Heart Failure.....

Heart failure is defined as an in ability of the heart to maintain adequate circulation because of an impaired pumping capability. The cardiac output is diminished and peripheral tissue is not perfused adequately. The congestion of the lungs and periphery will occur.

There are two kind of heart failure: acute heart failure that occurs suddenly, and chronic heart failure that develops over the time.

Type of Heart Failure: See also below....

1. Right Ventricular and Left Ventricular Failure: Most of them begin with left ventricular failure and then progresses to both of ventricles. Left ventricular failure can progress to acute pulmonary edema that death will occur if not treated immediately.
2. Forward and Backward Heart Failure: In forward failure, the output of the affected ventricle is inadequate and causes decreased perfusion to vital organs. In backward failure, blood backs up behind the affected failure that causes increased pressure in the atrium behind the affected ventricle.
3. Low Output and High Output: in low output failure, the cardiac output is not enough to meet the demand. In high output failure, the heart works harder to meet the demand.
4. Systolic Failure and Diastolic Failure: Systolic failure means the problem with contraction and the ejection of blood. Diastolic failure means the problem in relaxing of the heart and filling with blood.

Signs and Symptoms of Heart Failure

Right Ventricular Failure:

• Pitting, dependent edema in the feet, legs, sacrum, back, and buttocks
• Ascites form portal hypertension
• Distended neck veins
• Tenderness of right upper quadrant
• Abdominal pain
• Nausea and anorexia
• Weight gain
• Fatigue
• Nocturnal diuresis

Left Ventricular Failure:

• Cough with frothy sputum
• Dyspnea on exertion
• Paroxysmal nocturnal dyspnea
• Orthopnea
• Crackles on auscultation
• Tachycardia
• Pallor
• Cyanosis
• Fatigue
• Confusion and disorientation
• Signs of cerebral anorexia

Acute Pulmonary Edema:

• Severe dyspnea and orthopnea
• Tachycardia
• Pallor
• Bubbling respirations
• Expectoration of large amount of blood tinged
• Profuse sweating
• Cold and clammy skin
• Nasal flaring
• Cyanosis
• Use of accessory breathing muscle
• Tahycpnea
• Hypocapnia
• Anxiety, apprehension and restlessness

Emergency Interventions for Heart Failure:

• Place the patient in high fowler position with the legs in a dependent position to reduce pulmonary congestion and relieve edema
• Give oxygen in high concentration by mask or cannula
• Intubation and ventilator support if needed
• Suction fluids as needed
• Assess and monitor level of consciousness
• Monitor for vital signs closely
• Monitor for hypotension
• Monitor for dysrhythmias (using cardiac monitor)
• Assess for edema in dependent legs
• Insert foley catheter if needed
• Monitor intake and output
• Administer morphine sulfate as prescribed
• Administer diuretics as prescribed
• Administer digitalis as prescribed
• Administer bronchodilator as prescribed
• Administer additional inotropic medications as prescribed
• Administer vasodilator as prescribed
• Monitor weight
• Assess for hepatomegaly and ascites
• Monitor peripheral pulses
• Analyze arterial blood gas
• Monitor potassium level closely

Interventions Following Acute Episode of Heart Failure:

• Assist the patient to identify precipitating risk factors of heart failure
• Encourage patient to verbalize feeling
• Instruct patient in the prescribed medications and notify physician if side effect occurs
• Advice patient to avoid over-the-counter medication
• Avoid large amount of caffeine
• Diet: low sodium, low fat, and low cholesterol diet
• Instruct patient regarding fluid restriction as prescribed
• Avoid isometric activities that increases pressure in the heart
• Provide patient with a list of potassium rich foods because diuretics can cause hypokalemia
• Instruct patient to monitor daily weight and report signs of fluid retention such as edema or weight gain

Ace Inhibitors in Heart Failure: Advancing Clinical Practice: Supplement 1 (Cardiology International Journal of Cardiovascular Medicine, Surgery and Pathology)


Over time, conditions such as narrowed arteries in your heart (coronary artery disease) or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.
You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure. Lifestyle changes, such as exercising, reducing the salt in your diet, managing stress, treating depression, and especially losing excess weight, can improve your quality of life.
The best way to prevent heart failure is to control risk factors and conditions that cause heart failure, such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.

• Chest pain
• Fatigue and weakness
• Rapid or irregular heartbeat
• Shortness of breath (dyspnea) when you exert yourself or when you lie down
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged phlegm
• Swelling in your abdomen, legs, ankles and feet
• Difficulty concentrating or decreased alertness

Heart failure often develops after other conditions have damaged or weakened your heart. Over time, the heart can no longer keep up with the normal demands placed on it to pump blood to the rest of your body. The main pumping chambers of your heart (the ventricles) may become stiff and not fill properly between beats. Also, your heart muscle may weaken, and the ventricles stretch (dilate) to the point that the heart can't pump blood efficiently throughout your body. The term "congestive heart failure" comes from blood backing up into — or congesting — the liver, abdomen, lower extremities and lungs.
Heart failure can involve the left side, right side or both sides of your heart. Typically, heart failure begins with the left side — specifically the left ventricle, your heart's main pumping chamber.

