NSG 326 Adult Health IHeart FailureSlide 3Heart FailureSlide 5Heart FailureSlide 7Slide 8Slide 9Slide 10Slide 11Slide 12Slide 13Slide 14Slide 15Left-Sided HFSlide 17Right-Sided HFSlide 19What does HF look like?ADHF Signs & SymptomsADHFChronic HFSlide 24Slide 25Slide 26Heart Failure ComplicationsSlide 28Slide 29Heart Failure Diagnostic StudiesSlide 31Acute Decompensated HF [ADHF] Nursing and Collaborative ManagementADHF Nursing and Collaborative ManagementADHF Nursing and Collaborative ManagementSlide 35Slide 36Slide 37Management AddressesChronic HF Collaborative ManagementSlide 40Slide 41Slide 42Chronic HF Nursing ManagementSlide 44Slide 45Slide 46Slide 47Slide 48Slide 49Slide 50Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.Prepared & Adapted by Dr. K. A. Ennen NSG 326 Adult Health IHEART FAILUREHEART FAILURECopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Heart Failure An abnormal condition involving impaired cardiac pumpingHeart is unable to produce an adequate cardiac output (CO) to meet metabolic needsAn abnormal condition involving impaired cardiac pumpingHeart is unable to produce an adequate cardiac output (CO) to meet metabolic needsCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Heart Failure Characterized by Ventricular dysfunctionReduced exercise or activity toleranceDiminished quality of lifeShortened life expectancy Characterized by Ventricular dysfunctionReduced exercise or activity toleranceDiminished quality of lifeShortened life expectancyCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Heart FailureHeart failure (HF) is not a disease but a “syndrome”Associated with long-standing hypertension and coronary artery disease Affects about 5 million people in the United States The most common reason for hospitalization in adults >65 years oldHeart failure (HF) is not a disease but a “syndrome”Associated with long-standing hypertension and coronary artery disease Affects about 5 million people in the United States The most common reason for hospitalization in adults >65 years oldCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Heart FailureHeart failure is classified as systolic or diastolic failure  Primary risk factorsCoronary artery disease (CAD)Advancing ageContributing risk factors HypertensionDiabetesTobacco useObesityHigh serum cholesterolAfrican American descentHeart failure is classified as systolic or diastolic failure  Primary risk factorsCoronary artery disease (CAD)Advancing ageContributing risk factors HypertensionDiabetesTobacco useObesityHigh serum cholesterolAfrican American descentCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Heart FailureSystolic failure is most common Hallmark finding: Decrease in the left ventricular ejection fraction (EF)Caused byImpaired contractile function (e.g., MI)Increased afterload (e.g., hypertension)Afterload = Total peripheral resistance = pressure overload CardiomyopathyMechanical abnormalities (e.g., valve disease)Systolic failure is most common Hallmark finding: Decrease in the left ventricular ejection fraction (EF)Caused byImpaired contractile function (e.g., MI)Increased afterload (e.g., hypertension)Afterload = Total peripheral resistance = pressure overload CardiomyopathyMechanical abnormalities (e.g., valve disease)Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Heart FailureDiastolic failureLeft ventricular hypertrophy from chronic HTN; aortic stenosisImpaired ability of the ventricles to relax and fill during diastole resulting in decreased stroke volume and CODiagnosis based on the presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, normal ejection fraction (EF)Ejection fraction: The portion of blood that is pumped out of a filled ventricle as a result of a heartbeat.Isolated right ventricular diastolic failure from pulmonary hypertensionDiastolic failureLeft ventricular hypertrophy from chronic HTN; aortic stenosisImpaired ability of the ventricles to relax and fill during diastole resulting in decreased stroke volume and CODiagnosis based on the presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, normal ejection fraction (EF)Ejection fraction: The portion of blood that is pumped out of a filled ventricle as a result of a heartbeat.Isolated right ventricular diastolic failure from pulmonary hypertensionCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Heart FailureCompensatory mechanisms are activated to maintain adequate COCardiac output: The amount of blood that is pumped by the heart per unit time, measured in liters per minute (L/min).The amount of blood put out by the left ventricle of the heart in one contraction is called stroke volume. The stroke volume and the heart rate determine the cardiac output.Sympathetic nervous system (SNS) activation: First and least effective mechanism Release of catecholamines (epinephrine and norepinephrine)Increased heart rate (HR)Increased myocardial contractilityPeripheral vasoconstrictionCompensatory mechanisms are activated to maintain adequate COCardiac output: The amount of blood that is pumped by the heart per unit time, measured in liters per minute (L/min).The amount of blood put out by the left ventricle of the heart in one contraction is called stroke volume. The stroke volume and the heart rate determine the cardiac output.Sympathetic nervous system (SNS) activation: First and least effective mechanism Release of catecholamines (epinephrine and norepinephrine)Increased heart rate (HR)Increased myocardial contractilityPeripheral vasoconstrictionCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Heart Failure Neurohormonal responses: Kidneys release renin. Response is known as the renin–angiotensin–aldosterone system (RAAS)Renin converts angiotensinogen to angiotensin IAngiotensin I is