Congestive Heart Failure – Case Study Pathophysiology – BSRN – 420 Instructors: October 10, 2010 Report on Congestive Heart Failure The heart is a muscle, the most important one in the body. It works like a pump; it receives blood from the body and pumps the blood into the lungs, where it receives oxygen. This oxygen rich blood is then pumped out in to the body system to nourish the body. Congestive heart failure occurs when this pumping action is impaired, and the heart cannot pump enough blood to meet the body’s needs.

When the heart cannot pump out the blood it receives, excess fluid may back up into the lungs and other body tissues. If the amount of nourishment to the body decreases and causes fluid to overflow into the lungs, this may cause symptoms of congestive heart failure. According to (Understanding Congestive Heart Failure, 1995, pg. 1), this is an illustration on how the blood flows through the body and how the heart works. How the heart works: 1) Venous blood flows from the body to the right side of the heart. 2) Blood is then pumped to the lungs to pick up oxygen. ) After picking up oxygen, blood goes to the left side of the heart. 4) Blood is pumped out to nourish the body. [pic] Congestive heart failure is a condition in which the heart cannot pump enough blood throughout the body. Heart failure does not mean that your heart has stopped or is about to stop working, it means that your heart is not able to pump blood the way it should. The weakening of the heart’s pumping ability causes blood and fluid to back up into the lungs. The buildup of fluid in the feet, ankles and legs, called edema, and it causes tiredness and shortness of breath.

The leading causes of heart failure are coronary artery disease, high blood pressure and diabetes. It is almost always a chronic, long-term condition, although it can develop suddenly. This condition can affect the right side, the left side, or both sides of the heart. As the heart’s pumping action is lost, blood may back up into other areas of the body, including the liver, the gastrointestinal tract, and extremities (right sided heart failure), the lungs (left sided heart failure). Many organs do not receive enough oxygen and nutrients, which damages them and reduces their ability to function properly.

Most areas of the body can be affected when both sides of the heart fail. Heart failure becomes more common with advancing age, obesity, diabetes, use of alcohol or cocaine, and smoking cigarettes. Signs and Symptoms according to (Google Health, 2010, pg. 1) • Shortness of breath with activity, or after lying down for a while • Cough • Swelling of feet and ankles • Swelling of the abdomen • Weight gain • Irregular or rapid pulse • Sensation of feeling the heart beat (palpitations) • Difficulty sleeping • Fatigue, weakness, faintness • Loss of appetite, indigestion

Other symptoms may include: • Decreased alertness or concentration • Decreased urine production • Nausea and vomiting • Need to urinate at night Illustration (Google Health, 2010, pg. 1) of how the blood flows through the heart and into the lungs to get oxygenated and circulate throughout the body. This shows oxygen rich blood (red), and oxygen poor blood (blue), this illustration is similar to the one on page two of this report. It is a good image of the way the blood flows through the heart. The colors make this visual aid easier for the reader to understand the pathophysiology of the blood flow through the heart. pic] “The heart is a large muscular organ which constantly pushes oxygen-rich blood to the brain and extremities and transports oxygen-poor blood from the brain and extremities to the lungs to gain oxygen. Blood comes into the right atrium from the body, moves into the right ventricle and is pushed into the pulmonary arteries in the lungs. After picking up oxygen, the blood travels back to the heart through the pulmonary veins into the left atrium, to the left ventricle and out to the body’s tissues through the aorta. ” (Google, Health, 2010, pg. ) “Some patients with heart failure have no symptoms. In these people, the symptoms may develop only with these conditions: • Abnormal heart rhythm (arrhythmias) • Anemia • Hyperthyroidism • Infections with high fever • Kidney disease (Google Health, 2010, pg. 1) Risk factors for congestive heart failure include advancing age, as heart failure is the most common reason for hospitalization in the elderly, and as the population ages, the incidence of heart failure is rising dramatically. The positive aspect of this is that people with congestive heart failure are living longer.

Sex or gender is another risk factor, as men are at higher risk for heart failure than women. African American’s are at higher risk for heart failure than Caucasians. Genetics and family history of early heart failure Caused by cadiomyopathies (diseases that damage the heart muscle), may predispose people to this disease. Chronic alcohol abuse can damage the heart muscles, can cause hypertension, and may cause cardiomyopathy. Moderate alcohol consumption, on the other hand, may protect people from heart failure.

There are also several medical conditions that may cause congestive heart failure, such as diabetes, coronary artery disease, obesity, hypertension, heart valve problems and severe emphysema or chronic obstructive pulmonary disease, (COPD). Preventive measures to decrease the risk of congestive heart failure would be to eat a low salt diet, or adjusting your diet to avoid obesity. Avoid smoking or quit smoking, and start or continue an exercise program. Do not drink alcohol obsessively, drink in moderation. Avoid salty foods, and if you are on a diuretic (water pill), than watch fluid intake and output.