Type of heart failure	Description
Left-sided heart failure	Most common form of heart failure. Fluid may back up in your lungs, causing shortness of breath.
Right-sided heart failure	Often occurs with left-sided heart failure. Fluid may back up into your abdomen, legs and feet, causing swelling.
Systolic heart failure	The left ventricle can't contract vigorously, indicating a pumping problem.
Diastolic heart failure (also called heart failure with normal ejection fraction)	The left ventricle can't relax or fill fully, indicating a filling problem.

Any of the following conditions can damage or weaken your heart and can cause heart failure. Some of these can be present without your knowing it:

• Coronary artery disease and heart attack. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. Over time, arteries that supply blood to your heart muscle narrow from a buildup of fatty deposits, a process called atherosclerosis. Blood moves slowly through narrowed arteries, leaving some areas of your heart muscle weak and chronically deprived of oxygen-rich blood. In some cases, the blood flow to the muscle is just enough to keep the muscle alive but not functioning well. A heart attack occurs if plaques formed by the fatty deposits in your arteries rupture. This causes a blood clot to block blood flow to an area of the heart muscle, weakening the heart's pumping ability.
• High blood pressure (hypertension). Blood pressure is the force of blood pumped by your heart through your arteries. If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body. Over time, the heart muscle may become thicker to compensate for the extra work it must perform, enlarging the heart. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.
• Faulty heart valves. The valves of your heart keep blood flowing in the proper direction through the heart. A damaged valve, due to a heart defect, coronary artery disease or heart infection, forces your heart to work harder to keep blood flowing as it should. Over time, this extra work can weaken your heart. Faulty heart valves, however, can be fixed if found in time.
• Damage to the heart muscle (cardiomyopathy). Some of the many causes of heart muscle damage, also called cardiomyopathy, include infections, alcohol abuse, and the toxic effect of drugs such as cocaine or some drugs used for chemotherapy. In addition, whole-body diseases, such as lupus, or thyroid problems can damage heart muscle.
• Myocarditis. Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.
• Heart defects you're born with (congenital heart defects). If your heart and its chambers or valves haven't formed correctly, the healthy parts of your heart have to work harder to pump blood through your heart, which in turn may lead to heart failure.
• Abnormal heart rhythms (heart arrhythmias). Abnormal heart rhythms may cause your heart to beat too fast. This creates extra work for your heart. Over time, your heart may weaken, leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.
• Other diseases. Chronic diseases such as diabetes, severe anemia, hyperthyroidism, hypothyroidism, emphysema, lupus, hemochromatosis and buildup of proteins in your muscles (amyloidosis) also may contribute to heart failure. Causes of acute heart failure include viruses that attack the heart muscle, severe infections, allergic reactions, blood clots in the lungs, the use of certain medications or any illness that affects the whole body.

A single risk factor may be enough to cause heart failure, but a combination of factors increases your risk.
Risk factors include:

• High blood pressure. Your heart works harder than it has to if your blood pressure is high.
• Coronary artery disease. Narrowed arteries may limit your heart's supply of oxygen-rich blood, resulting in weakened heart muscle.
• Heart attack. Damage to your heart muscle from a heart attack may mean your heart can no longer pump as well as it should.
• Irregular heartbeats. These abnormal rhythms can create extra work for your heart, weakening the heart muscle.
• Diabetes. Having diabetes increases your risk of high blood pressure and coronary artery disease.
• Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure. Don't stop taking these medications on your own, though. If you're taking them, discuss with your doctor whether you need to make any changes.
• Sleep apnea. The inability to breathe properly at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
• Congenital heart defects. Some people who develop heart failure were born with structural heart defects.
• Viruses. A viral infection may have damaged your heart muscle.
• Alcohol use. Drinking too much alcohol can weaken heart muscle and lead to heart failure.
• Kidney conditions. These can contribute to heart failure because many can lead to high blood pressure and fluid retention.

The heart failure may be of severe nature because of fundamental diseases present already for example kidney impairment, hypertension, vascular disease, or diabetes. Among the general symptoms of heart failure shortage of breath, edema, difficulty exercising, fatigue and dizziness (due to low blood pressure) are included.
The treatment of heart failure could be outpatient including diuretics, ACE inhibitors, vasodilators, beta-blockers, digitalis, and anticoagulants that does not need hospitalization. In case of Inpatient treatment when patient has advance heart failure, he/she may be advised to stay in hospital taking intravenous (IV) medications. A surgical procedure may also be advised by the doctor depending on the condition of heart failure. Possible options are angioplasty, coronary bypass surgery, valve surgery, or heart transplantation. Furthermore, adopting a healthy life style can improve the chances to heal up from the heart failure. A healthy diet, regular exercise, controlled weight and regular visit to doctor are amongst the general suggestions.