NR 507 What is the etiology of congestive heart failure?

Congestive heart failure (CHF) is a gradual clinical set of symptoms in which the heart does not pump ample amount of blood to the body because of functional or structural cardiovascular disturbance (Scott & winters, 2015). While frequently denoted simply as “heart failure,” CHF particularly refers to the state in which fluid accumulates around the heart and triggers the heart to pump inadequately (Scott & winters, 2015). Left-side heart failure is the most prevalent kind of CHF (Scott & winters, 2015). It develops when the left ventricle does not sufficiently pump blood to the systemic circulation (Scott & winters, 2015). When the disease advances, fluid may accumulates in the lungs, which makes it hard to breathe (Scott & winters, 2015). There are two types of left-sided heart failure systolic and diastolic heart failure. Systolic heart failure happens when the left ventricles are unable to contract normally (Scott & winters, 2015). Systolic heart malfunction decreases the level of intensity available to push blood into circulation. Without intensity the heart cannot pump accordingly (Scott & winters, 2015). Diastolic inadequacy happens when the muscle in the left ventricle comes to rigid (Scott & winters, 2015), because it is unable to ease off, the heart cannot completely fill up the blood between heart beats (Scott & winters, 2015). It is probable to have left sided and right sided congestive heart failure concurrently (Scott & winters, 2015). Most often the illness begins in the left side and then migrates to the right side when left side heart failure is not treated (Scott & winters, 2015). CHF can arise from medical illnesses that precisely affect the cardiovascular structure like high blood pressure, coronary artery infection and valve infection (McCance, Huether, Brashers, & Rote, 2013). There are other unassociated diseased such as diabetes, thyroid disease and obesity may lead to CHF (McCance, Huether, Brashers, & Rote, 2013).

Describe in detail the pathophysiological process of congestive heart failure.

The syndrome of CHF starts as a result of an impairment in cardiac structure, performance, rhythm, or transmission (Scott & winters, 2015). CHF demonstrates not just failure of the heart to manage satisfactory oxygen transport; which is a systemic feedback trying to remunerate in for the inefficiency (Scott & winters, 2015). The factors of cardiac output encompass heart rate and stroke volume (Scott & winters, 2015). The stroke volume is additionally ascertained by the preload (the cubic measure of blood that enters the left ventricle), contractility, and after load (resistance blood flow from the left ventricle) (Scott & winters, 2015). These variables are imperative in comprehending the pathophysiological ramifications of heart failure. Contractility is decreased by illness that interrupts monocot activity (McCance, Huether, Brashers, & Rote, 2013). Myocardial infarction is the most frequent reason of reduced contractility; other causes include inflammation of the heart muscle and cardiomyopathies (McCance, Huether, Brashers, & Rote, 2013). Ventricular remodeling causes interruption of the healthy myocardial extracellular anatomy with consequential dilation of the myocardium and gives rise to gradual myocyte contractile malfunction overtime (McCance, Huether, Brashers, & Rote, 2013). When the right and left ventricles fail as pumps, pulmonary and systemic venous high blood pressure develop, causing CHF (McCance, Huether, Brashers, & Rote, 2013). When contractility has reduced, stroke volume decreases, and left ventricular end-diastolic volume increases (McCance, Huether, Brashers, & Rote, 2013). This results in dilation of the heart and upsurges foreload (McCance, Huether, Brashers, & Rote, 2013). Preload rises with lowered contractility or when there is overflow of blood volume administration, kidney failure, mitral valve infection (McCance, Huether, Brashers, & Rote, 2013). A healthy normal heart is competent of producing exact adjustments in the stroke volume to perform the body’s amending metabolic requirements varying from sleep to cardio exercise (Scott & winters, 2015). The physiological variations in stroke volume are attainable because of innate flexibility of the myocardium that produces maximum ventricular ejection (cardiac output) without rise in myocardial oxygen need or variation in mean pressure.

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Identify hallmark signs identified from the physical exam, diagnostic lab work and symptoms.

