CHF Heart Failure Adult Health Nursing b

CHF

1. CONGESTIVE HEART FAILURE (CHF) OR CONGESTIVE CARDIAC FAILURE (CCF) Ms. Sakshi M.Sc (Medical Surgical Nursing)

2. CONTENT Anatomy and physiology of heart. Introduction. Definition. Classification of Congestive Heart Failure. Causes. Pathophysiology. Clinical Manifestation. Diagnostic Findings. Management Including Medical, Surgical, Nursing, Preventive Treatment. Summarization. Recapitulation.

3. Objectives: By the end of the presentation the student must be able to: Define CHF. Causes of CHF. Classification of CHF. Clinical manifestation and Diagnostic finding of CHF. Management of CHF.

4. ANATOMY AND PHYSIOLOGY OF HEART

5. ANATOMY AND PHYSIOLOGY OF HEART Heart is a muscular organ situated in the mediastinum ( the space between sternum & vertebrae & between lungs). Weight of heart in adult Male 300 gm &in adult Female 250gm . Shape - Cone shaped like closed fist. Size - 12*9*6 cm. Location - About two-third part in left to sternum and one-third part right to sternum.

6. Cont… A double layered membrane called the Pericardium surrounds heart like a sac. Heart has four chambers (The upper chambers are called the left and right Atria, and lower chamber are called the left and right Ventricles). The four valves of heart: Tricuspid Valve: allow blood to flow from the right atrium to right ventricle. Pulmonary Valve: allow blood to flow from the right ventricle to pulmonary artery. Mitral valve: allow blood to flow from the left atrium to left ventricle. Aortic Valve: They open to let blood flow from heart’s left ventricle to the aorta.

7. BLOOD CIRCULATION IN HEART The Heart circulates blood through two pathway: Pulmonary Circulation. Systemic Circulation

8. Cont… Cardiac Output: Amount of blood pumped by heart per minute. Normal cardiac output = 4-8 liters per minute. Stroke Volume: It is the amount of blood ejected by the left ventricle in one contraction. Normal Stroke Volume = 60-120 ml/kg

9. CONGESTIVE HEART FAILURE (CHF) OR CONGESTIVE CARDIAC FAILURE (CCF)

10. INTRODUCTION Heart failure is common cardiovascular disease with high morbidity and mortality. Unlike western countries where heart failure is predominantly a disease of the elderly, in India it affects younger age group. The incidence of HF increases with age. Approximately 6 million people in United states have HF. 5,50,000 new cases are diagnosed each year .

11. DEFINITION Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body .(CDC- Center of Disease Control & Prevention). A complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood .(AHA American Heart Association)

12. Cont… Heart Failure can be defined as a physiological state in which the heart is unable to pump enough blood to meet the metabolic needs of the body at rest or during exercise even though filling pressure are adequate. CHF means that one or more chambers of the heart fail to keep up with the volume of the blood flowing through them.

13. CLASSIFICATION

14. Left Sided Heart Failure The most common type of heart failure. Pulmonary congestion occurs when the left ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic circulation. Symptoms typically include congestion in the lungs, which can affect breathing.

15. Right Side Heart Failure The in ability of the right side of the heart(right ventricle) to adequately pump venous blood into the pulmonary circulation. This causes a back-up of fluid in the body, resulting in swelling and edema due to elevated pressure and congestion in systemic vein and capillaries.

16. Left heart failure Right heart failure Definition The left ventricle cannot pump blood as it should. This causes blood to build up in the veins of the lungs. The right ventricle cannot pump blood effectively, which leads to a buildup of fluid that causes swelling in the lower body. Common causes Heart Attack Coronary artery disease (CAD) Left side heart failure COPD Symptoms Symptoms typically include congestion in the lungs, which can affect breathing. Symptoms typically include swelling and fluid retention in the body

17. Systolic And Diastolic heart failure Systolic failure, or heart failure with reduced ejection fraction:  In systolic heart failure, the left ventricle cannot contract in the usual manner and the heart cannot pump blood with enough force to propel blood into circulation. Diastolic failure, or heart failure with preserved ejection fraction:  In diastolic heart failure, the muscles of the left ventricle have stiffened and cannot relax normally and the heart cannot fill with blood between beats.

