HEART FAILURE (HF)

• A condition in which a problem with the structure or function of the heart impairs its ability
to supply sufficient blood flow to meet the body's needs.
• It indicates a myocardial disease in which there is a problem with contraction of the heart
(systolic dysfunction) or filling of the heart (diastolic dysfunction) that may or may not cause
pulmonary or systemic congestion.

Causes:
A. CHRONIC Heart Failure
LEFT Sided RIGHT Sided
C – oughing & dyspnea H – epatomegaly
H – emoptysis E – dema
O – rthopnea A – scitis
P – ulmonary congestion D – istended neck vein

 Dx Procedures:
(Left Sided) (Right Sided)
1. CXR – cardiomegaly 1. CXR – cardiomegaly
2. Echocardiography – cardiomyopathy 2. CVP – pressure at R atrium
3. ABG – respiratory acidosis 3. Echocardiography –cardiomyopathy
4. CVP – indicates hydration status 4. Liver Enzymes – elevated

 Managements:
1. High Fowlers, sodium restriction, oxygenation, enhance relaxation.
2. Reduce afterload (rest, Vasodilators)
3. Reduce preload (Diuretics, Rotating tourniquet – prevents venous return but not arterial
blood flow)
4. Increase cardiac contractility (Digitalis/Lanoxin)
 has positive inotropic effect, negative chronotropic & dromotropic effect, and
has a cumulative effect (hence has toxicity).
 Remember that Hypokalemia, old age, acute MI, severe arrhythmia potentiates
toxicity.

B. ACUTE Decompensated Heart Failure (a.k.a. Pulmonary Edema) – Chronic stable heart
failure may easily decompensate. This most commonly results from an intercurrent illness (such as
pneumonia), myocardial infarction (a heart attack), arrhythmias, uncontrolled hypertension, or a
patient's failure to maintain a fluid restriction, diet or medication.

Clinical Manifestations:
 Restless, anxious
 Cyanotic, cold moist skin
 Distended neck vein with weak, rapid pulse
 “Drowning in secretions” with increasing quantities of mucoid sputum

Managements:
1. Oxygenation, high fowlers
2. Suction secretions
3. Remain with the pt, give concise & simple information
4. IV infusions & meds (morphine, diuretics)
5. Monitoring medications, VS, ECG changes