing. Each year,
another 550,000 people are diagnosed for the first
time. It contributes to or causes about 300,000
deaths each year.
Other names for heart failure

Congestive heart failure (when the poor pumping
function results in symptoms)
Left-sided heart failure
Right-sided heart failure
Systolic heart failure
Diastolic heart failure
The major causes of CHF may be divided in
to two subgroups
1- underlying diseases e.g.
Coronary artery disease
Hypertensive heart disease
Congenital heart disease
Acute myocardial infarction
Pulmonary emboli
2- Precipitating causes e.g.
Anemia
Infection
Bacterial endocarditic
Pulmonary embolism
Hypervolemia
Nutritional deficiencies
Precipitating causes often increase the workload of
the ventricles, causing a decompen -sated
condition that leads to decreased myocardial
function .
Pathology of ventricular failure

Heart failure can be described as systolic or
diastolic :

Systolic failure , the most common cause of CHF,
results from an inability of the heart to pump
blood .

It is a defect in the ability of the ventricles to
contract (pump) the left ventricle loses its ability
to generate enough pressure to eject blood forward
through the high pressure aorta.
Systolic failure is caused by impaired contractile (
e.g., myocardial infarction ) , increased after load
(e.g., hypertension ), cardiomyopathy, and
mechanical abnormalities ( e.g., valvular heart
disease ) .

Diastolic failure is an impaired ability of the
ventricles to fill during diastole. decreased filling
of the ventricles will result in decreased stroke
volume. In diastolic failure there is normal systolic
function .
. It is characterized by high filling pressures and
the resultant venous engorgement in both the
pulmonary and systemic vascular . It is usually the
result of left ventricular hypertrophy from chronic
systemic hypertension, aortic stenosis, or
hypertrophic cardiomyopathy .
Mixed systolic and diastolic failure

Systolic and diastolic failure of mixed origin is seen
in disease states such as dilated cardiomyopathy, a
condition in which poor systolic function is further
compromised by dilated left ventricular walls
that are unable to relax .
This patient often has extremely poor ejection
fractions , high pulmonary pressures , and
biventricular failure ( both ventricles may be
dilated and have poor filling and emptying
capacity ) .
Types of congestive heart failure

Left- sided failure
results from left ventricle dysfunction, which
causes blood to back up through the left atrium
and into the pulmonary veins .
Right sided failure
Causes back ward blood flow to the right atrium
and venous circulation .venous congestion in the
systemic circulation result in peripheral edema,
hepatomegaly, splenomegaly vascular congestion
of the GT.
What Causes Heart Failure?

Heart failure is caused by other diseases or
conditions that damage or overwork the heart
muscle. Over time, the heart muscle weakens and
is not able to pump blood as well as it should.

The leading causes of heart failure are:
1- High Coronary artery disease (CAD)
CAD, including angina and heart attack is the most
common underlying cause of heart failure. People who
have a heart attack are at high risk of developing heart
failure.
2- Diabetes
3-High blood pressure
Most people with heart failure also have high Blood
pressure, and about one in three has diabetes.
Other Causes of Heart Failure
1- Cardiomyopathy (a disease of the heart muscle)
2- Diseases of the heart valves
3- Abnormal heartbeats or arrhythmias
4- Congenital heart defects (a heart defect or problem
you are born with)
Other conditions that may injure the heart
muscle and lead to heart failure include:
Treatments for cancer, such as radiation and
certain chemotherapy drugs

Thyroid disorders (having either too much or too
little thyroid hormone in the body)

Alcohol abuse

HIV/AIDS

Cocaine and other illegal drug use
Who Is At Risk for Heart Failure?

Heart failure can happen to anyone, but its more
common in:

People 65 years of age and older
Heart failure is very common in people 65 years of
age and older. Its the #1 reason for a hospital visit
in this age group.
African Americans

African Americans are more likely to have heart
failure and suffer more severely why ?
Develop symptoms at an earlier age
Have their heart failure get worse faster
Have more hospital visits
Die from heart failure

Men have a higher rate of heart failure than
women. But in actual numbers, more women have
heart failure because many more women live into
their seventies and eighties, when heart failure is
common.
Children with congenital heart defects can also
have heart failure. Congenital heart defects
happen when the heart, heart valves, and/or blood
vessels near the heart do not develop correctly in
babies when they are in the womb.

This can weaken the heart muscle and lead to
heart failure. Children do not have the same
symptoms or get the same treatment for heart
failure as adults.

Clinical manifestations of congestive heart
failure

Fatigue
Is one of the earliest symptoms of chronic CHF.
Dyspnea
Is a common manifestation of chronic CHF. It is
caused by increased pulmonary pressures
secondary to interstitial and alveolar edema.
Tachycardia
May be the first clinical manifestation of CHF. One
of the body's' first mechanisms to compensate for
a failing ventricle is the increase the heart rate.

Edema
It may occur in the legs, liver, abdominal cavity,
lungs .
Nocturia
When the person lies down at night. Fluid
movement from interstitial spaces back into the
circulatory system is enhanced . this causes
increased renal blood flow and diuresis. The
patient may complain of having to void six or
seven times during the night .
Skin changes
Because tissue capillary oxygen extraction is
increased in a person with CHF, the skin may
appear dusky, may be cool to the touch from
diaphoresis .
Behavioral changes

Cerebral circulation may be impaired with chronic
CHF secondary to decreased CO. The patient may
report usually behavior, including restlessness,
confusion and decreased attention span or
memory .

Chest pain
Because of decreased coronary perfusion from
decreased CO and increased myocardial work.
Weight changes
Many factors contribute weight changes .Initially
there may be a progressive weight gain from fluid
retention. Abdominal fullness from ascites and
hepatomegaly frequently cases anorexia and
nausea .


