AN-Najah National University Faculty of Nursing Cardiovascular Diseases Management & Nursing Care

1. AN-Najah National University Faculty of Nursing Cardiovascular Diseases Management & Nursing Care Prepared by : Masoudeh Assaira Fadia qasim Supervised by: Miss Shurouq qadose 2006

3. Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working. It means that your heart is not able to pump blood the way that it should. The heart can’t fill with enough blood or pump with enough force, or both.

4. Heart failure develops over time as the pumping action of the heart grows weaker. It can affect the left side, the right side, or both sides of the heart. Most cases involve the left side where the heart can’t pump enough oxygen-rich blood to the rest of the body. With right-sided failure, the heart can’t effectively pump blood to the lungs where the blood picks up oxygen.

5. The weakening of the heart’s pumping ability causes: 1- Buildup Blood and fluid to "back up" into the lungs 2- The buildup of fluid in the feet, ankles, and legs 3- Tiredness and shortness of breath

6. Heart failure is a serious condition. About 5 million people in the United States have heart failure, and the number is growing. Each year, another 550,000 people are diagnosed for the first time. It contributes to or causes about 300,000 deaths each year.

7. Other names for heart failure • Congestive heart failure (when the poor pumping function results in symptoms) • Left-sided heart failure • Right-sided heart failure • Systolic heart failure • Diastolic heart failure

8. The major causes of CHF may be divided in to two subgroups 1- underlying diseases e.g. • Coronary artery disease • Hypertensive heart disease • Congenital heart disease • Acute myocardial infarction • Pulmonary emboli

9. 2- Precipitating causes e.g. • Anemia • Infection • Bacterial endocarditic • Pulmonary embolism • Hypervolemia • Nutritional deficiencies

10. Precipitating causes often increase the workload of the ventricles, causing a decompen -sated condition that leads to decreased myocardial function .

11. Pathology of ventricular failure • Heart failure can be described as systolic or diastolic : • Systolic failure , the most common cause of CHF, results from an inability of the heart to pump blood .

12. It is a defect in the ability of the ventricles to contract (pump) the left ventricle loses its ability to generate enough pressure to eject blood forward through the high pressure aorta.

13. Systolic failure is caused by impaired contractile ( e.g., myocardial infarction ) , increased after load (e.g., hypertension ), cardiomyopathy, and mechanical abnormalities ( e.g., valvular heart disease ) .

14. Diastolicfailure is an impaired ability of the ventricles to fill during diastole. decreased filling of the ventricles will result in decreased stroke volume. In diastolic failure there is normal systolic function .

15. . It is characterized by high filling pressures and the resultant venous engorgement in both the pulmonary and systemic vascular . It is usually the result of left ventricular hypertrophy from chronic systemic hypertension, aortic stenosis, or hypertrophic cardiomyopathy .

16. Mixed systolic and diastolic failure • Systolic and diastolic failure of mixed origin is seen in disease states such as dilated cardiomyopathy, a condition in which poor systolic function is furthercompromised by dilated left ventricular walls that are unable to relax.

17. This patient often has extremely poor ejection fractions , high pulmonary pressures , and biventricular failure ( both ventricles may be dilated and have poor filling and emptying capacity ) .

18. Types of congestive heart failure Left- sided failure • results from left ventricle dysfunction, which causes blood to back up through the left atrium and into the pulmonary veins .

19. Right – sided failure • Causes back ward blood flow to the right atrium and venous circulation .venous congestion in the systemic circulation result in peripheral edema, hepatomegaly, splenomegaly vascular congestion of the GT.

20. What Causes Heart Failure? • Heart failure is caused by other diseases or conditions that damage or overwork the heart muscle. Over time, the heart muscle weakens and is not able to pump blood as well as it should.

21. The leading causes of heart failure are: • 1-High Coronary artery disease (CAD) CAD, including angina and heart attack is the most common underlying cause of heart failure. People who have a heart attack are at high risk of developing heart failure.

22. 2-Diabetes • 3-Highblood pressure Most people with heart failure also have high Blood pressure, and about one in three has diabetes.

