Essay on Heart Failure

Pathophysiology between right and left heart failure

The left side of the heart is involved in pulmonary circulation upon receipt of oxygen-rich blood from the lungs into the right atrium. Eventually, the blood leaves the heart from the left ventricle in the systemic circulation. Therefore, this means that the left ventricle is larger than the other heart chambers because of its demanding pumping action. Left-sided heart failure relates to systolic and diastolic failure.

Systolic failure is a condition where heart failure manifests with lowered ejection fraction. The left ventricle loses its ability to contract and pump blood efficiently. It lacks the force to pump blood into the systemic circulation. Systolic pressure is generated when the left ventricle contracts and pushes blood through the aorta, increasing arterial pressure. In this condition, body organs are insufficiently supplied with blood.

Diastolic dysfunction of the left side of the heart arises due to the inability of the left ventricle to relax usually; therefore, blood fill-up in the chambers is inadequate in the resting phase of the heartbeat. Even if the heart muscle is strong to pump out blood, blood is reserved in the chambers as not enough blood is pumped out to the body. Cardiac diastole follows, involving a complete relaxation of the atria and ventricles and typically lasts 0.4s (Waugh & Grant, 2018, p. 92). When blood is pumped out of the left ventricle into the arteries, the low pressure in the heart chambers is created, and the differential pressure causes blood to rush in and fill up the atria, beginning a new pulsating cycle after the myocardium recovers from the last heartbeat.

Right-sided heart failure seemingly occurs when the right ventricle weakens and loses its ability to pump blood to the lungs. The right side of the heart receives deoxygenated blood from the rest of the body through the venous system into the right auricle. The blood is pumped to the right ventricle, through which it is pumped into the lungs through the branched pulmonary arteries to each lung. Shortcomings of the right side of the heart mainly arise from the defective functioning of the left chambers. Fluid pressure increases when the left ventricle fails, which affects the lungs causing damage to the right side of the heart. Upon deterioration of the right side of the heart, blood is retained in the veins, causing congestion and swelling in the abdomen and legs.

Diagnostic testing for heart failure

The health care professional will require a physical examination and other tests. For physical examinations, the patient fills in a medical history form highlighting their symptoms. Weight and blood pressure levels are recorded, and the healthcare professional uses a stethoscope to listen to the heart and lungs. To diagnose heart failure, the doctor would require blood tests, electrocardiograms (ECGs), echocardiogram, chest X-ray, and breathing tests. Various markers are indicative of heart failure. Electrolytes, albumin, creatinine, and levels of other bio-indicators serve as pointers for heart failure. Chest x-ray scans can either be taken in the anterior-posterior position, posterior-anterior or lateral positions to assess the pulmonary congestion and cardiomegaly (Matsumoto et al., 2020). Electrocardiograms are performed to detect any arrhythmias or abnormal heart rhythm, a previous heart attack, or the enlargement of the left ventricle. Echocardiography is requested to study the structure and motion of the heart by performing an ultrasound test. The test commonly assesses the ejection fraction.Multiple-gated acquisition scanning (MUGA) is carried out to test the competence of the heart chambers, blood supply of the heart, and assess the regional damage of the heart. The painless procedure is carried out by injecting radionuclides into one’s bloodstream (IV) and the location of the radionuclides visualized and images generated to record the visuals. Similarly, an MRI can be carried out to illustrate the structure of the heart and blood flow from the heart through major vessels. For MRA magnetic resonance angiography, a contrast dye is injected IV to visualize the venous system better. Cardiac catheterization is performed to show coronary blockages and the weakened or damaged parts of the heart.

Risk factors

The chances of heart failure increase with advancement in age, gender influence, diabetes, obesity, genetics and unhealthy living. Most patients hospitalized for heart failure usually are 65 years and above. Gender influences the probability of suffering from heart failure, whereby men are at a higher risk of heart failure. However, women are known to develop diastolic heart failure more frequently than men. Genetics are a likely risk factor for the development of heart failure. People who are more genetically predisposed to suffering from heart failure are more susceptible than those without genetic inclinations. People with diabetes are also at a high risk of heart failure due to their medication and association with coronary artery disease. Obese individuals are predisposed to heart failure as well. Unhealthy lifestyle factors fuel an individual’s likelihood of suffering from heart failure. Alcohol, tobacco, and sedentary living increase the chances of developing heart failure.

Clinical manifestations

Clinical manifestations of heart failure include;

Exercise intolerance is evidenced by dyspnea, fatigue, light-headedness, recurrent arrhythmias, low pulse pressure, unintended weight loss, and refractory volume overload (Lee & Oh, 2020). Specifically, left-sided heart failure causes symptoms such as pulmonary congestion, dry, nonproductive coughs, dyspnea, fatigue, tachycardia, weak pulse, and inadequate tissue perfusion, while right-sided heart failure causes anorexia and nausea, ascites, edema affecting lower extremities, hepatomegaly, visceral congestion and general fluid retention.

Nursing diagnoses

A nursing diagnosis determined for heart failure using the NANDA format upon investigation is suspected decrease in cardiac output. Other related factors include:

• Medication side effects.
• Low cardiac reserves.
• General weakness.
• Valvular and ventricular defects.
• Altered rhythm and heart rate.
• Changes in contractility.

The reduced cardiac output would present itself through increased heart rates, reduced urine output, chest pains, orthopnea, changes in blood pressure, and cool, ashy skin.

A second diagnosis would be activity intolerance due to failure of blood reaching the lower extremities. The patient reports exhaustion in carrying out even simple activities such as walking or carrying a bag. Related factors include immobility, generalized weakness, and an imbalance between oxygen demand and supply. The defining characteristics are fatigue, dyspnea, arrhythmias, and pallor.

Expected outcomes

When reduced cardiac output is managed, the patient is expected to recover their desired cardiac output, carry out exercises and report a lower frequency of anginas and dyspnea.

Once the activity intolerance is in control, the patient will be required to run their daily activities and stabilize vital signs.

Nursing interventions

Some nursing interventions include checking vital signs and monitoring blood pressure to address hypotension, including assessing possible causes of fatigue such as pain and medication and the patient’s general condition. The therapeutic interventions include cardiac rehabilitation to improve and strengthen cardiac function, ROM exercises to prevent deep vein thrombosis caused by vascular congestion. The nurse should encourage adequate sleep and bed rest for body relaxation and comfort, assistance in ambulation to reduce falls, and record factors that aggravate the condition.

For patients showing oxygen deficit, the nurse should administer oxygen and reposition the patient every two hours to reduce bedsores. The nurse should give cardiac glycosides while checking for toxicity that improves myocardial contractility and perform passive exercises to improve blood circulation lower extremities.

Medications to be administered include diuretics such as furosemide and bumetanide, vasodilators including nitrates, angiotensin II receptor antagonists valsartan and eprosartan, and ACE inhibitors lisinopril, ramipril, quinapril, and captopril, among others.

References

Matsumoto, T., Kodera, S., Shinohara, H., Kiyosue, A., Higashikuni, Y., Akazawa, H., & Komuro, I. (2020). Diagnosing heart failure from chest X-ray images using deep learning. European Heart Journal, 41(Supplement_2). https://doi.org/10.1093/ehjci/ehaa946.1201

Lee, K. S., & Oh, S. (2020). An Integrative Review of the Symptom Perception Process in Heart Failure. Journal of Cardiovascular Nursing, Publish Ahead of Print. https://doi.org/10.1097/jcn.0000000000000750

Waugh A., Grant A (2018). Ross& Wilson Anatomy and Physiology in health and illness. 13^th Edition. Elsevier.