18. CAUSES OF CONGESTIVE HEART FAILURE SYSTOLIC DYSFUNCTION Coronary artery disease (Ischemic heart disease). Hypertension. Large salt intake in diet. Diabetes. Myocarditis. Overweight, smoking, alcohol. Heart valve disease. Dilated Cardiomyopathy. Arrhythmias.

19. Diastolic Dysfunction Coronary artery disease (Ischemic heart disease). Hypertension. Myocardial Infarction. Cardiomyopathy ( Hypertrophic & Restrictive). Constrictive Pericarditis. Cardiac Temponate . Myocarditis. Aortic Stenosis. Amyloidosis.

20. PATHPHYSIOLOGY

21. Cont…

22. Clinical manifestations LEFT SIDED HEART FAILURE Fatigue, shortness of breath, dyspnea on exertion. Paroxysmal nocturnal dyspnea. Orthopnea. Pulmonary edema. Wheezing sound. Pale or bluish skin. Palpitation. Weakness, Insomnia, Restlessness.

23. RIGHT SIDED HEART FAILURE Swollen legs or peripheral edema of lower extremities. Liver & spleen enlargement. Abdominal pain. Jugular venous Distention. Ascites. Nausea, vomiting, appetite decrease. Slow weight gain. Arrhythmia. Nocturia.

24. NYHA (New York Association) Heart Failure Symptom Classification NYHA Class Level Of Impairment Class I Patient in this category feel no symptoms and can perform ordinary physical activities without any limitation. Class II Ordinary physical activity somewhat limited by dyspnea. No symptoms at rest. Class III Exercise limited by dyspnea with moderate workload Class IV Symptoms of cardiac insufficiency with any physical activity or even at rest. Dyspnea at rest or with little exertion

25. Diagnostic Evaluation

26. MEDICAL MANAGEMENT Diuretics- Bumetanide ( Bumex ) and Furosemide ( Lasix ) ACE Inhibitors ( Angiotensin - converting enzyme) Enalapril . Beta Blocker- Metoprolol , bisoprolol . Vasodilator- Nitroglycerin, Hydralazine .

27. Surgical Management Coronary Angioplasty (PTCA)

28. Coronary artery bypass surgery

29. Implantable Cardiac Defibrillator (ICD)

30. Intra – Aortic Balloon Pump(IABP)

31. Cardiac Resynchronization therapy (CRT)

32. Heart Transplantation

33. Nursing management Assessment: Obtain history of symptoms, limits of activity, response to rest and history of drug therapy. The nurse explores sleep disturbances, particularly sleep suddenly interrupted by shortness of breath.

34. Nurses Diagnosis Decreased Cardiac output related to increased preload as evidence by bradycardia. Fluid volume excess related to decreased cardiac output as evidence by crackles on both lungs. Ineffective tissue perfusion related to decreased cardiac output.

35. Intervention Auscultate heart sounds frequently and monitor cardiac rhythm. Assess for abnormal heart and lung sounds. Monitor for edema, weight gain, jugular vein distention(JVD) , and lung crackles. Administer prescribed diuretic as ordered. Provide oxygen and monitor oxygen saturation via pulse oximetry, as ordered.

36. PREVENTION

37. PREVENTION Stop Smoking-better yet, don’t start- it’s a major factor in the arterial damage that can cause heart failure. Eat Healthy- the food that help you are those that contain little saturated fat, trans fat, sugar or sodium Take fruit and vegetables, low fat dairy, avocadoes. Lose pound if you’re overweight- Along with diet, being physically active help achieve this goal and is also great for heart. If one is having another type of heart disease or related condition, closely follow treatment program.

38. CONCLUSION Heart failure is common cardiovascular disease with high morbidity and mortality. Unlike western countries where heart failure is predominantly a disease of the elderly, in India it affects younger age group. Cases of heart failure should be thoroughly assessed and investigated for underlying cause for appropriate diagnosis/treatment Follow up is essential to monitor progress, and ensure proper development of the child.

39. BIBLIOGRAPHY Ansari Javed , Kaur Davinder . A text book of: Medical Surgical Nursing. Volume 2. 5 th edition. Pee Vee ; 2020.PP 927-943. Hinkle JancieL , Cheever Kerry H. Brunner and Suddarth’s . A Textbook of: Medical Surgical Nursing ,Volume-2, PP-1773-1781 Willis Laura. A text book of :Medical Surgical Nursing. 10 th edition, Wolters Kluwer , PP- 1666-1668