Congestive Heart

Failure
HNI 473
Adult Health Nursing
Professor Patricia Voelpel
Revised 2014

CONGESTIVE HEART
FAILURE
Textbook

definition: inability
of the myocardium to pump
sufficient blood to the tissues
of the body to meet metabolic
demands
Hemodynamic and
neurohormonal derangements
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RENIN-ANGIOTENSIN SYSTEM
Renin + Angiotensinogen
Angiotensin I
Angiotensin II
Peripheral vasoconstriction
BP

Aldosterone secretion
Na + H20 retention

Increased plasma volume

Congestive Heart Failure

Normal Heart

Diseased Heart

Pulmonary Edema

Magnitude of the Problem of

CHF
Most

65

common admission diagnosis over age

risk for readmission within 30-90 days

High

financial toll

654,000 admissions cost $5.6 billion in 1992

Low

adherence rates

account for approximately 50% of admissions

Inaccurate

symptom appraisal or awareness

symptoms thought to be due to normal aging

ETIOLOGY
Anything that induces chronic d
volume or d pressure or d metabolic
demand on myocardium
Hypertension
Coronary heart disease
Idiopathic cardiomyopathy
Valvular heart disease
Thyrotoxicosis, anemia, hypoxia

Definitions

Cardiac Output: volume of blood in liters

pumped by the heart in one minute.
Cardiac Index: CO adjusted for BSA.
Preload: volume within the ventricleat the
end of diastole.
Afterload: forces opposing ventricular
ejection.
Vascular resistance: resistance of either
the systemic or pulmonary vascular bed.
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Hemodynamic Monitoring
Measurement

Normal

CVP (preload RV)

2-8 mm Hg

PAWP (preload LV)

6-12 mm Hg

SVR (afterload LV)

800-1200 dynes/sec/cm

PVR (afterload RV)

<250 dynes/sec/cm

Hemodynamic Monitoring
So

what do these numbers mean to

me?
How do we acquire them?

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11

Cardiac output
CO = heart rate X stroke

volume

Stroke volume
preload
afterload
contractility
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Etiology and Cardiac Output

preload

aortic regurgitation
VSD

afterload

aortic stenosis
hypertension

contractility

myocardial infarction
cardiomyopathy
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Systolic vs Diastolic Failure

Systolic

Diastolic

Problem

Inability of the heart

to pump blood
effectively.

Inability of the
ventricles to relax
and fill during
diastole.

Cause

Impaired contraction
(MI)
Increased afterload
(HTN)
Mechanical
abnormality (Valve
disease)

Stiff ventricles that

lead to high filling
pressures.
LVH 2 HTN
Myocardial ischemia
Valve disease
Cardiomyopathy

Hallmark sign

Decreased LV EF

Decreased stroke
volume and cardiac
output.
HF with normal EF

Ejection Fraction

< 45%

Normal

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CHF Compensatory
Mechanisms
d

sympathetic adrenergic activity

preload secondary to activation

of renin-angiotensin-aldosterone
system

Ventricular

hypertrophy
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Common CHF Symptoms

Fatigue

Sleeplessness

Edema

Angina

Weight gain

Palpitations

Cough
Dyspnea
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HF Management
Lifestyle

modifications

low Na diet
pacing of activities
Medication

complexity

multiple medications
Symptom

monitoring

daily weight
symptom monitoring
often insidious symptom pattern
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Research Recommendations
from Recent CHF Studies
Interventions needed to improve
symptom awareness
Utilize patient perspective in
interventions
Interventions to promote earlier
treatment
Address quality of life issues as well as
decreased mortality rates (AHCPR, 1994)

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Goals of Management
Identify

and eliminate precipitating

cause
Management of symptoms
Increase functional capacity
Prevention of exacerbations
Educate and assist patient and family
to cope with lifestyle changes (self
care)
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Pharmacological
Management

ACEIs - .pril drugs (enalapril/Vasotec)

Diuretics - thiazides and loops (HCTZ or
furosemide/Lasix)
Beta blockers - .olol drugs
(carvediol/Coreg)
Digoxin/Lanoxin
ARBs (angiotensin II receptor blockers) .sartan drugs (losartan/Cozaar)
Morphine
Anticoagulants
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Considerations for Home

Care
Discharge

planning begins on admission

Assess support systems
Symptom monitoring
Provide resources and educational materials
Dietary needs
Daily weights
Medication supply
Exercise

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Left side vs. Right side

What

will you see?

What are some causes?
How are they treated?
What is the other name for Right
sided failure?
Can you have Right and Left sided
failure at the same time?
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