The manifestations of congestive heart failure can develop subtly in individuals with life-long underlying cardiovascular issues, like uncontrolled high blood pressure, or can develop suddenly in individuals with MI (Scott & winters, 2015). The medical characteristic of CHF differs resting on the level of decompensation. Some individuals can be dyspenic and able to report only in short phrases, while others look relaxed and asymptomatic (Scott & winters, 2015). Any individual who shows up with new development of difficulty breathing on physical exertion, paroxysmal nocturnal dyspnea, orthopnea must be assessed for CHF (Scott & winters, 2015). The dyspnea arises from pulmonary vascular congestion and orthopnea, because of the heightened blood return to the inefficient left ventricle of the heart (Scott & winters, 2015). Percussion can unveil dullness in the dependent parts of the lungs secondary to fluid build-up (Scott & winters, 2015). Individuals with respiratory congestion also depict a non-productive “hacking” cough, which ensues a few hours after lying down and is frequently alleviated by sitting up (Scott & winters, 2015). Other physical assessment conclusions can include moist crackles (rales) in the lung substrata all through lung fields, which can be followed by wheezing (Scott & winters, 2015). Incidents of pulmonary edema the individuals can disclose having a cough with generation of frothy sputum. Heart sound can be erratic depending on the heart rhythm (McCance, Huether, Brashers, & Rote, 2013). Auscultation of the heart can unveil systolic and or diastolic murmurs (McCance, Huether, Brashers, & Rote, 2013). Proof of a third heart sound (S3) or ventricular gallop is regarded the hallmark of ventricular failure and is a consequence of ventricular overload (McCance, Huether, Brashers, & Rote, 2013). Peripheral edema in ambulatory patients with CHF is consistently dependent and bilateral (Scott & winters, 2015). Radiographic evidence of CHF is exhibited on the CXR when interstitial edema in the lungs builds up more (Scott & winters, 2015).

NR 507 What is the etiology of congestive heart failure

When pulmonary congestion rises; there is a classical bilateral hilar cloudiness or opacity often denoted as a butterfly pattern on the CXR (Scott & winters, 2015). The level of fluid excess will conclude the height of the interstitial pattern. Confirmation of Kerley B lines, horizontal fluid overload and weight gain (Scott & winters, 2015). The diagnostic assessment of individuals with symptoms of CHF must be centered on finding the precipitating episode, which includes, non conformity with diet or medications or an acute MI (Scott & winters, 2015). The patient history can offer important information about probable cause of the heart failure. Once the history and physical assessment are completed, the marginal diagnostic workup can incorporate a complete blood count (CBC), serum electrolytes, cardiac enzymes, chest radiography (CXR) and electrocardiogram (Scott & winters, 2015). Provided whether the heart failure is acute or long-term, the CXR might present an expanded cardiac silhouette indicative of cardiomagaly (Scott & winters, 2015). First diagnosis is made by echocardiography, which shows inadequate ventricular filling with normal ejection fractions (McCance, Huether, Brashers, & Rote, 2013). ECG is also a fast diagnostic tool for discovering an MI (Scott & winters, 2015). In the United States approximately 6.5 million individuals are diagnosed with CHF and 23 million globally (Scott & winters, 2015). Risk determinants include being black, African descent or Hispanic, male, middle aged or older, smoking, having diabetes, obesity or a high body mass index (Scott & winters, 2015).

Describe the pathophysiology of complications of congestive heart failure

Complications of heart failure include:

Arrhythmias- Arrhythmia or dysrrythmias is a disruption of heart rhythm. Dysrrythmias can vary in acuteness from intermittent or rapid heartbeats to severe disruptions that impair the pumping capability of the heart, contributing to heart failure and death (McCance, Huether, Brashers, & Rote, 2013).
- Thromboembolism- Persons may present with a stroke, peripheral embolism, deep venous thrombosis and pulmonary embolism due to thromboembolism (Scott & winters, 2015).
- Gastrointestinal- Liver congestion and liver malfunction, malabsorbtion (Scott & winters, 2015).
- Musculoskeletal- Muscle wasting (Scott & winters, 2015).
- Respiratory- Pulmonary congestion, pulmonary hypertension (Scott & winters, 2015).

