Congestive cardiac failure

heart failaire

1. Congestive Cardiac Failure
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

2. Definition
CCF is the inability of the heart to pump
an adequate amount of blood to the
systemic circulation at normal filling
pressure.
Heart failure refers to the inability of
cardiac output to meet the metabolic
demands of the body.
JERIN.T.S, 3RD YEAR BSC
NURSING, KRSMCON
MANGALORE. PH:
[phone]

3. According to American Heart
Association:
Heart failure is a complex clinical
syndrome that can result from any
structural or functional cardiac disorder
that impairs the ability of the ventricle to fill
with or eject blood.
JERIN.T.S, 3RD YEAR BSC
NURSING, KRSMCON
MANGALORE. PH:
[phone]

4. Etiology
Depending on volume, pressure,
contractility and cardiac output.
1.Volume overload: left to right shunt. Hypertrophy of the right
ventricle to compensate for additional volume of blood.
2.Pressure overload: resulting from obstructive lesions such as valvular
stenosis
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

5. 3.Decreased contractility: Cardiomyopathy, myocardial ischemia
from severe anemia or asphyxia, heart block.
4.Increased cardiac output demand: in sepsis, hyperthyroidism with
severe anemia
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

6. The causes of systolic failure or mixed systolic
and diastolic failure can be divided into two
groups according to the age.
1) Infants:
Congenital heart diseases
Myocarditis and primary myocardial disease
Paroxysmal tachycardia
Anemia and Infections
Upper respiratory obstructions
Hypoglycemia and Hypocalcaemia
Neonatal asphyxia
Persistent fetal circulation
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

7. 2) In children
Rheumatic fever & heart disease
Congenital heart disease complicated by infection,
anemia, endocarditis
Hypertension
Myocarditis and primary myocardial diseases
Upper respiratory obstruction
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

8. Obstructive lesions
Artesia or critical stenosis= CCF
If the lesion is mild -asymptomatic till late years
Arrhythmias
CCF in infancy is due to paroxysmal supraventricular
tachycardia
More in males
HR >180/min precipitates CCF
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

9. Anemia
In normal heart Hb <5g% =CCF
In compromised heart Hb <7g%=CCF
Infections
URTI & LRTI=CCF
Other infections in the body where cardiac output demand increases
even after compromise.
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

10. Pathophysiology
In right sided failure: develop around 6-
8wks of life
a)Right ventricular function is impaired
b)Right ventricular end diastolic
pressure is increased
c)Elevated CVP & systemic venous
engorgement
d)Systemic venous hypertension
causes hepatomegaly and edema
in the extremities
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

11. In left sided failure: within few days of life
a)Left ventricular function is impaired
b)Left ventricular end diastolic pressure increases
c)Increased pressure in left atrium & pulmonary veins
d)Lungs become congested with blood
e)Increased pulmonary pressure and pulmonary edema
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

12. Compensatory mechanisms
1)Hypertrophy and dilatation of cardiac muscles
2)Stimulation of sympathetic nervous system
3)Systemic venous congestion
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

13. Clinical manifestations
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

14. Symptoms
 Slow weight gain
1)Infant takes small feeds due to easy fatigue
2) Excessive loss of calories from increased work of breathing
 Wheezing
 Excessive perspiration
 Pedal edema & Puffiness of face
 Irritability & persistent hoarse crying
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

15. Signs
Systemic manifestations
Growth failure
Exercise intolerance
Diaphoresis
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

16. Cardiac manifestations
1)Tachycardia
2)Increased precordial activity
3)Gallop rhythm
4)Altered perfusion:
i. diminished pulses
ii. pulses paradoxicus
iii. pulses alternans
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

17. Respiratory manifestation
1)Tachypnea
2)Wheezing / cough
3)Rales
4)Cyanosis
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

18. Manifestations of systemic
venous congestion
Hepatomegaly
Jugular venous distension
Peripheral edema
Ascitis
Periorbital edema
JERIN.T.S, 3RD YEAR BSC NURSING,
KRSMCON MANGALORE. PH:
[phone]

19. Diagnostic assessment
1)Chest radiography
2)ECG
3)Echocardiography
4)Lab investigations:
 ABG analysis
 Electrolytes
 Glucose
 CBC
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

20. JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

21. Treatment
Goals:
A.To improve cardiac function
B.Reduce the cardiac work
C.Remove accumulated fluid and sodium
D.To Decrease cardiac demand
E.To decrease 0
2
consumption, improve tissue
oxygenation
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

22. Improve cardiac functioning
Pharmacological:
1)Digitalis glycosides:
To improve myocardial contractility, and reduces the
heart rate.
lanoxin, digoxin
2) ACE inhibitors:
To reduce after load of heart,
captopril, enalapril
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

23. Reduce the cardiac work
Restricting the patients activities
Sedatives
Treatment of fever, anemia, obesity
Vasodilators
Nitroglycerine-IV-0.05-20m/k/min IV infusion
Iso-sorbide dinitrate-IV-0.01mg/kg q6hr
Prazosin-IV or Arterial 5-25mcg/kg q6hr
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

24. Reduce heart size-
Remove accumulated
sodium and fluid
1)Diuretics
2)Possible fluid restriction
3)Possible sodium restriction
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

25. To decrease cardiac demand:
Minimize metabolic demand by:
Neutral temperature
Treat infections
Reduce efforts of breathing
Provide rest & reduce environmental stimuli.
Improve tissue oxygenation:
Cool humidified 0
2
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

26. Correcting the underlying
cause
By curative or palliative surgery For rheumatic heart
disease.
In supraventricular tachycardia lanoxin or verapamil IV
0.1-0.2mg/kg very effective but used with caution.
Keep ready atropine
Prolonged bed rest with anti congestive measures
In cardiomyopathies use betablockers
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

27. Stepwise management of
CCF
Step 1: use of furosamide with K
+
S diuretic
Step 2: digoxin
Step 3: ACE Inhibitors & stop K
+
S diuretic
Step 4: isosoride dinitrate
Step 5: dopamine or combined with
dobutamine
Step 6: myocardial biopsy+steroids
Step 7: cardiac transplantation (when
above fail)
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

28. Goals of nursing
management
Child will
 exhibit improved cardiac output
 Experience decreased cardiac demands
 Improve respiratory function
 Maintain adequate nutritional status by frequent diet
 No evidence of fluid excess : I/O chart, weight check
 Adequate family support & education
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

29. Nursing management
Assess for signs of CHF
Tachycardia
Tachypnea
Profuse sweating
Increased weight
Edema
Respiratory distress
Fatigue and irritability
JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

30. JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]

31. JERIN.T.S, 3RD YEAR BSC NURSING, KRSMCON MANGALORE. PH:[phone]