Congestive Heart Failure is a disease in which the heart is unable to properly keep up with the amount of blood being sent to the heart. The heart muscle itself, in the case of heart failure, is unable to sufficiently pump the blood away from the heart and to the body to keep up with the incoming deoxygenated flow. This failure to pump blood can build up pressure and cause additional pumping resistance. The decreased cardiac output of heart failure causes the circulation to become backed up, and this is where the term “congested” comes into description.
In respect to recognizing this condition in a physical assessment, some signs detected are from pulmonary congestion and an increased presence of blood retained in the pulmonary vessels. Air sacs that are dependent may become deflated, the pulmonary capillaries may become engorged, and the bronchial mucosa can experience edema. Upon inspection, the presence of Congestive Heart Failure will procure signs of an increase in resting respiratory rate, shortness of breath on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturia, edema of the ankles and legs, ascites of the abdomen, and unusual pallor in fair skinned individuals.
Through the method of palpation, signs of heart failure include moist, clammy skin, yet the tactile fremitus tends to be normal. Percussion in the physical assessment will produce a resonant sound upon striking. Auscultation of the thorax and lungs with the presence of heart failure will present a normal vesicular sound over the lungs, and a third galloping heart sound. Adventitious lung sounds upon assessment may include crackling at the lung bases from the deflated alveoli. (Jarvis 2011).
Other abnormal findings in the physical assessment of a patient suffering from Congestive Heart Failure may include anxiety from the inability to breathe easily with pulmonary congestion, and hypoxia of the systemic blood circulation which can lead to confusion when the brain feels the effects of a lack of oxygen. The jugular vein may be more visible on inspection from venous edema, and the patient may appear to suffer from fatigue from the lowered cardiac output. (Jarvis 2011) There are numerous causes for Congestive Heart Failure.
Significant predisposing factors for the heart’s inability to pump the preload of blood volume may result from restrictions upon pumping or an increased presence of afterload blood volume. Restrictions on the myocardium being able to normally pump blood may result from muscle weakness in the myocardium itself. This weakness may stem from stenosis of the coronary arteries, thrombosis within the coronary arteries, or by other contributing factors such as myocarditis or certain cardiomyopathies. Additional physical factors can contribute to pumping restriction in a functional myocardium.
Such factors may include: valve malfunction which allows a backflow of blood within the heart, congenital internal obstructions of the heart, tumor related obstruction of blood flow within the heart, cardiac dysrhythmia and electrolyte imbalances that interfere with electrical stability, chronic constrictive pericarditis or pericardial effusion, and cardiac tamponade. As previously mentioned, the presence of an increased afterload volume of blood may interfere with the heart’s capability to pump out the blood that the body demands.
This higher afterload may occur when the heart muscle is under constant physical exertion and strain. This may be from pulmonary hypertension which strains the right ventricle and, in turn, decreases cardiac output. Hypertension can contribute to increased resistance that the left ventricle must overcome in order to successfully pump the afterload. Similar to the restrictions on pumping discussed, increased afterload can result from congenital defects of the valves and vessels.
A high demand of cardiac output on a patient suffering from Congestive Heart Failure may induce complications even with a lower afterload blood volume. The metabolic tissue demand for increased circulation in the event of physical activity can exhaust the already weakened heart. Chronic anemia in combination with Congestive Heart Failure can be a critical combination in that the tissues are already deprived of oxygen from the anemic disorder, and therefore there is an increased demand on blood flow to compensate.
There is a plethora of causes for a decrease in the myocardium’s ability to sufficiently pump blood to the body. Myocardial weakness, congenital and oncological obstructions, disruption in electrical stability, pericardial surface change and edema, and limitations on cardiac filling contribute to restrictions on the pumping mechanism. Excessive demands on cardiac output, systemic hypertension, and congenital defects contribute to an increased afterload that interferes with normal circulation patterns. (Hanford, Nowak, 2004).
Disease Process The onset of Congestive Heart Failure is by nature a slowly developing process that depends on the factors of the heart’s inability to keep blood flow moving fast enough, and the lengthy duration of time in which it takes for symptoms to appear. The onset of pathogenesis can take various routes depending on the type of failure and its origination. In the case of a mitral stenosis, or hardening of the mitral valve, makes it harder for blood to flow through the valve and decreases the amount of blood pumped over time.
This example of a cause for the chain of reaction of Congestive Heart Failure will lead to an onset of physiologic occurrences. Congestion, or back up of blood, will arise in the left side of the heart in this scenario, followed by an increased blood pressure in the pulmonary vessels which consequently leads to swelling of the lung tissue. Therein stems the onset of labored breathing from damage lung tissue and the beginning of hypoxia related to fluid within the lung cells, and their inability to sufficiently oxygenate the available blood.
The next phase of this domino effect of heart failure would be a back-up of blood within the right side of the heart, and as a compensation mechanism, the myocardium hypertrophies in attempt to more effectively pump the blood through the body. This eventually weakens the heart. The build-up of congestion eventually backs up into the systemic vessels. This is evident by the distension of the internal jugulars that are commonplace with patients suffering from CHF.
The back-up of blood throughout the body increases blood pressure and the capillaries lose fluid to the tissues causing edema throughout various locations of the body. Eventually the hepatic portal system backs up and swelling of the liver and spleen will ensue. Overall CHF usually follows the pattern of pulmonary and then systemic congestion from the heart’s inability to keep up with the blood being delivered to it. In most cases right heart failure will follow left heart failure, although it is possible for heart failure to originate on the right side.