What teaching would you provide this patient to avoid heart failure symptoms?

Heart failure is a condition in which the heart fails pump well. This causes the heart to lag behind in its function of moving blood throughout the body. As a result, fluid back up in the body and the organs in the body do not get as sufficient blood as they should. This can result in symptoms, such as swelling, trouble breathing and feeling tired (Zhang, Dindoff, Arnold, Lane & Swartzman, 2015). If your heart is not pumping sufficiently, at first you might not have any symptoms (Zhang, Dindoff, Arnold, Lane & Swartzman, 2015). But as the illness worsens, it can bring about, tiredness, weakness, difficulty breathing, which may lead you to be less active, a racing heartbeat while at rest, swelling in your feet, ankles, legs and stomach. Cut down your salt intake, lose weight, stop smoking, limit alcohol, and be active (Zhang, Dindoff, Arnold, Lane & Swartzman, 2015). Take your medications, even if you feel better, watch your symptoms closely and weigh yourself every day at the same time, if you our weight is up 2 or more pounds a day, contact your doctor (Zhang, Dindoff, Arnold, Lane & Swartzman, 2015).

Respectfully,

References

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby

Scott. M.C., & Winters, M. (2015). Congestive heart failure. Emergency Medicine Clinics, 33(3), 553-562. Zhang, K., Dindoff, K., Arnold, J. M., Lane, J., & Swartzman, L. C. (2015). What matters to patients with heart failure? The influence of non-health related goals on patient adherence to self-care management. Patient Education and Counseling, 98(8), 927-934.

What is the etiology of congestive heart failure?

Heart failure is a chronic disease where the left ventricle, the right ventricle, or both, are unable to squeeze effectively, be it from enlarged ventricles or myocardial hypertrophy or compromised cardiac output. If the left ventricle is unable to pump blood through the aorta to the body efficiently, a decrease in oxygenated blood to the body is present and blood back up into the lungs. If the right ventricle is not pumping efficiently, a decrease in blood to the lungs is present and there is a backup of blood into the right atrium and body. Risk factors for heart failure include any disease process that can reduce heart contracture or alter ventricle filling, such as hypertension, coronary heart disease, diabetes mellitus, stenosis, regurgitation, cardiomyopathies, and arrhythmias (Rogers & Bush, 2015). Even though this is a disease that can be caught early and managed well, its prevalence is a serious public health concern and accounts for countless hospitalizations each year (Marques de Sousa, dos Santos Oliveira, Oliveira Soares, Amorim de Araújo, & dos Santos Oliveira, 2017).

Describe in detail the pathophysiological process of congestive heart failure.

In general, the pathophysiologic mechanisms of CHF in infants and children are very similar to those in adults. The same compensatory mechanisms are activated in the face of inadequate cardiac output. An acute decrease in blood pressure stimulates stretch receptors and baroreceptors in the aorta and carotid arteries, which in turn stimulate the sympathetic nervous system. With the release of catecholamines and the stimulation of β receptors, heart rate and the force of myocardial contraction increase (McCance et al., 2013). Venous smooth muscle tone also increases, which increases the return of venous blood to the heart. Sympathetic stimulation also decreases blood flow to the kidneys, skin, spleen, and extremities so that maximum flow to the brain, heart, and lungs can be maintained. Decreased blood flow to the kidneys causes the release of renin, angiotensin, and aldosterone. If chronic, this cycle results in retention of sodium and fluid by the kidneys, which in turn increases volume in the circulatory system (McCance et al., 2013). These neurohumoral and hemodynamic changes create abnormal ventricular wall stress and cause the myocardium to hypertrophy. The myocardial fibers also stretch to accommodate the increased volume. Hypertrophy and fiber stretch temporarily increase contractility and hence the force of ventricular contraction. These mechanisms eventually fail to maintain cardiac output as CHF progresses.

