Left Sided

Heart Failure
 Clinical
Manifestations
Fatigue or weakness

Shortness of breath
with or without activity

Orthopnea
Rapid or irregular pulse

chronic dry or frothy cough

Nocturia

Palpitations
Oliguria

Loss of appetite or
indigestion
Cold, diaphoretic (sweaty)
dusky colored skin

Changes in behavior such

as restlessness, confusion,
decreased attention span
and memory
PATHOPHYSIOLOGY
Left sided Heart Failure
 Left sided Congestive Heart
Failure

CAUSES:
MI
HPN
Aortic stenosis/insufficiency
Mitral stenosis/insufficiency
 Increased workload

Enlargement of Ventricles

Diminished Left ventricular function

Pooling of blood in the ventricle &

atrium

Regurgitation to pulmonary veins and

capillaries
Pulmonary circulation becomes
engorged

Increase capillary pressure

Pushing of Na+ and H2O to the

interstitial space

Pulmonary edema
 Clinical manifestations of pulmonary
congestion:

Dyspnea /DOE
Cough
Pulmonary crackles
Low O2 saturation levels
S3 or ventricular “gallop”

Inadequate tissue perfusion

Widespread diminished CO and SV

Stimulation of Sympathetic NS

Further impedes perfusion to other

organs

Blood flow to kidneys decreases

Causing decreased perfusion and

reduced urine output

Release of renin from the kidney

Aldosterone secretion

Increase intravascular volume

As HF progresses CO may cause other
symptoms:

GI perfusion (altered digestion)

Brain perfusion (dizziness, lightheadednes,

confusion restlessnes,anxiety)

SNS response (pale,cool,clammy skin)

Ejected ventricular volume (palpitations, weak

pulse

Without adequate CO the body cannot respond

to energy demands (easily fatigued,activity
intolerance)
Diagnostic
Exams
and Tests
• Blood tests to evaluate
thyroid, liver, and kidney
function

• Chest x-ray

• Coronary angiography
• Electrocardiogram
(ECG)

• Heart stress test

•Ultrasound of the heart

(echocardiogram)
Treatment
The goals of treatments are:
•Treat the disease that is causing
the heart failure
•Reduce symptoms
•Relieve stress on the heart
•Reduce risks of worsening heart
failure
•Improve chances of survival
Treatment may involve:

•Lifestyle changes such as

stopping drinking alcohol
•Medicines for high blood
pressure
• Surgery or cardiac
catheterization to open blocked
heart arteries
Medicines that may be used include:
•Beta-blockers to prevent death in certain patients
•Digitalis to help slow heart rhythms and increase
the heart beat
•Diuretics to help the body get rid of extra fluid
•Spironolactone or epleronone to prevent salt
retention and help patients with severe heart
failure
•ARBs, ACE inhibitors, long-acting nitrates, and
hydralazine to reduce the stress on the heart and to
prevent further muscle damage and scarring
•Digoxin to increase muscle strength and slow down
abnormally fast heart rates
 For Listening

Group 1 Integrity