Heart Failure Management Overview

Heart Failure (HF) Management

• Definition: Inability of the heart to pump enough blood to meet the body's oxygen and nutrient needs.
• Ejection Fraction (EF): Percentage of blood pumped out of ventricles during systole. Crucial in classifying HF types.
• Types:
  • Low EF (Systolic HF): Weakened ventricles struggle to pump effectively.
  • Normal EF (Diastolic HF): Stiff ventricles fail to fill adequately during diastole.
  • Left-sided HF: Primarily pulmonary symptoms (dyspnea, orthopnea) due to congested lungs.
  • Right-sided HF: Primarily systemic symptoms (peripheral edema, JVD) due to fluid backup.

Etiology (Causes)

• Coronary artery disease (atherosclerosis)
• Systemic or pulmonary hypertension
• Valvular disorders (mitral stenosis or regurgitation)
• Diabetes mellitus
• Cardiomyopathy

Clinical Manifestations

• Left-sided HF: Dyspnea, orthopnea, pulmonary crackles, paroxysmal nocturnal dyspnea.
• Right-sided HF: JVD, peripheral edema, hepatomegaly, ascites.

Assessment and Diagnosis

• Comprehensive history and physical exam
• Echocardiography: Essential for EF measurement.
• Chest X-ray: Shows pulmonary congestion.
• BNP: Elevated levels indicate HF severity.
• Electrolytes, CBC, ECG: Supporting diagnostic evaluation.

Medical Management

• Goal: Improve cardiac function, reduce symptoms/hospitalizations, delay disease progression, and enhance quality of life.
• Pharmacologic Therapy:
  • ACE inhibitors (captopril): Vasodilation, diuresis
  • ARBs (valsartan): Lower BP, improve cardiac output
  • Beta-blockers: Slow heart rate, reduce workload
  • Diuretics (furosemide): Increase urine output
  • Digoxin: Improves contractility (caution for toxicity; therapeutic range 0.5–2.0 ng/mL)
  • Anticoagulants: Prevent thromboembolism
  • Avoid NSAIDs for this condition.

Lifestyle and Nutritional Modifications

• Low-sodium diet (≤2 g/day): Essential for reduced fluid retention.
• Restrict fluids, supplemental oxygen in cases of congestion.
• Avoid excess alcohol, smoking.
• Maintain a healthy weight and regular exercise.

Nursing Management

• Monitoring: Daily weights (monitor for excessive fluid gain), lung sounds, JVD, symptoms (orthopnea, dyspnea), skin turgor.
• Interventions: Medication administration, psychological support.

Nursing Diagnoses

• Activity intolerance
• Excess fluid volume
• Anxiety
• Noncompliance

Complications and Management

• Pulmonary Edema: Anxiety, restlessness, dyspnea, cyanosis, moist hands, distended neck veins. Immediate management includes supplemental oxygen, diuretics, and vasodilators.
• Thromboembolism: Prophylactic anticoagulation is crucial.
• Cardiac Arrest: Immediate CPR and advanced life support.

Diseases of the Heart Valves

• Mitral Regurgitation: Symptoms - Fatigue, dyspnea, palpitations. Management - ACE inhibitors, ARBs, surgery (valvuloplasty).
• Mitral Stenosis: Symptoms - Dyspnea, fatigue, orthopnea. Management - Anticoagulants, surgery (commissurotomy).
• Aortic Stenosis: Symptoms - Chest pain, syncope, exertional dyspnea. Management - Valve replacement or TAVI (transcatheter aortic valve implantation).