23. Other Causes of Heart Failure • 1- Cardiomyopathy (a disease of the heart muscle) • 2- Diseases of the heart valves • 3- Abnormal heartbeats or arrhythmias • 4- Congenital heart defects (a heart defect or problem you are born with)

24. Other conditions that may injure the heart muscle and lead to heart failure include: • Treatments for cancer, such as radiation and certain chemotherapy drugs • Thyroid disorders (having either too much or too little thyroid hormone in the body)

25. Alcohol abuse • HIV/AIDS • Cocaine and other illegal drug use

26. Who Is At Risk for Heart Failure? Heart failure can happen to anyone, but it’s more common in: • People 65 years of age and older Heart failure is very common in people 65 years of age and older. It’s the #1 reason for a hospital visit in this age group.

27. African Americans African Americans are more likely to have heart failure and suffer more severely why ?

28. Develop symptoms at an earlier age • Have their heart failure get worse faster • Have more hospital visits • Die from heart failure

29. Men have a higher rate of heart failure than women. But in actual numbers, more women have heart failure because many more women live into their seventies and eighties, when heart failure is common.

30. Children with congenital heart defects can also have heart failure. Congenital heart defects happen when the heart, heart valves, and/or blood vessels near the heart do not develop correctly in babies when they are in the womb.

31. This can weaken the heart muscle and lead to heart failure. Children do not have the same symptoms or get the same treatment for heart failure as adults.

32. Clinical manifestations of congestive heart failure Fatigue • Is one of the earliest symptoms of chronic CHF.

33. Dyspnea Is a common manifestation of chronic CHF. It is caused by increased pulmonary pressures secondary to interstitial and alveolar edema.

34. Tachycardia May be the first clinical manifestation of CHF. One of the body's' first mechanisms to compensate for a failing ventricle is the increase the heart rate.

35. Edema It may occur in the legs, liver, abdominal cavity, lungs .

36. Nocturia When the person lies down at night. Fluid movement from interstitial spaces back into the circulatory system is enhanced . this causes increased renal blood flow and diuresis. The patient may complain of having to void six or seven times during the night .

37. Skin changes Because tissue capillary oxygen extraction is increased in a person with CHF, the skin may appear dusky, may be cool to the touch from diaphoresis .

38. Behavioral changes • Cerebral circulation may be impaired with chronic CHF secondary to decreased CO. The patient may report usually behavior, including restlessness, confusion and decreased attention span or memory .

39. Chest pain Because of decreased coronary perfusion from decreased CO and increased myocardial work.

40. Weight changes Many factors contribute weight changes .Initially there may be a progressive weight gain from fluid retention. Abdominal fullness from ascites and hepatomegaly frequently cases anorexia and nausea .

41. The actual weight loss may be apparent until after the edema subsides .

42. Complications of congestive heart failure • - pleural effusion • - Arrhythmias • - Left ventricular thrombus • - Hepatomegaly

43. Classification of congestive heart failure • The New York Heart Association has developed functional guidelines for classifying people with CHF. The classification is based on the persons' tolerance to physical activity .

44. Class 1 • No limitation of physical activity. Ordinary physical activity does not cause fatigue, dyspnea, palpitations, or anginal pain.

45. Class 2 • Slight limitation of physical activity . No symptoms at rest ordinary physical activity results in fatigue, dyspnea, palpitations or anginal pain .

46. Class 3 • Marked limitation of physical activity . usually comfortable at rest. Ordinary physical activity causes fatigue, dyspnea, palpitation or anginal pain .

47. Class 4 Inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of angina may be present even at rest. If any physical activity is undertaken, discomfort in increased .

48. Nursing and collaborative management: A- For acute congestive heart failure. • Goal: • 1- Decreasing intravascular volume. • 2- Decreasing venous return. • 3- Decreasing after load.

49. 4- Improving gas exchange and oxygenation. • 5- Improving cardiac function. • 6- Reducing anxiety.

50. B-For chronic congestive heart failure: • The main goal in the treatment of CHF is to: • 1-Treat the underlying cause and contributing factors maximize CO. • 2- Provide treatment to alleviate symptoms .