The actual weight loss may be apparent until after
the edema subsides .

Complications of congestive heart failure

- pleural effusion
- Arrhythmias
- Left ventricular thrombus
- Hepatomegaly
Classification of congestive heart failure

The New York Heart Association has developed
functional guidelines for classifying people with
CHF. The classification is based on the persons'
tolerance to physical activity .
Class 1
No limitation of physical activity. Ordinary
physical activity does not cause fatigue, dyspnea,
palpitations, or anginal pain.
Class 2
Slight limitation of physical activity . No
symptoms at rest ordinary physical activity results
in fatigue, dyspnea, palpitations or anginal pain .
Class 3
Marked limitation of physical activity . usually
comfortable at rest. Ordinary physical activity
causes fatigue, dyspnea, palpitation or anginal
pain .
Class 4
Inability to carry on any physical activity without
discomfort. Symptoms of cardiac insufficiency or
of angina may be present even at rest. If any
physical activity is undertaken, discomfort in
increased .

Nursing and collaborative management:
A- For acute congestive heart failure.
Goal:
1- Decreasing intravascular volume.

2- Decreasing venous return.

3- Decreasing after load.
4- Improving gas exchange and oxygenation.

5- Improving cardiac function.

6- Reducing anxiety.
B-For chronic congestive heart failure:
The main goal in the treatment of CHF is to:
1-Treat the underlying cause and contributing
factors maximize CO.
2- Provide treatment to alleviate symptoms .
-Non pharmacologic therapy:
New technique is the utilization of biventricular
pacing;. Cardiac resynchronization therapy
coordinated right and lifts ventricle contractility
through biventricular pacing.
- Cardiac transplantation:
Is often the treatment of choice. However the lack
Of donor hearts
and the challenges of care make it an option for
only a small number of patients with CHF.
Drug therapy :

1- Angiogenesis converting enzyme
inhibitors:
Inhibitors are useful in both systolic and diastolic
heart failure. and they are the first treatment of
CHF e.g., captopril , enalapril .
2- Diuretics are used in heart failure to mobilize
edematous fluid ,reduce pulmonary venous
pressure and reduce preload
- e.g., loop diuretics (lasix )
- potassium sparing diuretic ( alductone ) .
3- Inotropic drugs: To improving cardiac
contractility to increase CO, decrease LV diastolic
pressure and decrease systemic vascular resistance
Examples:
- Digoxin (lanoxin).
- B- adrenergic agonists. (Dopamine, dobutamine)
- Calcium sensitizers (simdax).
- Vasodilator drugs .
e.g., nitroprusside, nitroglycerin
- B- adrenergic blockers
e.g., carvedilol.

Nutritional therapy:
Diet education and weight management:
Are critical to the patient Control of chronic CHF.
The nurse should obtain
detailed diet history, determine not only what but
also the sociocultural value of food.
Nursing care plan for Congestive heart
failure

1- Nursing diagnosis Activity intolerance related
to fatigue secondary to cardiac insufficiency and
pulmonary congestion as manifested by dyspnea,
shortness of breath , weakness.
Nursing interventions:-

- Encourage alternate rest and activity periods to
reduce cardiac workload

- Provide emotional and physical rest to reduce
oxygen consumption and to relieve dyspnea and
fatigue .
- Monitor cardio respiratory response to activity to
determine level of activity that can be performed

- Teach patient techniques of self care to minimize
oxygen consumption .

2-Nursing diagnosis excess fluid volume related
to cardiac failure as manifested by edema, dyspnea
on exertion, increased weight gain .
Nursing interventions:-

- Weigh daily and monitor trends to monitor fluid
retention and weight reduction

-Monitor respiratory pattern for symptoms of
respiratory difficulty.
- Monitor fluid intake and fluid output

- Monitor for therapeutic effect of diuretic to
assess response to treatment .
- Monitor for serum electrolyte levels to assess as a
response to treatment
3- Nursing diagnosis disturbed sleep pattern
related to nocturnal dyspnea, nocturia as
manifested by inability to sleep through the night .
Nursing interventions:-

- Determine patients / activity pattern to establish
routine .

-Encourage patient to establish a bedtime routine
to facilitate transition from wakefulness
to sleep
- Adjust environment to promote sleep adjust
medication administration schedule to support
patients' sleep cycle

- Monitor patients' sleep pattern and number of
sleep hours to determine hours of sleep .
4-Nursing diagnosis Impaired gas exchange
related to increased preload , mechanical failure,
or immobility manifested respiratory rate,
dyspnea, shortness of breath .
Nursing interventions:-

- Monitor rate, depth, and effort of respirations

- Monitor for dyspnea and events that improve and
worsen it .
- Administer oxygen supplemental as ordered to
maintain oxygen levels .

- position to alleviate dyspnea( semi-fowler
position )

- Monitor the effectiveness of oxygen therapy by
measuring oxygen saturation .
5-Nursing diagnosis Anxiety related to dyspnea
or perceived threat of death

Nursing interventions:-

-Explain all procedures, to promote sense of
security .
- Instruct patient on the use of relaxation
techniques to help alleviate anxiety

- Create an atmosphere to facilitate trust (e.g.,
make frequent checks )

6-Nursing diagnosis Deficient knowledge
related to disease process as manifested by
questions about the disease .
Nursing interventions:-

- Assess the patients' current level of knowledge
about his condition

- Describe common signs and symptoms of the
disease
- Instruct the patient on measures to
prevent/minimize side effects of treatment for the
disease

-Include family or significant others in teaching to
provide support for the patient