Butuan Doctors’ College Department of Nursing Butuan City
Case Study Of
Submitted by: Ian Leonard C. Celebrado BSN-III C
Submitted to: Mr. Mr. Ryan Lister Flores, R.N. Clinical Instructor
Congestive Heart Failure Congestive heart failure (CHF), or heart failure , is a condition in which the heart can't pump enough blood to the body's other organs. This can result from: •
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narrowed arteries that supply blood to the heart muscle — coronary artery disease past heart attack, or myocardial infarction, with scar tissue that interferes with the heart muscle's normal work high blood pressure heart valve disease due to past rheumatic fever or other causes primary disease of the heart muscle itself, called cardiomyopathy. heart defects present at birth — congenital heart defects. infection of the heart valves and/or heart muscle itself — endocarditis and/or myocarditis
The "failing" heart keeps working but not as efficiently as it should. People with heart failure can't exert themselves because they become short of breath and tired. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing congestion in the tissues. Often swelling (edema) (edema) results. results. Most often there's swelling in the legs and ankles, but it can happen in other parts of the body, too. Sometimes fluid collects in the lungs and interferes with breathing, causing shortness of breath, especially when a person is lying down. Heart failure also affects the kidneys' ability to dispose of sodium and water . water . The retained water increases the edema. o o o o
Predisposing Factors Infection. Anaemia.. Anaemia Thyrotoxicosis.
Pregnancy: Women with rheumatic valvular disease can first experience symptoms during pregnancy and following delivery of the baby these symptoms may be resolved. o o o o o
Abnormal heart rhythms. Rheumatic fever. Infective endocarditis and Myocarditis Myocarditis.. Hypertension (High Blood Pressure) . Heart attack.
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Myocardial infarction. infarction . Pulmonary embolism. Overexercise. Sudden increase in salt in the diet. Excessive environmental heat or humidity. Emotional crises.
Pathophysiology Causes: Myocarditis Ventricular aneurysm Cardiac temponade Pericarditis Hypertension
Tachycardia Ventricular dilatation Myocardial hypertrophy
Decrea Decrease se cardia cardiacc out out ut Decrease renal erfusion Increase sodium retention
Fluid overload Water reabsorption
Increase ADH Increase Osmotic pressure
Anatomy and Physiology To understand what occurs in heart failure, it is useful to be familiar with the anatomy of the the hear heartt and how it works works.. The The hear heartt is comp compos osed ed of two indepen independe dent nt pump pumpin ing g systems, one on the right side, and the other on the left. Each has two chambers, an atrium and a ventricle. The ventricles are the major pumps in the heart.
The external structures of the heart include the ventricles, atria, arteries, and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide. The Right Side of the Heart The right system receives blood from the veins of the whole body. body. This is "used" blood, which is poor in oxygen and rich in carbon dioxide. • •
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The right atrium is the first chamber that receives blood. The chamber expands as its muscles relax to fill with blood that has returned from the body. body. The blood enters a second muscular chamber called the right ventricle. The right ventricle is one of the heart's two major pumps. Its function is to pump the blood into the lungs. The lungs restore oxygen to the blood and exchange it with carbon dioxide, which is exhaled.
The Left Side of the Heart The left system receives blood from the lungs. This blood is now oxygen rich. •
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The oxygen-rich blood returns through veins coming from the lungs (pulmonary veins) to the heart. It is received from the lungs in the left atrium, the first chamber on the left side. Here, it moves to the left ventricle, ventricle, a powerful powerful muscular chamber that pumps the blood back out to the body. The left ventricle is the strongest of the heart's pumps. Its thicker muscles need to perform contractions powerful enough to force the blood to all parts of the body. This strong contrac contraction tion produces produces systoli systolic c blood blood pressure pressure (the first first and higher higher number number in blood blood pressur pressure e measure measurement ment). ). The lower lower number number (diastol (diastolic ic blood blood pressure) pressure) is measured measured when the left ventricle relaxes to refill with blood between beats. Blood leaves the heart through the ascending aorta, the major artery that feeds blood to the entire body.
