Heart failure

Heart failure

1. Us. WaleedAmeen

5. Classification of Heart Failure
•Onset:
•Acute heart failure
•Chronic heart failure
•Affected side of the heart:
•Left heart failure
•Right heart failure
•Stages of heart failure severity:
•New York Heart Association
•American Heart Association/American College of Cardiology

6. NYHA Classification of
Functional Capacity
Description
NYHA class I Asymptomatic
NYHA class II Symptoms with moderate exertion
NYHA class III Symptoms with minimal exertion
NYHA class IV Symptoms at rest
Table 1
New Classification based on symptoms Corresponding NYHA class
Asymptomatic NYHA class I
Symptomatic NYHA class II/ III
Symptomatic with recent history of dyspnea
at rest
NYHA class IIIB
Symptomatic withdyspnea at rest. NYHA class IV
Table 2
Heart Failure Classification

7. Myocardial Disease / Injury
Impaired Ventricular Performance
Cardiac
Output
↑SNS
↑ HR
↑ Contractility
Vasoconstriction
↑RAAS
Vasoconstriction
Na/H2O
Retention
Cardiac
Workload
Ventricular
Remolding
Dilation &
Hypertrophy
Vicious Cycle
of
Heart Failure

11. © 2008 Heart Failure Society of America, Inc.
What Are The Symptoms
of Heart Failure?
Think FACES...
•Fatigue
•Activities limited
•Chest congestion
•Edema or ankle swelling
•Shortness of breath

15. Therapy for heart failure
Myocardial
dysfunction
Increased load
Neurohomonal
activation
Cardiomyocyte
dysfunction
Cell death
Heart failure
Drug therapy
Drug therapy
Gene therapy
Heart
transplantation
Cell
transplantation

16. Treatment Considerations
Non-Pharmacologic
•Diet:
1.Salt restriction
2.Fluid restriction
3.Weight loss
4.Lipid control
•Alcohol
•Smoking
•Exercise
•Cardiac Rehab
•Palliative Services
•Social Support
Pharmacologic

17. Pharmacologic Interventions
Good Evidence to use the following exist:
1.ACE-Inhibitors
2.Beta Blockers
3.Spironolactone
4.Diuretics
5.Digoxin

18. Angiotensin Converting Enzyme Inhibitors
•Indication: All HF patients with sDysfunction (symptomatic or
not); [A]
•Goal :Reduce morbidity & Mortality
•Dose: Ideal dose controversial, start low and increase to
common dose
•Precautions:
-Baseline Serum K+ and Cr. at initiation of therapy required.
-Careful monitoring if sBP <100mmHg, or if elevated serum
Cr.
-Titrate as tolerated if administered with b-blockers [C].

19. ß-BLOCKERS
Limit the donkey’s speed, thus saving energy

20. Spironolactone
•Indication: Symptom at rest or new onset of
symptom in last 6mo. Beneficial for moderate to
severe HF.
•Dose: 25mg OD
•Precautions: Monitor kidney function & K+, >25mg
is rarely indicated.

21. Diuretics
•Indication: to control fluid overload (Edema, Ascites, Wt
gain)
•Goal: Improve morbidity
•Dose:
-Usually Furosemide, start @ 20mg/d and incr/decr as
needed
-Diuretics can be stopped if fluid overload resolves.
•Precautions: K+ wasting, typically given with
KClsupplements, Monitor serum K+.

22. ACE-Inhibitors
Evidence for Use:
Systemic reviews & RTCs show that ACE-Inhibitors
•reduced ischemic events
•slow disease progression
•improve exercise capacity
•decrease hospitalization & mortality for heart
failure compared with placebo.

23. DIURETICS, ACE INHIBITORS
Reduce the number of sacks on the wagon

24. Digoxin
•Indication:
1.HF + A.fib [A]
2.Patients still symptomatic despite use of Diuretics, ACEI &
b-Blockers.
3.PRN use to control dyspnea at rest (existing or new onset)
[A].
•Goal: Improve morbidity
•Dose: 0.125 –0.25mg /d
•Precautions:
-Digoxin levels [when toxicity is suspected].
-Pushed to backburner b/c of recent discovery that it can incr
risk of death from any cause amongst women [not men]
w/HF and decr LVEF.

25. DIGITALIS COMPOUNDS
Like the carrot placed in front of the donkey

26. CARDIAC RESYNCHRONIZATION
THERAPY
Increase the donkey’s(heart) efficiency

37. Heart Failure: Nursing Diagnoses
•Impaired gas exchange related to ventilation perfusion
imbalance.
•Ineffective (cardiopulmonary) tissue perfusion related
to impaired arterial blood flow.

38. Heart Failure: Nursing Diagnoses
•Excess fluid volume related to excess fluid or sodium
intake and retention of fluid secondary to heart failure
and its treatments.
•Anxiety related to breathlessness and / or restlessness
secondary to inadequate oxygenation.
•Powerlessness related to inability to perform usual role
responsibilities.
•Knowledge deficit related to heart failure and its
treatments.

39. Nursing Management: Heat Failure
•Nursing Considerations
•Respiratory
•Supplemental oxygen
•Good lung assessment
•Monitoring
•Hemodynamic Monitoring
•Daily Weights
•I & O’s
•Laboratory Results
•i.e. electrolytes, BNP & digoxin levels
•Maintain
•Small frequent meals; low in salt
•Skin integrity

40. Nursing Management: Heat Failure
•Nursing considerations Cont.,
•Promote rest and avoid fatigue
•Assess for peripheral edema
•Client Education
•Medications
•Lifestyle changes
•i.e. low-sodium diet & activity-rest balance
•Daily weights
•S/Sx of worsening heart failure to report
•Importance of follow-up care

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