RIGHT SIDED HEART FAILURE ; LEFT SIDED HEART FAILURE ; HEART FAILURE TREATMENT
Heart failure (right sided heart failure and left sided heart failure) is the inability of the heart to maintain adequate circulation due to decreased myocardial contractility. It can also be defined as the inability of the heart to carry out its pumping function thereby reducing blood, oxygen and nutrient to vital organs needed for metabolism.
TYPES OF HEART FAILURE
- Right Ventricular Failure/ right sided heart failure or congestive heart failure
- Left ventricular failure / left sided heart failure
CAUSES OF HEART FAILURE
- Valvular defect
- Pulmonary Occlusions
- Septicemia (a dangerous infection of the blood)
- Hyperthyroidism (excessive functional activity of the thyroid gland)
- Infusion overload
- Emotional Stress
- Drug Abuse
- Excess Salt Intake
- Kidney Dysfunction
- Pregnancy with underlying diseases
- Family history
- Coronary Artery Disease
- Pericarditis (inflammation of the pericardium-the membranous sac that encloses the heart)
- Myocardial infection
PATHOLOGY OF HEART FAILURE
The various causes of heart failure elevates heart rate consistently. This is on compensatory mechanism. Initially, there is increase in stole volume and cardiac output . Persistent contraction of the heart over a long period of time will lead to heart failure. This will result to stasis or accumulation of blood within the ventricle and its atrium. There is back flow through pulmonary veins into the lungs resulting in pulmonary congestion. This will cause difficulty in breathing . There will be coughing due to irritation.
If the condition persists, the compensatory mechanism will slow down and contractions will reduce causing decrease cardiac output which will diminish circulation or supply to vital organs, such as the kidney, brain and G.I.T causing oliguria, sodium-water retention, mental sub normality, dyspnea(difficult or laboured respiration) and fatigue, congestion of lungs will impair pulmonary circulation (no place for pulmonary artery to empty) leading to right heart failure.
CLINICAL MANIFESTATION (HEART FAILURE SYMPTOMS)
HEART FAILURE TREATMENT is administered whenever these symptoms surface
Right heart failure
Below are the common symptoms of right sided heart failure
- Edema (dependent pitting edema)
- Hepatomegaly (Liver congestion)
- Abdominal pain
- Weight gain
- Jugular Vein Distention
Left sided failure
Below are the common symptoms of Left sided heart failure
- Coughing (Frothy Blood Tinged Symptom)
- Mental Confusion (insomnia & restless)
- Exercise, Intolerance
- Rapid and Irregular Pulse
- Pale Cool Extremities
- Radiological examination of the chest will reveal cardiomegaly and vascular congestion of the lungs. Hypertrophy or myocardial damage.
- Arterial blood gas studies reveal decreased partial pressure of arterial oxygen and increased partial pressure of arterial carbon dioxide
- Elevated blood sodium
- Elevated blood urea nitrogen
- Pulse oximeter will reveal decreased oxygen saturation
- Elevated central venous pressure in right sided heart failure
HEART FAILURE TREATMENT
The aim of management is to reduce the work load of the heart, improve its pumping ability and prevent the various factors that can lead to the condition.
The management is basically chemotherapy (use of drugs). Drugs used to manage the condition:
- Cardiac glycosides: These drugs increases the force of myocardial contractions and sgow heart rate and conduction through atrioventricular node and bundle of HIS. Examples are digoxin and digitoxin o.25mg T.D.S. if pulse is less than 60 beats/min, hold and question order.
- Diuretics: These drugs are used to get rid of excess and the accumulated sodium, thereby decreasing the blood volume which decreases the workload of the heart
- Vasodilator therapy: These drugs act directly on blood vessels to cause dilations and decrease peripheral vascular resistance thereby decreasing the heart work. Examples are hydralazine and nitroprusside sodium. If blood pressure is less than 90/60mg, hold and question the order
- Broncho-dilators e.g. aminophiline are used to dilate the broncho tree to ease respiration
- Expectorants: e.g. beniline and codine are used to clear excess secretions in the respiratory tract.
- Antilipidermics agents are used to lower serum cholesterol level thereby enhancing free flow of blood within the blood vessels
- Angiotensin converting enzyme inhibitors: They are used to block angiotensints at the receptor site thereby decreasing peripheral vascular resistance examples are loartan and valsartan. The patient should be taught about orthostatic hypotension and should be instructed not to discontinue therapy abruptly. The drug should not be given if the blood pressure of the patient is less than 90/60mmhg.
NURSING MANAGEMENT (HEART FAILURE TREATMENT)
- Admission: Patient should be admitted in cardiac bed with back elevated to attain fowler's position, the environment should not be noisy to prevent irritation. Adequate rest is very necessary to reduce the heart work load and to conserve energy since the patient is fatigue
- Observation: Routine observation of vital signs in the parent is very necessary. The weight of the patient is taken daily and thee authority/supervisor is notified if patient gains weight daily. This is a sign of fluid retention.
- Nutrition/Diet: Patient needs low sodium diet as prescribed to decrease fluid retention and subsequently the workload of the heart. Reduction of high cholesterol diets. Institute high fiber
- Physical care: Bed bath/care of pressure area should be carried out to prevent pressure sores since the patient spends more time on the bed. Assistance should be given to the patient in self care activities, such as oral hygiene and grooming. Passive and Active exercise is necessary to prevent contractions.
- Psychological care: The patient should be reassured that he or she will be relieved of the various symptoms after treatment regimes instituted
- Education/Advise on Discharge: Patients clients and family should be taught on adhering to low fat/cholesterol and sodium diet. Patient should avoid climbing, walking or lifting heavy objects, pushing , emotional upset and constipation. Smoking should be discontinued, the importance of medical checkup/supervision should also be stressed.
- Impaired gas exchange related to pulmonary venous congestion evidenced by dysponea, cyanosis and restlessness
- Fluid volume excess related to decreased cardiac contraction/increased sodium retention evidenced by weight gain, jugular vein distention, ascitis and edema
- Anxiety related to fear of prognosis or fear of death evidenced by patient's complain
- Absence of heartbeat
- Brain damage
- Deep vein thrombosis