The Valves Valves are muscular flaps that open and close so blood will flow in the right direction. There are four valves in the heart: •
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The The tricus tricuspid pid regu regulat lates es bloo blood d flow flow betwe between en the right right atrium atrium and and the right right ventricle. The pulmonary valve opens to allow blood to flow from the right ventricle to the lungs. The The mitra mitrall valve valve regu regulat lates es blood blood flow flow betwe between en the left left atriu atrium m and and the left left ventricle. The aortic valve allows blood to flow from the left ventricle to the ascending aorta.
The Heart's Electrical System . The heartbeats are triggered and regulated by the conducting system, a network of spec special ialize ized d musc muscle le cells cells that that form form an indep indepen enden dentt elect electric rical al syste system m in the the heart heart muscles. muscles. These cells are connected by channels that pass chemically caused electrical impulses.
Left Sided Congestive Heart Failure Pathophysiology Causes o o o o
Reduced myocardial contractility Increases cardiac workload Decreased diastolic filling Obstructions of left atrial emptying
Myocardial Infarction Hypertension Aortic stenos is insufficiency Mitral stenos is insufficienc
Bloods dams back into the pulmonary capillary bed
Left sided CHF
Left atrial pressure
Stroke volume decreases Pressure at the pulmonary capillary bed
Pulm Pulmon onar ar edem edemaa
Tissue perfusion decreases Cellular h
oxia
Bloods flow to the kidneys
RAAS stimulation
Vasoconstriction and reabsorption of Na and water
ECF volume
S/S Total blood volume Systemic BP
Sign and Symptoms Symptoms are dependent on two factors. The first is based on the side of the heart, right or left, that is involved. The second factor is based on the type of failure, either diastoli diastolic c or systoli systolic. c. Symptom Symptoms s and presenta presentation tion may be indisti indistingui nguisha shable ble making making diagnosis impossible based on symptoms. Left side of the heart pumps blood from the lungs to the organs, failure to do so leads to congestion of the lung veins and symptoms that reflect this, as well as reduced supply of blood to the tissues.
The predomin predominant ant respira respiratory tory symptom symptom is shor shortn tnes ess s of brea breath th on exer exerti tion on (dyspnea) dyspnea) or in severe severe cases cases at rest rest - and and easy easy fatigu fatigueab eabili ility ty . Orthopnea is incre increasi asing ng breat breathle hless ssnes ness s on recli reclinin ning, g, often often meas measur ured ed in the numb number er of pillow pillows s required to lie comfortably. Paroxysmal nocturnal dyspnea is a nighttime attack of severe breathlessness, breathlessness , usually several hours after going to sleep. Poor circulation to the body leads to dizziness, dizziness , confusion and diaphoresis and cool extremities at rest. rest. Predominant Predominant left-sided clinical signs are tachypnea and increased work of breathing (signs of respiratory distress not specific to heart failure), rales or crackles, crackles , which suggest suggests s the develop development ment of pulmonary pulmonary edema, edema, dulln dullnes ess s of the the lung lung fields fields to percussion and diminished breath sounds at the bases of the lung, which suggests the devel develop opme ment nt of a pleural effusion (flui (fluid d colle collect ction ion in the pleur pleural al cavit cavity) y) that that is trans transuda udativ tive e in natur nature, e, and and cyanosis which which sugg suggest ests s hypox hypoxem emia, ia, cause caused d by the decr decrea ease sed d rate rate of diff diffus usio ion n of oxyg oxygen en from from flui fluidd-fi fill lled ed alve alveol olii to the the pulm pulmon onar ary y capillaries.
Right Sided Congestive Heart Failure Pathophysiology Causes: LSCHF Pulmonary Embolism Right ventricular infarction Congenital septal defects
Reduced myocardial contractility
Increases cardiac workload
Decreased diastolic filling Obstruction of right atrial emptying
Contraction of right sided atrial filling
Increase right atrial pressure
Right sided CHF
s/s:
Neck vein engorgement hepatomegaly Portal hypertension ascites Peripheral edema sleenomegaly Jaundice
Blood drains back from RV to RA
Increased pressure in the veins