Identify hallmark signs identified from the physical exam, diagnostic lab work, and symptoms.

57-year-old with dyspnea on exertion, fatigue, frequent dyspepsia, nausea, occasional epigastric pain, trouble breathing at night especially while lying on back, vital signs of 180/110 blood pressure. After a thorough assessment, to diagnosis heart failure and rule out other disease processes, such as valvular dysfunctions, a chest x-ray, and echocardiogram (Echo) would be ordered. A chest x-ray will reveal if the heart is enlarged and if there is any fluid in the lungs. An echo will measure the heart’s ability to pump, therefore conveying the EF. A serum BNP should be obtained to assess the severity of the disease (McCance et al., 2013). BNP is secreted via the ventricles when pressures within the ventricles change, the higher the serum level, the more severe the disease progression (McCance et al., 2013).

Describe the pathophysiology of complications of congestive heart failure.

When heart failure occurs, they heart may not be strong enough to pump out as much blood as the body needs. As it tries to move more blood, the heart gets larger. It also pumps faster, and the blood vessels narrow to get more blood out to the body. As the heart works harder, it becomes weaker, and the damage increases. The body gets less oxygen, and the symptoms such as shortness of breath, swelling in the legs, and fluid buildup are present. In a normal heart, the upper chambers (called the atria) and lower chambers (the ventricles) squeeze and relax in turn to move blood through the body. If the ticker is weak, these chambers might not squeeze at the right time. The heart might beat too slowly, too quickly, or in an irregular pattern. When the rhythm is off, the heart can’t pump enough blood out to one body. Atrial fibrillation (AFib) is one type of abnormal heart rhythm that heart failure can cause. It causes the heart to quiver and skips instead of beating. An irregular heartbeat can lead to clots and cause a stroke. Also as the heart damage gets worse, the heart has to work harder to pump out blood, and it gets bigger and can damage the valves. Just like your other organs, they need a steady supply of blood to work as they should. Without the amount of blood, they need, they won’t be able to remove enough wastes from your blood. This is called kidney failure. Damaged kidneys can’t remove as much water from the blood as healthy ones. Consequently, the body will start to hold onto fluid, cause high blood pressure and make the heart work even harder.

What teaching would you provide this patient to avoid heart failure symptoms?

To help prevent recurrence of heart failure symptoms in patients I would stress the importance of home control and monitoring of daily weight. Patients must be instructed to check their weight in the morning after urinating and before breakfast, wearing light clothes and using the same scale. An increase of 1.3 kg or more in body weight in two days, or of 1.3 – 2.2 kg in one week may be an indication of fluid retention (Roger & Bush, 2015). I would also educate on the use of their medication and diet. It is import to teach patients that they must always take their medication, even when they feel well in order to obtain efficient treatment. Also, fluid restrictions and managing salt intake would be highlighted. Most importantly, self-care education, including the control of non-pharmacological measures, would be part of the daily management, reinforcement, improvement, and evaluation of self-care abilities.

References:

Marques de Sousa, M., dos Santos Oliveira, J., Oliveira Soares, M.G., Amorim de Araújo, A., & dos Santos Oliveira, S.H. (2017). Quality of life of patients with heart failure: Integrative review. Journal of Nursing UFPE/Revista De Enfermagem UFPE, 11(3), 1289-1287. doi: 10.5205/reuol.10544-93905-1-RV.1103201720

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2013). Pathophysiology: The biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Mosby.

McMurray, J. J., Gerstein, H. C., Holman, R. R., & Pfeffer, M. A. (2013). Heart failure: a cardiovascular outcome in diabetes that can no longer be ignored. The Lancet Diabetes & Endocrinology, 2(10), 843-851.

Rogers, C. & Bush, N. (2015). Heart failure: Pathophysiology, diagnosis, medical treatment guidelines, and nursing management. Nursing Clinics of North America, 50(4), 787-799.

