Heart failure happens when the heart is too weak to pump efficiently. This restricts it from providing proper cardiac output to maintain the body’s metabolic needs.
Complex clinical syndrome that results from any structural or functional impairment of ventricular filling (diastole) or ejection of blood (systole)
2013 ACC/AHA
Systolic Heart Failure is attributed to a pumping problem experienced by the heart where it is unable to contract enough to pump blood to supply to the body, thus resulting in contraction and ejection fraction problems. In this case the patient presents with left ventricular failure with reduced ejection fraction of <40% and marked cardiomegaly (where the ventricle becomes enlarged in size).
Diastolic Heart Failure is attributed to a filling problem experienced by the heart where it is unable to relax the left ventricle, leading to a build-up in the lungs, resulting in relaxation and blood filling problems. In this scenario the patient presents with pulmonary congestion and at times with slightly enlarged ventricles, both due to an increased resistance to filling due to increased ejection fraction of >50%.
The ejection fraction is a comparison between the amount of blood in the heart and the amount of blood pumped out of the heart.
Cardiac output is the amount of blood pumped out of each ventricle per minute. Factors affecting cardiac output include the heart rate, blood volume, contractility and venous return.
Stroke volume is the volume of blood pumped out of each ventricle with every beat.
Cardiac Output = Heart Rate X Stroke Volume
Causes of HF include:
- Coronary Artery Disease
- Hypertension
- Cardiomyopathy
- Arrhythmias
- Valvular and Congenital Heart Disease
- Alcohol and Drugs
HF risk factors
- Age
- Obesity
- Smoking
- African Descent
- Hypertension
- High Cholesterol
- Diabetes Mellitus
- Coronary Artery Disease
Signs and symptoms of heart failure include shortness of breath, coughing, sleep disturbance, feeling overtired, loss of appetite, dizziness, swollen ankles and abdominal bloating.
HF can be classified in relation to:
CARDIAC OUTPUT: an issue with the ejection fraction (amount of pumped blood to the body). This can be subdivided into High Output Failure and Low Output Failure. High Output Failure occurs due to obesity, anaemia, hyperthyroidism and pregnancy. Usually presents as right sided heart failure followed by left sided heart failure. Low Output Failure happens when the heart fails to generate enough output due to left ventricular systolic or diastolic dysfunction, right ventricular dysfunction caused by changes in the heart rate, preload, afterload and heart contraction.
ANATOMY: issue or defect within the heart muscle
ONSET: acute or chronic
Left Sided HF is characterised by pulmonary oedema. Signs and symptoms include tachypnoea, tachycardia, third heart sound and cardiomegaly.
Right Sided HF is characterised by peripheral oedema, raised jugular venous pressure, hypotension and congestive hepatomegaly (enlarged liver which usually causes an enlarged abdomen).
Below you can find a collection of videos that can help provide a more visual approach to Heart Failure Treatment, Management, Nursing Interventions & Drugs.
Heart Anatomy and Physiology
Congestive Heart Failure (CHF) Treatment, Management, Nursing Interventions & Medications Part 1
Congestive Heart Failure (CHF) Treatment, Management, Nursing Interventions & Medications Part 2
Stroke Volume and Cardiac Output – Preload & Afterload
Special thanks to the creator of the featured videos on this post, specifically Youtube Channel Registered Nurse RN
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