Understanding Heart Failure: Causes, Symptoms, and Treatments

Heart Failure

Heart failure is the inability of the heart to pump sufficient blood volume into the peripheral circulation, resulting in a diminished cardiac output.

Classification

Location: Left, right, or general.

Pathophysiological Impact:

• Anterograde Heart Failure: Reduced volume expelled.
• Retrograde Heart Failure: Increased resistance to pumping.

Presentation: Acute or chronic.

Etiology

• Cardiac Ischemia and Myocardial Infarction: Affect contractility.
• Valvular and Congenital Heart Disease: Affect pre- and afterload.
• High Blood Pressure: Affects afterload.
• Renal Failure: Affects preload.

Mechanisms

• Decreased Myocardial Contractility
• Systolic Overload: Hypertension and valvular stenosis.
• Diastolic Overload: Valvular heart disease and shunt.
• Effects on Myocardium: Ischemic cardiomyopathies.
• Mechanical Failure: Reduced ventricular filling, pericarditis, and cardiac tamponade.
• Arrhythmias: Disrupt the cardiac cycle.

Pathophysiology

Pulmonary Congestion: Occurs in left-sided heart failure. Right-sided heart failure can also contribute.

Compensation

• Increased heart rate.
• Systemic vasoconstriction.
• Increased reabsorption of sodium and water.
• Myocardial dilation and hypertrophy.

Clinical Manifestations

General: Dyspnea (left-sided heart failure), edema (right-sided heart failure), weakness (general heart failure), gallop rhythm.

Clinical Manifestations of Left-Sided Heart Failure

• Cheyne-Stokes respiration.
• Insomnia.
• Hemoptysis.
• Cyanosis or pallor.
• Laterally displaced and downward apical impulse.
• Tachypnea.
• Compensatory tachycardia or bradycardia.
• Anxiety and fear.

Clinical Manifestations of Right-Sided Heart Failure

• Increased jugular venous pressure.
• Hepatojugular reflux.
• Ascites.
• Hepatomegaly.
• Gastrointestinal and neurological weight gain.

Compensatory Mechanisms

• Tachycardia.
• Dilation of heart cavities.
• Ventricular hypertrophy.

Assessment of Heart Failure

• Health perception-health management pattern (information deficit).
• Nutritional-metabolic pattern.
• Activity-exercise pattern.

Interview and Physical Examination

• Inspection and Auscultation: Valvular murmurs and gallops.
• Palpation: Displaced apical impulse, hypotension, weak pulse, and hepatojugular reflux.

Diagnostic Procedures

• Blood and urine tests.
• Electrocardiogram (ECG).
• Chest X-ray.
• Doppler echocardiography.
• Cardiac catheterization.
• Ventriculography.
• Myocardial scintigraphy.

Therapeutic Procedures

• Inotropic agents (increase contractility).
• Diuretics and vasodilators.
• Surgical treatment.
• Mechanical circulatory assist (e.g., intra-aortic balloon pump).

Nursing Diagnoses

• Activity intolerance.
• Excess fluid volume.
• Impaired gas exchange.
• Anxiety.
• Altered cardiac output.
• Knowledge deficit regarding nutrition.

Potential Complications

• Decreased cardiac output.
• Acute pulmonary edema.
• Arrhythmias.
• Shock.
• Complications related to procedures.

A patient with a hiatal hernia presenting to the emergency department with retrosternal pain should always receive an ECG to rule out heart disease.