Professional Documents
Culture Documents
A. Definition
Heart failure is a physiologic state in which the heart is unable to pump
enough blood to meet the metabolic needs of the body (determined oxygen
consumption) at rest or during exercise even though filling pressures are
adequate. The heart fails when, owing to intrinsic disease or structural
defects, it cannot handle a normal blood volume or, in the absence of disease,
it cannot tolerate a sudden expansion in blood volume (e.g., during exercise).
Heart failure is not a disease itself; instead. The term denotes a group of
manifestations related, to inadequate pump performance from either the
cardiac valves or myocardium. Whatever the cause, pump failure results in
hypoperfused tissue followed by pulmonary and systemic venous congestion.
Because heart failure causes vascular congestion, it is often called congestive
heart failure, although this term is no longer advised by most cardiac
specialists. Other term used to denote heart failure include cardiac
decompensate, cardiac insufficiency, and ventricular failure.
Estimates from the American Heart Association indicate 4,7 million
American have heart failure and are alive. The incidence of new cases is
around 400.000 annually. Annually, about 39,387 clients die from heart
failure. The incidence of heart failure approaches 10 in 1000peopel after age
65.
B. Etiology
The performance of the heart depends on two essential components. Fiber
length (Frank-Starling mechanism) and the inherent contractility (isotropic
state) of the muscle. The normal heart automatically responds to maintain
cardiac output. Several factors automatically adjust the extent of shortening
of myocardial fibers and consequently, the stroke volume and cardiac output.
Five interrelated factors are involved: preload, after load, contractility, the
coordinated pattern of contraction, and the heart rate. Adverse changes in
these determinants of myocardial performance ultimately cause the heart of
fail. The causes of heart failure can be divided into tree subgroup:
1. Abnormal Loading Condition
Recall the analogy that the heart muscle is like a stretched rubber band.
When the rubber band is stretched it contracts with more force. The heart
muscle does the same. Venous return stretches the heart and improves
contractility. Extending the analogy, when the rubber band is
overstretched it becomes limp and cannot contract. Likewise, when the
heart overloaded with blood. Excessive stretch and decreased contraction
occurs. Overload develops because blood dose not leave the ventricle
during contraction. Therefore, cardiac workload increases to try to move
blood.
2. Abnormal Muscle Function
There art certain conditions that directly interfere with myocardial
contractility. Intrinsic condition are inherent in the cardiac muscle and
include MI; myocardium, an inflammation of the myocardium associated
with viral, bacterial, fungal, or parasitic diseases or toxic chemical injury;
cardiomyopathy; and ventricular aneurysm. Such disorder impair the
contractile Function of the myocardial fibrils, which reduces ventricular
emptying and stork volume.
3. Conditions That Precipitate or Exacerbate Heart Failure
Physical or Emotional Stress
Stannous physical exercise and strong emotions (fear, excitement, and
anxiety) increase sympathetic nervous tone and catecholamine
release. This increases myocardial work by increasing heart rate,
myocardial, and blood pressure.
Dysrhythmias
Cardiac dysrhythmias, most notably tachycardia (rapid heart rate).
Are the most common factors precipitating heart failure. A rapid
heartbeat shorten the time or ventricular filling (diastole), which in
turn reduces cardiac output and decreases myocardial perfusion. In
addition. The workload ad oxygen requirements of the myocardium
increase.
Infection
Any systemic infection increases the oxygen demand of the body
tissues. The heart must keep pace with theses demands. Fever and
hypoxemia, which occur in some pulmonary infection, further tax the
ailing heart and may precipitate failure.
Anemia
Reduction in the oxygen-curing capacity of the blood. As in anemia,
necessitates increased cardiac output to meet body’s need for oxygen.
Whereas a normal heart my adjust to the increased worked, a
compromises heart cannot, and failure ensues
Thyroid Disorder
Thyrotoxicosis, associated with hyperthyroidism, augments the
metabolic need of the body, accelerating heart rate and the workload
of the heat. If thyrotoxicosis is untreated, heart failure may occur. In
hypothyroidism, the thyroids produce an inadequate amount of
thyroxin (thyroid hormone). This can indirectly lead to heart failure
by predisposing the client to coronary atherosclerosis.
Pregnancy
Heart failure rank high among causes of death during pregnancy, like
anemia and hyperthyroidism, pregnancy increases the metabolic need
of the body, thereby increasing he workload of the heart. Pregnant
women with rheumatic vulvular disease are particular prone to heart
failure.
Puget’s Disease
In some cases, Puget’s disease also increases myocardial worked.
This daises causes vascular proliferation in the bones. When the
diseases involves over one third of the skeleton, a high cardiac output
state exists and may tax the compromised heart.
Nutritional Deficiency
Thiamine (vitamin B1) deficiency causes beriberi. It occurs in culture
in which polished rice constitutes the primary food sources.
Pulmonary disease
Increased pressure in the pulmonary system due to chronic
obstructive lung disease, severe pulmonary embolization, or primary
pulmonary artery hypertension can produces sizable resistance to
right ventricular.
Hypervolemia
An excess in circulating blood volume can result from poor renal
function, cardiac disease, medication, or excessive intake of sodium
(promoting water retention).
C. Pathophysiology
The healthy heart can meet the demands of life through the use of cardiac
reserve. Cardiac reserve is the heart’s ability to increase output in response to
stress. The normal heart can increase its output up to five times the resting
level. However, the failing heart, even at rest, is pumping near its capacity
and thus has lost much of its reserve. The compromised heart has a limited
ability to respond to the body’s needs for increased output in situations of
stress.
Ventricular dilation
Ventricular dilation refers to lengthening of the muscle fibbers, which
increases the volume of the heart chambers. Dilation causes an increase in
preload and thus cardiac output, because a stretched muscle contracts more
forcefully (starling’s law). However, dilation has limits as a compensatory
mechanism. Muscle fibbers, if stretched be yond a certain point, become
ineffective. Second, a dilated heart requires more oxygen. thus, the dilated
heart with a normal coronary blood flow can suffer from a lack of oxygen.
Hypoxia of the heart further decreases the muscle’s ability to contract.
Ventricular hypertrophy
Ventricular hypertrophy is an increase in the diameter of the muscle
fibbers in order to increase the contractile power of the musclefibers. Like
dilation, hypertrophy has limits as a compensatory mechanism. A
hypertrophied heart does far greater work than a normal-sized heart and, as a
consequence, has a greater demand for oxygen.
Activity Intolerance
Client with heart failure have little or no cardiac reserve to meet increase
oxygen demands. As the disease progresses and cardiac function is further
compromised, activity intolerance increases. The low cardiac output and
inability participate in activities may hinder self-care.
Organize nursing care to allow rest periods. Grouping activities together
allows adequate to “recharge.”
Assist with ADLs as needed. Encourage independence within prescribed
limits. Assisting with ADLs help ensure that care needs are met while
reducing cardiac workload. Involving the client promotes a sense of
control and reduces helplessness.
Plant and implement progressive activities. Use passive and active ROM
exercise and appropriate. Consult with physical therapist on activity plan.
Progressive activity slowly increases exercise capacity by strengthening
and improving cardiac function without strain. Activity also helps prevent
skeletal muscle atrophy. ROM exercise prevent complication of
immobility in severely compromised clients.
Provide written and verbal information about activity after discharge.
Written information provides a reference for important information.
Verbal information allows clarification and validation of the material.