Compensations are made by the myocardium, nervous system, and renal system to temporarily rectify the systemic congestion. The myocardium will dilate and hypertrophy, the nervous system will stimulate increased cardiac output and blood pressure in combination with keeping the blood at the core organs which can produce a symptom later discussed of clammy skin. The renal system will induce retention of sodium and water to increase plasma blood volume, but this can lead to further complications eventually by increasing congestion. Hanford, Nowak, 2004). Symptoms Congestive Heart Failure can be a chronic condition with a slowly progressive onset, or in certain cases, an acute condition with a rapid appearance of symptoms. Chronic symptoms may include shortness of breathing, or trouble breathing when in a supine position. This dyspnea and orthopnea result from pulmonary congestion occurring. Confusion, lethargy, and a diminished level of consciousness can appear in the individual from a lowered flow of blood, and from hypoxia occurring in the very blood available.
Such symptoms become apparent when the brain stem begins to feel the effects of oxygen deprivation. As the flow of blood pools and backs up, various locations of the body will exemplify edema from the excess fluid. The ankles and legs may start to swell as a result from the systemic congestion and an according downward pull from gravity. Ascites of the abdomen is likely to occur from fluid retention as well. There may be a rapid or irregular heartbeat and often times there is a third heart sound present which can be a helpful diagnostic tool.
The individual may experience symptoms of nausea and appetite loss despite a possible period of weight gain from the fluid retention. (Mayo Clinic 2011). Similarly, in the event of acute congestive heart failure, symptoms resembling those of chronic congestive heart failure will arise with increased intensity and shorter intervals. The individual will rapidly become systemically congested and possess an irregular heartbeat. Onset of dyspnea is rapid and severe, and the sufferer may also cough up reddish frothy mucus.
If the acute heart failure is being caused by a myocardial infarction, chest pain will be present. (Hanford 2011). Diagnosis In reference to the process of diagnosing congestive heart failure, there are several diagnostic tests available. Electrocardiography, chest radiography, echocardiography, angiography, magnetic resonance imaging (MRI), and cine computed tomography (CT scans) are common methods. Electrocardiographs are standard in screening all patients with suspected heart failure to detect any irregular heart patterns.
Chest radiographs are helpful in detecting hypertrophy of the heart, an increased coronary venous pressure, and pleural effusion. Echocardiographs are performed to visualize and assess left ventricular activity. Particularly radionuclide angiographs, MRIs, and CT scans are used to quantify the heart’s ejection fraction and to observe the motion of the heart walls. (Mitchell 2000) Treatment Treatments for congestive heart failure, once diagnosed, are the implementation of cardiopulmonary resuscitation, and the use of automated external defibrillators and stents for emergency fast action care.
There are various heart medications and surgical procedures to cope with the CHF. For example, ACE inhibitors are utilized to widen arteries, ARB’s function to block angiotensin II receptors, and anti-arrhythmics help regulate heartbeat. Other medications used to treat CHF are aspirin, beta blockers, calcium channel blockers, thrombolytics, digoxin, diuretics, vasodilators, and warfarin. Some surgical procedures done in response to CHF are angioplasty and use of stents, bypass surgery, heart valve surgery, cardioversion, and enhanced external counterpulsation.
Other methods include heart transplants, and implantation of pace makers, cardioverter defibrillators, and left ventricular assistive devices. (WebMD 2011) Safety Concerns The individual suffering from congestive heart failure needs to take some safety precautions in the home setting. One should be aware of symptoms that indicate emergency involvement: abnormal weight gain despite diuretic use, worsening dyspnea, orthopnea, or edema of the legs, and especially any form of chest pain. In the event of an emergency concerning the progression of the disease, one needs to have easy access to contacting emergency health professionals for help.
It is imperative to have a friend and family system in place to check in on him or her rather regularly and to provide assistance in an emergency situation as well. On a less severe basis, the individual with CHF should make it a point to attend all of the necessary medical appointments, and try to maintain a healthy lifestyle despite the condition. (Parentgiving 2011) Educational Needs As mentioned previously, the patient needs to be aware of symptoms of Congestive Heart Failure and those that indicate deteriorating health status.
A physician recommended activity program would be a good idea to keep the patient safely active, for excess exercise can be dangerous to his or her health and a sedentary lifestyle has been correlated with detraction from overall health and well-being. A proper nutritious diet should be followed, one with limited sodium and regulation of fluid intake, in order to help keep blood pressure lowered. This is important because hypertension can significantly irritate and progress congestive heart failure.
In addition to the importance of regulating hypertension, it is important to keep cholesterol at a healthy level. Both conditions can catalyze the progression of congestive heart failure. The patient needs to learn the importance of avoiding alcohol and smoking, as well as taking self-monitoring precautions such as weighing and monitoring one’s blood pressure on a regular basis. Taking medications as prescribed is extremely important to help control such conditions, as well as controlling various mechanisms such as fluid balance, regulation of the heart rhythm and strength. (Owensboro 2011).
Cite this Congestive Heart Failure
Congestive Heart Failure. (2016, Oct 16). Retrieved from https://graduateway.com/congestive-heart-failure/