Heart failure is a continuous condition characterized by the weakening of the heart’s muscles. It results from any state that lowers the myocardium’s or heart muscle’s performance as a result of harm or overburdening caused by a heart attack or high blood pressure. This makes the heart lose its efficiency in propelling blood throughout the body bit by bit. Heart failure could be left side or right side, chronic or acute (Brunner, Smeltzer, Bare, Hinkle & Cheever, 2009, p. 807).
Typically, oxygenated blood from the lungs enters through the left side of the heart into the aorta, which then supplies it to other systems of the body. Thus left-sided heart failure or left ventricular failure refers to a condition where the left part of the heart (ventricle) is unable to propel adequate oxygenated blood from the pulmonary transmission to the body through the arteries; this jeopardizes aortic flux (Porth, 2010, p. 489).
Since the heart’s capacity to push the blood is lowered, the rest of the body is not able to get adequate oxygen. This means that the left side requires to work extra hard to pump the blood forward. The accelerating pressure on the lungs could lead to fluid gathering in the lungs leading to pulmonary edema and running out of breath (Timbly & Smith, 2004, p. 425).
Left-sided heart failure could be systolic or diastolic; systolic failure happens when the left ventricle is no longer able to contract, hence regularly rendering the heart incapable of pumping with adequate force to propel the blood into circulation. Diastolic failure or dysfunction, on the other hand, refers to the left ventricle’s inability to relax in the usual way owing to stiff muscles. This way, the heart is not able to fill with blood while resting between the beats (Porth, 2010, p. 488).
Pathophysiology
Anomalies in the left ventricle undermine the output of oxygenated blood to the entire body circulation. However, the first symptoms are often the results of impacts on the pulmonary circulation. During systolic failure, the discharge fraction is minimized, causing an unnatural high blood level in the left ventricle.
During diastolic failure, the end-diastolic pressure is increased. These developments advance to the left atrium and proceed to the pulmonary veins. High blood capacity or pressure in the pulmonary veins affects the alveoli’s conventional drainage, allowing fluid to flow from the capillaries to the parenchyma of the lungs (Timbly & Smith, 2004, p. 426).
Retrogressive performance of the left ventricle causes clogging of the pulmonary vessels. This could be as a result of deterioration of the left atrium and the left ventricle or both. This in turn greatly affects the left or right cardiac cavities, resulting in a number of signs and manifestations.
Thus left-sided heart failure is often manifested in common respiratory symptoms like shortness of breath (dyspnea) during vigorous activity or worse even while lying down (orthopnea), and paroxysmal nocturnal dyspnea, which is unexpected shortness of breath late at night (Porth, 2010, p. 489).
In extreme cardiac conditions, these symptoms are more conspicuous and are evident through fatigue, exercise incapability, dizziness, confusion, and clammy limits during relaxation, cyanosis, syncope and overall weakness. Pulmonary oedema, which results from fluid accumulating in the alveoli, is preceded by crackles in the lungs. At its worst, it is manifested through cyanosis and it causes hypoxia, which leads to pulmonary vasoconstriction or pulmonary hypertension (Brunner et al., 2009, p. 811). Laterally relocated apex beat from a swollen heart, a gallop rhythm and extra heart sounds are also signs of left-sided heart failure from valvular conditions.
Treatments
While conditions that result into heart failure are irreversible, treatments go a long way in helping patients with such conditions. It could take many dimensions; low-tech to high-tech depending on each particular ailment. This is because there are many conditions affecting the heart.
Basically, treatment or management of these conditions encompasses alterations in lifestyle, medication and surgery. On changes in lifestyle, a heart-friendly diet and exercise help keep the patient in shape and lower his or her risk of cardiac failure. It includes putting a stop to activities that increase blood pressure such as smoking, low or no alcohol consumption, lowering salt intake, controlling stress, managing depression, exercise and diet pills, and boosting the quality of life one leads (Buckler, 2009, p. 829).
Heart failure conditions could also be treated by a combination of drugs. According to the American Heart Association (2011), patients with heart conditions require numerous medications as each takes care of a different symptom or contributing element (p.1). There are a variety of drugs that aid the heart in pumping blood thus ameliorating blood circulation.
