Congestive Heart Failure

• 2 types of CHF:

  Right sided - blood dams back into the venous circuit.
• 2 types of CHF:

  Right sided CHF or Backward heart failure
• 2 types of CHF:

  Left sided - The left ventricle is unable to pump blood to the systemic circulation.
• 2 types of CHF:

  Left sided CHF or Forward heart failure
• Congestive Heart Failure


  Is pump failure of the heart
• Congestive Heart Failure

  occurs whenever the ventricles are unable to eject blood as fast as blood returns to the atria.
• Left-sided CHF

  Due to:

  1. pulmonary edema ("left - lungs")
  2. cellular hypoxia
  3. activation of RAAS
• Left-sided CHF

  Pulmonary Edema

  • When the left ventricle is unable to pump blood into the systemic circulation as fast as blood returns to the left atrium, blood from the pulmonary circulation cannot be transported back to the heart adequately. This results to pulmonary edema.
• Left-sided CHF

  Cellular Hypoxia

  • Since very little oxygenated blood can return to the heart, cellularhypoxia occurs.
• Left-sided CHF

  Activation of RAAS

  • The kidneys are profoundly affected by cellular hypoxia. In response to renal hypoxia, RAAS is activated.
• Left-sided CHF

  Signs and Symptoms:

  1. s/sx ng pulmonary edema
  2. cerebral hypoxia
  3. and raas activation such as hypokalemia and hypertension
  4. Abnormal heart sounds: s3 and s4 (s3 is ventricular gallop and s4 is atrial gallop). These are dt accumulation of blood in the atrium and ventricle
• Left-sided CHF

  RAAS

  • Angiotensin causes vasoconstriction → hypertension
  • Aldosterone retains sodium and water → hypertension, edema
  • Aldosterone enhances excretion of potassium → Hypokalemia
  • (Aldosterone is "pro-Sodium", "anti-Potassium")
• Right-sided CHF

  The signs and symptoms of right - sided CHF are due to venous back -up.
• Right-sided CHF

  When the right ventricle is unable to eject blood as fast as blood returns to the right atrium, blood that goes back to the heart via the superior and inferior vena cavae dams back into the venous circuit.
• Right-sided CHF

  Signs and symptoms:Jugular vein distention

  • This is due to stagnation of blood from the upper part of the body in the jugular vein.
• Right-sided CHF

  Signs and symptoms:Hepatomegaly

  • This is due to stagnation of blood from the lower part of the body in the liver.
• Right-sided CHF

  Signs and symptoms:Portal Hypertension

  • This is due to accumulation of blood in the portal vein due to hepatomegaly.
• Right-sided CHF

  Signs and symptoms:Ascites

  • Portal hypertension and hepatomegaly cause shifting of plasma into the abdominal cavity.
• Right-sided CHF

  Signs and symptoms:Splenomegaly

  • Splenic vein is unable to transport blood from the spleen to the portal vein. This is due to portal hypertension.
• Right-sided CHF

  Signs and symptoms:Hemolytic Anemia

  • The red blood cells trapped in the spleen undergo hemolysis, causing severe anemia.
• Right-sided CHF

  Signs and symptoms:Jaundice

  • Hemolysis of rbc's trapped in the spleen cause elevation of serum bilirubin. (Splenomegaly causes hemolytic anemia)
• Right-sided CHF

  Signs and symptoms:

  Peripheral edema, internal hemorrhoids, leg varicosities, weight gain, and elevated CVP

  • These are due to venous-back up.
• Right-sided CHF

  Signs and symptoms:

  Abnormal heart sounds: s3 and s4
• Cor Pulmonale 


  Right sided CHF due to pulmonary disorders like COPD, pulmonary embolism, etc.
• Stages of Congestive Heart Failure

  1/A - all people are at risk

  2/B - (+) hf, asymptomatic

  3/C - (+) hf, with symptoms during activity

  4/C - (+) hf, with symptoms at rest
• Congestive Heart Failure

  DX: Confirmatory - B-type Natriuretic Peptide
• Congestive Heart Failure

  Mngt: Digoxin or Digitalis

  Digitalis has four major effects:

  • Positive Inotropic. It increases the force of cardiac contractility.
  • Negative Chronotropic. It slows down heart rate.
  • Negative Dromotropic. It decreases conduction of the heart cells.
  • Increases stroke volume.
• Congestive Heart Failure

  Nursing Responsibilities in Digitalis Therapy

  • Check apical rate before administration of the drug. If apical rate is 60 bpm and below or 120 bpm and above, hold the medication and notify physician. Bradycardia or rebound tachycardia may occur.
• Congestive Heart Failure

  Nursing Responsibilities in Digitalis Therapy

  • Check serum potassium level. Hypokalemia enhances digitalis toxicity.
• Congestive Heart Failure

  Nursing Responsibilities in Digitalis Therapy

  • Digoxin Toxicity

  V - vomiting

  A - anorexia

  N - nausea

  D - diarrhea

  A - abdominal pain
• Congestive Heart Failure

  Nursing Responsibilities in Digitalis Therapy

  • Therapeutic range: 0.5 to 2.0
• Congestive Heart Failure

  Nursing Responsibilities in Digitalis Therapy

  • Diet: increase potassium
• Congestive Heart Failure

  Nursing Responsibilities in Digitalis Therapy

  • Antidote: Digibind
• Congestive Heart Failure

  Nursing Responsibilities in Digitalis Therapy

  • Evaluate effectiveness: increase CO, increase UO, stronger pulse, lowering of BP, slowing of HR, absence of rales and crackles.
• Congestive Heart Failure

  Diuretics - to enhance excretion of sodium and water.
• Congestive Heart Failure

  Nursing Responsibilities in Diuretic Therapy

  • Administer the medication early morning and/or early afternoon, not later than 6 pm. This is to prevent sleep pattern disturbance related to frequent voiding during the night.
• Congestive Heart Failure

  Nursing Responsibilities in Diuretic Therapy

  • Check vital signs especially BP for hypotension prior to administration.
• Congestive Heart Failure

  Nursing Responsibilities in Diuretic Therapy

  • Initiate I and O monitoring; take daily weights.
• Congestive Heart Failure

  Nursing Responsibilities in Diuretic Therapy

  • Observe for signs and symptoms of hypokalemia if potassium - wasting diuretics are administered. Advise the client to eat potassium - rich foods. To prevent hypokalemia.
• Congestive Heart Failure

  Nursing Responsibilities in Diuretic Therapy

  • Observe for signs and symptoms of hyperkalemia if potassium-sparing diuretics are administered. Advice client to avoid potassium-rich foods.