Heart Failure: Signs, Symptoms and Treatment

• Heart Failure (HF) means the heart cannot pump forward effectively
• This leads to HEAVY FLUID retention in the lungs and body

Memory Trick

• S = Sodium Swells
• W = Weight Gain = Water Gain Crisis

Signs & Symptoms

Right-Sided Heart Failure

• Fluid retention in the body
• Peripheral edema
• Weight gain due to water retention
• Pitting edema
• Jugular Vein Distention (JVD)
• Abdominal growth
• Ascites (fluid in the abdomen)
• Hepatomegaly (enlarged liver)
• Splenomegaly (enlarged spleen)

Left-Sided Heart Failure

• Lung congestion
• Pulmonary edema, with crackles or rales that don't clear with cough
• Frothy pink, blood-tinged sputum
• Orthopnea, difficulty breathing while lying flat

Causes

Right-Sided Heart Failure

• Can be caused by left-sided heart failure
• Pulmonary hypertension
• Fibrotic lungs

Left-Sided Heart Failure

• Myocardial Infarction (heart attack)
• Ischemic Heart Disease and CAD (Coronary Artery Disease)

Treatment Priority

• Focus on Pulmonary Edema Crisis
• Administer Furosemide to drain fluid
• Elevate the Head Of Bed to 45 degrees (semi-Fowler's, high-Fowler's, or orthopneic position)
• Give Oxygen
• Push Furosemide, Morphine, and Positive Inotropes
• End sodium and fluids (treat Sodium Swells)
• Avoid giving fluids (no drinking, stop IV fluids)

Diagnostic Tests

• BNP (Brain Natriuretic Peptide) lab test indicates "Broken Ventricles"
  • 300+ is mild HF
  • 600+ is moderate HF
  • 900+ is severe HF
• An echocardiogram will show ejection fraction
  • 40% or less indicates heart failure (normal range is 55-70%)
  • LVH indicates Left Ventricular Hypertrophy
• A Swan-Ganz catheter hemodynamic monitor measures pressures in the heart
  • Central Venous Pressure (CVP)
    • Normal range is 2-8
    • Over 8 suggests fluid overload/HF

Risk Factors

• Hypertension (HTN) is a primary risk factor
• ECG Dysrhythmias, especially Atrial Fibrillation
• Valvular Malfunction like mitral valve regurgitation
• Cardiomyopathy

Nursing Care - DR. BEDS

• D-Diet: Low Sodium, Calories, and Cholesterol
  • Restrict fluids to 2L or less per day, and sodium to 2g or less per day
  • Avoid Over-The-Counter (OTC) medications for cough or flu, and antacids or NSAIDs
  • Avoid canned or packaged foods (chips, sauces, meats, cheeses, wine)
• R-Risk for Falls: Change positions slowly
• B-Blood Pressure & BNP should NOT be increasing
• E-Elevate Head Of Bed (HOB) and legs with pillows; high Fowler's position
• D-Daily Weights, Intake & Output (I&O): Worsening if gaining over 3 lbs/day or 5 lbs in 7 days
• S-Stairs: Avoid sex or climbing stairs until able to climb 2 flights of stairs without dyspnea
• S-Stocking (TED hose): Decreases blood pooling; remove daily
• Avoid massaging calves in CHF patients

Pharmacology

• A-ACE Inhibitors (-pril): Lisinopril "chill pril" 1st choice
  • Act on blood pressure only, not heart rate
  • Avoid during pregnancy
  • Angioedema (airway risk) particularly with ACE inhibitors
  • Can cause a cough
  • Can cause Elevated Potassium (normal range is 3.5-5.0)
• A-ARBs (-sartan): Losartan "relax man" 2nd choice
  • Angioedema (airway risk) particularly with ACE inhibitors
• B-Beta Blockers (-lol): AtenoLOL "LOL = LOW"
  • Blocks both blood pressure and heart rate
  • Hold if the patient has Bradycardia (HR less than 60) and low BP (90/60)
  • Breathing problems ("wheezing")
  • Bad for heart failure patients
  • Blood sugar masking in diabetics, hides S/S
• C-Calcium Channel Blockers
  • Calms both Blood Pressure and Heart Rate
  • Avoid in low HR or BP
    • Nifedipine class
    • -dipine
    • -amilipine "chill heart"
• D-Diuretics: Drain Fluid
  • Furosemide & Hydrochlorothiazide
  • Can cause potassium wasting
  • Monitor potassium levels
  • Encourage foods like bananas and green leafy vegetables
• K+ Sparing-Spironolactone "Spares potassium"
  • Avoid salt substitutes, melons, & green leafy
• D-DILATORS (Vasodilators)
  • Nitroglycerin, Isosorbide
  • Works as a "pillow for the heart"
  • Do not combine with "-afil" medications (Sildenafil) - DEATH
  • If administering via Nitro drip, STOP if Systolic BP is below 90 or with 30 mmHg Drop
  • Headache is a side effect
  • Low BP is an adverse effect (change positions slowly)
• D-DIGOXIN (Inotropic)
  • Digs for a DEEP contraction
  • Increases contractility
  • Check Apical Pulse x 1 minute
  • Toxicity is over 2.0
  • Vision changes and N/V occur
  • Increased risk of toxicity if Potassium is 3.5 or less

This lesson covers the key aspects of heart failure (HF), focusing on the inability of the heart to pump effectively, leading to fluid retention. It highlights the differences between right-sided and left-sided heart failure, including their specific symptoms, causes, and initial treatment priorities. It uses memory tricks to recall the signs and symptoms of heart failure.