Some of the common prescriptions include anticoagulants, inhibitors, diuretics, vasodilators, blockers, antagonists and statins. These help boost the signs and symptoms of heart failure and elongate the patients’ lives. However, patients have to be keen on taking the drugs in order to have the desired impact; drugs are also very expensive.
Sometimes medical treatments fail to achieve the desired results as heart failure advances. Devices and surgery become necessary to restore injured valves. Valves may be prosthetic (artificial valves) or bioprosthetic valves (from animal tissue). The valve type is dependent on the age and condition of the patient and also on the affected valve. In extreme cases, a heart transplant is deemed necessary (Dimitra, 2010, p. 3). Biventricular pacing is among the typical surgical interventions that can be used while heart transplant is a resort for cases of advanced and imminent heart failure.
However, owing to the scarcity of donors, not every patient gets the transplant immediately. In some of these situations, an acceptable alternative therapy like the use of the left ventricular assisting gadget is used in some patients to aid the heart as the patient awaits a donor; such an intervention acts as a bridge to heart transplants and destination therapy (Brunner et al, 2009, p. 809).
Nowadays, devices have been generated to aid in controlling the fluid condition of the patient remotely. These gadgets are implanted beneath the skin and the information is sent to the healthcare practitioner’s data. Such devices have helped patients with advanced heart failure. All these treatments aim at managing the risk factors and conditions that are likely to lead to heart failure.
Nursing Interventions
Nursing plays a significant role in managing risk factors and conditions leading to heart failure throughout its course. It involves appraising its signs and symptoms, observing treatment, educating patients, psychological and moral support and counseling (Dimitra, 2010, p. 1). It may also include coming up with behavior change approaches all with the aim of lowering death rates, thwarting hospitalization, improving capacity to function and the general health status of the patients.
During diagnosis, the patient’s medical history, risk profile and physical examination is carried out to assess the disease. A treatment plan then follows and this includes administering drugs, appraising the patients’ reaction to the medication, evaluating fluid balance, weighing the patients, examining their diet and monitoring their general progress (Brunner et al., 2009, p. 799). Nursing intervention also involves patient follow up to avoid readmission and improve their quality of life.
Patient Educational Hand Out
Heart Failure
What is heart failure?
Heart failure is a chronic or sudden condition resulting from any state, which lowers the heart muscle’s performance as a result of damage or overburdening for instance a heart attack, diabetes or high blood pressure. This weakens the heart muscles making the heart to gradually lose its efficiency in propelling blood throughout the body.
Signs and Symptoms
Symptoms include struggling to breathe, coughing, exhaustion, deprived appetite, irregular heartbeats and breathlessness during activity or rest, puffy body parts such as the belly, feet, and ankles, weight increment and distended neck veins.
Medication
It is important to take your medicine as prescribed and on schedule and never take any other medication without consulting your health care provider. Medicines treat the symptoms, assist in keeping your heart function stable, stay energetic, alleviate your symptoms, ease your breathing, improve your level of activity, reduce swelling, prevent hospitalization or readmission and most importantly help you live longer.
Taking your drugs
Adhere to your doctor/nurse’s treatment recommendations. Take all medications as advised. Use water to take your medication.
Diet and fluids
Refrain from smoking and alcohol consumption. Minimize your salt intake. Eat heart friendly diet.
Follow ups
Go for regular check-ups as directed. Call your healthcare provider in case of any abnormal changes. Check your weight regularly.
Activity
Activity helps keep your blood pressure, heart rate, and cholesterol level in check making you feel good as you carry on with other. Get enough rest, exercise and take part in other activities like work, and sex. Consult your doctor before embarking on exercise activities and programs.
References
American Heart Association. (2011). Heart failure medication. Web.
Buckler, L. R. N. (2009). Managing heart failure. Nursing Made Incredibly Easy, 7(3), 12-21.
Brunner, L. S., Smeltzer, S. C., Bare, B.G., Hinkle, J. L. & Cheever, K. H. (2009). Brunner and Suddarth’s textbook of medical–surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Dimitra, A. R. N. (2010). Caring for the Heart Failure Patient: Contemporary Nursing Interventions. Hospital Chronicles, 5(1), 1-8.
Porth, C. M. (2010). Essentials of pathophysiology: concepts of altered health states (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Timbly, B. K. & Smith, N. E. (2004). Essentials of nursing: Care of adults and children. Philadelphia, PA: Lippincott Williams & Wilkins.