I had the pleasure of reading your discussion post let me say I truly enjoyed it and especially love the part about home control or maintaining daily weight and/or what we call keeping an daily log as I to had that in my post as well I believe it is an essential factor when it comes to the care of a patient with congestive heart failure. Pictures also bring it home for a lot of patients, being able to see what contributing factors are and what congestive heart failure does to the body. The daily log for weight is also important as you mentioned. When a patient is being weighed each day, it is also essential to educate the patient on specific instructions on when to weight themselves. Such as on the same scale, wearing the same amount of clothing, letting the patient know that every scale is different. The patient should weigh themselves first thing in the morning and after they have emptied their bladder (Boyde & Peters, 2014). The daily weight recording should have the date, time, and recorded symptoms such as feet swelling, shortness of breath, are they increasing tired or a persistent cough. Of course, when to call the doctor Weight gain of 2-3 pounds in 1 day or 5 pounds in 5 days, Shortness of breath that is worse or shortness of breath at rest.

Swelling in legs, feet, hands, or abdomen, feeling tired all the time, which keeps you from your usual activities, Bloated or full feeling in your stomach, Dry or wet hacking cough, Harder to breathe while lying down or unable to rest. You may notice you need to prop up on more pillows for comfort, Feeling dizzy or lightheaded. When to call 911- Chest discomfort or pain that lasts more than 15 minutes and is not any better after resting or taking nitroglycerin, Unable to catch your breath, Fainting or passing out Fast or irregular heartbeat and Coughing up pink or white foamy sputum (Boyde & Peters, 2014).

Reference

Boyde, M., & Peters, R. (2014). Education material for heart failure patients: what works and what does not? Current heart failure reports, 11(3), 314-320.

The first action to take is to Teach our patients that uncontrolled hypertension can lead to congestive heart failure. Thus, coronary disease and hypertension trends in population studies both suggest that the attributable risk of hypertension for HF should remain high. (Finally, the rising tide of diabetes puts a strain on the heart and cause it to work harder. Obesity raises the concern of an increasing role of these two entities in the genesis of HF. Being obese notwithstanding uncertainties with regards to the exact cellular and molecular mechanisms by which obesity and diabetes impact both systolic and diastolic left the ventricular function, there is mounting evidence for their causal link to HF independently of clinical coronary disease and hypertension. (Roger, 2013). To this end, the population burden of HF attributable to obesity and diabetes was recently examined in the ARIC study for obesity, while complete elimination of obesity/overweight could prevent almost one third (28%) of new HF cases, a more realistic 30% reduction in obesity/overweight could prevent 8.5% of incident HF cases. (Roger, 2013). For diabetes, a relatively modest 5% reduction in its prevalence would lead to approximately 53 and 33 fewer incident HF hospitalizations per 100,000 person-years in African-American and Caucasian persons, respectively. These results indicate that even modest modification of these risk factors would favorably impact the burden of HF. (Roger, 2013). Education is one of the importance of controlling and preventing worsening CHF. Daily weight is essential to maintain fluid imbalance.

Reference

Roger, V. L. (2013). Epidemiology of Heart Failure. Circulation Research, 113(6), 646–659. http://doi.org/10.1161/CIRCRESAHA.113.300268

What is the etiology of congestive heart failure?

Good job!

Describe in detail the pathophysiological process of congestive heart failure.

That is correct!

Identify hallmark signs identified from the physical exam, diagnostic lab work, and symptoms.

Nice work!

Describe the pathophysiology of complications of congestive heart failure.

Really good job with your details in this section!

What teaching would you provide this patient to avoid heart failure symptoms?

What is the etiology of congestive heart failure?

Good job!

Describe in detail the pathophysiological process of congestive heart failure.

That is correct!

Identify hallmark signs identified from the physical exam, diagnostic lab work, and symptoms.

Nice work!

Describe the pathophysiology of complications of congestive heart failure.

Really good job with your details in this section!

NR 507 What is the etiology of congestive heart failure?