Congestive heart failure is a clinical diagnosis. The symptoms presented in a good clinical exam are extremely important. Doctor’s, advanced practice nurses, physician’s assistants, and even nursing personnel can pick up on the diagnosis of congestive heart failure, based on a physical examination and symptoms that a patient describes. The healthcare personnel will check pulses for strength and rate, swollen or distended neck veins, swelling of the liver, fluid retention, wet or fluid sounds in the lung fields and listening to heart tones.

To confirm a diagnosis, he/she may perform a number of tests, including a twelve lead electrocardiogram, chest x-ray, blood tests a specific blood test is called a BNP, cardiac stress test, echocardiogram, angiography, and cardiac catheterization if needed. There are many clinical presentations that would lead the healthcare provider to the diagnosis of congestive heart failure without a single test, but to confirm the healthcare provider’s diagnosis, they are obligated to do testing before treating. “Congestive heart failure is generally a progressive disease with periods of stability punctuated by episodic clinical exacerbations.

The course of the disease in any given individual, however, is extremely variable. ” (MedicineNet. Com, 1996-2010, pg. 7). According to (MedicineNet. Com, 1996-2010, pg. 7) – factors involved in determining the long term prognosis for a give patient include: ? The nature of the underlying heart disease. ? The response to medications. ? The degree to which other organ systems are involved in the severity of other accompanying conditions. ? The person’s symptoms and degree of impairment, and other factors that remain poorly understood. With the availability of new drugs to potentially favorably affect the progression of the disease, the prognosis in congestive hert failure is generally more favorable than that observed just ten years ago. ” (MedicineNet. Com, 1996-2010, pg. 7). In some cases, especially when the heart muscle dysfunction has recently developed, a significant spontaneous improvement is not uncommonly observed, even to the point where heart function becomes normal. “Heart failure is often graded on a scale of I to IV based on the patient’s ability to function. 1. Class I is patients with a weakened heart but without limitation or symptoms. 2. Class II is only limitation at heavier workloads. 3. Class III is limitation at everyday activity. 4. Class IV is severe symptoms at rest or with any degree of effort. (MedicineNet. Com, 1996-2010, pg. 7). According to (MedicineNet. Com, 1996-2010, pg. 7), the prognosis of heart failure patients is very closely associated with the functional class. “An important issue in congestive heart failure is the risk of heart rhythm disturbances (arrhythmias).

Of those deaths that occur in individuals with congestive heart failure, approximately 50% are related to progressive heart failure. Importantly, the other half are thought to be related to serious arrhythmias. A major advance has been the finding that nonsurgical placement of automatic implantable cardioverter/defibrillators (AICD) in individuals with severe congestive heart failure (defined by an ejection fraction below 30%-35%) can significantly improve survival, and has become the standard of care in most such individuals.

In some people with severe heart failure and certain ECG abnormalities, the left and right side of the heart does not beat in a rhythm, and inserting a device called a biventricular pacer, can reduce symptoms. ” (MedicineNet. Com, 1996-2010, pg. 7). New areas of research in congestive heart failure. (MedicineNet. Com, 1996-2010, pg. 8). “Despite the significant advances in drug therapy for congestive heart failure over the past 20 years, many exciting developments are under active study.

New classes of medications are being tested in clinical trials, including the calcium sensitizing agents, vasopeptidase inhibitors, and natriuretic peptides. As was the case with the ACE inhibitors and beta-blockers, the potential use of these drugs is based on theoretical considerations that have resulted from an increased understanding of the processes both underlying and resulting from heart failure. Additionally, gene therapy that is targeted toward certain genes thought to contribute to heart failure is being tested.

These developments have justified an unprecedented optimism in the treatment of congestive heart failure. The majority of individuals, with appropriate lifestyle measures and medical regimens, can maintain active, fulfilling lifestyles. The range of treatment options has been significantly strengthened by drugs such as the ACE inhibitors and beta-blockers. In the future, we will surely see the addition of many more and equally potent interventions. ” (MedicineNet. Com, 1996-2010, pg. 8).

Supportive roles and teaching in the community. The majority of hospitals and clinics hold educational classes on certain disease processes, and congestive heart failure is one of these classes they hold for the aging population and others with congestive heart failure. There are support groups for all types of disease processes in Calhoun County and adjacent Counties and Cities. This is a highly promotional for the hospital marketing. If you hold educational classes for free, then people choose to use these hospitals to seek care.

There is a line in Calhoun County and other Counties for self help programs, all a person has to do is call 211 and they can get free information and help on whatever issues they may have. In conclusion, congestive heart failure is a treatable disease, but as we age and the disease process worsens, the likelihood of rapid treatment diminishes. Many people are admitted to the hospital for an overnight stay, to ensure that they get the appropriate medications and they do not have another onset of shortness of breath or any other signs and symptoms of congestive heart failure.

Many hospitals want to ensure highest quality patient care and the outcomes are usually very good for those with congestive heart failure, unless they are in the end stages and they have other disease processes going on. The congestive heart failure patient can do a lot for themselves to prevent a relapse of the disease, but they have to be on a strict regimen of dietary intake, exercise and be compliant with their medicinal regimens. .


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