An Elderly With Congestive Heart Failure

Congestive heart failure is an older name for heart failure. Congestive heart failure takes place when the heart is unable to maintain an adequate circulation of blood in the bodily tissues or to pump out the venous blood returned to it by the veins (Merriam-Webster). The heart is split into two distinct pumping structures, the right side of the heart and the left side of the heart. Appropriate cardiac performance involves each ventricle to extract even quantities of blood over intervals. If the volume of blood reimbursed to the heart develops more than both ventricles can manage, the heart can no longer be an efficient pump.

Systolic heart failure is characterized by enlarged ventricles that are unable to fully contract to pump enough blood into circulation to adequately perfuse tissues. The enlargement in ventricles is due to an increased end-systolic volume. If the heart is not able to sufficiently pump the expected volume of blood with each contraction, which in a normal healthy heart is 50-60%, there will be a residual volume left in the heart after every pump (Heart Healthy Women, 2012). With the next period of filling, the heart will receive the same amount of blood volume from the atria combined with that residual volume from the previous contraction. This causes the ventricles to have to dilate to accommodate this increase in volume. The dilation causes the walls of the ventricles to stretch and become thin and weak. Also the myocardium, the muscle layer of the heart, will stretch and not be able to adequately make a full and forceful enough contraction to push blood from the ventricles (Lehne, 2010).

I. Description: Congestive Heart Failure is more of a syndrome than a disease. Heart failure may be classified according to the side of the heart affected, (left- or right-sided failure), or by the cardiac cycle involved, (systolic or diastolic dysfunction). (Schilling-McCann p. 176). The word "failure" refers to the heart's inability to pump enough blood to meet the body's metabolic needs. (Schilling-McCann p. 176). When the heart fails to deliver adequate blood supply edema may develop. (Cadwallader p. 1141). Where edema occurs depends on what side of the heart is failing.

Although these interventions may improve immediate survival in the short term, only coronary artery revascularization and cardiac transplantation have been shown to improve long-term survival.” (DeMarco & Chatterjee, 1993)

In the case study it discusses a patient, Mrs. Harris, who is a 72 year old and is complaining of fatigue and swelling in her feet. Mrs. Harris also expresses her concern on the swelling, as some days she is unable to put her shoes on despite proper elevation. She also states walking to her mailbox can be challenging because it causes her to feel more tired and to have shortness of breath, also known as dyspnea. Mrs. Harris is currently taking medication for high blood pressure, hypertension; and is also drinking approximately 8-12 glasses of wine a week. While examining Mrs. Harris it’s clear she is a little overweight and has swollen ankles. Upon listening to Mrs. Harris’s breathing, crackles are heard. Therefore, Mrs. Harris seems to have congestive heart failure.

The diagnosis is made when an ejection fraction of less than 40% is found during an echocardiogram test. Patients with known systolic heart failure and current or prior symptoms are Stage C. Most common symptoms include, shortness of breath, fatigue and reduced ability to exercise. Stage D is patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care. Other risk factors for heart failure are some diabetes medications, sleep apnea, congenital heart defects, viruses, and irregular heartbeats. Heart Failure can be treated and managed but not cured. It is a chronic condition.

In systolic ventricular dysfunction or systolic heart failure the heart is not able to produce enough output for adequate tissue perfusion. Heart rate and stroke volume produce cardiac output. Contractility, preload, and afterload influence the heart’s stroke volume. These factors are important in understanding the pathophysiologic consequences of this syndrome and possible treatments. Patients with systolic heart failure usually have dilated, large ventricles and impaired systolic function.

Patients who have congestive heart failure and do not respond to diuretics may benefit from a combination of several types of diuretic medication, each with a different system of action. Another medication for someone that has congestive heart failure can take Beta-blockers. Side effects include fatigue, cold hands, headache, upset stomach, constipation, diarrhea, dizziness, and shortness of breath. Data reported from 17 studies, researchers came to the conclusion that the risk of death from all causes was 31 percent lower in patients with heart failure who were treated with beta-blockers than in those not receiving such medications. Aldosterone blockers is a form of medication one may take to help slow down the rate of congestive heart failure.This medication can sometimes affect kidney function and can also increase potassium levels. Aldosterone blockers are prescribed to individuals who develop heart failure after a heart attack. Studies show that these medications can reduce the risk of hospitalization and death from cardiovascular disease. The last form of medication is BiDil (isosorbide

There is a decrease in cardiac output. Joan Grif Alspach, RN, MSN, explains what heart failure is, “The most recent American College of Cardiology Foundation/American Heart Association guideline for the management of heart failure (HF) defines this disorder as a complex clinical syndrome that results from either a structural or functional impairment of ventricular filling or ejection” (p. 8). Alspach explains what most patients experience with CHF, “…most patients with HF experience fatigue and dyspnea, clinical symptoms that reflect impaired left ventricular function. Some but not all patients with HF present with clinical manifestations of volume overload” (p. 8). My patient had multiple factors that played a role in her diagnosis of CHF which include hypertension, shortness of breath, fatigue, and being a borderline diabetic. She has had both a pacemaker and coronary stent placed inside of her due to cardiovascular problems. Treatment for CHF includes rest, a heart healthy diet, medications, and lifestyle

The major causes of diastolic heart failure are hypertension-induced myocardial hypertrophy and myocardial ischemia-induced ventricular transformation (coronary artery disease). Hypertrophy and ischemia cause a decreased ability of the myocytes to actively pump calcium from the cytosol, resulting in impaired relaxation. Some of the other causes are aortic valvular disease and cardiomyopathies. Diabetes can also lead to diastolic heart failure (Huether and McCune 2012). Other risk factors for this disease are chronic kidney disease, obstructive sleep apnea, and older age. There are two types of the heart failure: systolic heart failure and diastolic heart failure. In systolic heart failure, the left ventricle has difficulty contracting and ejecting blood into the circulation, which causes reduced left ventricular fraction. On the other hand, diastolic heart failure has a slow and delayed relaxation and increased chamber rigidity, which then causes inadequate filling of blood and

The causes of acute HF should be promptly recognized, treated, and monitored to determine if the heart failure is reversible. The commonly cause of acute onset of left HF heart failure is acute myocardial ischemia in conjunction with the underlying coronary disease. Treatment include oxygen, nitrates, and morphine administration to improve myocardial oxygenation and help relieve coronary spasm while lowering preload through systemic venodilation. Diuretics are firtst line therapy in reducing preload while intravenous inotropic drugs, such as dobutamine and milrinone, increase contractility and also help raise the blood pressure in hypotensive patients. In some people, calcium-sensitizing inotropic drugs such as levosimendan have been effective in treatment of acute HF. Other treatments that can be used include ACE inhibitors which reduce preload and afterload, and intravenous beta-blockers which reduce myocardial demand. However, these treatments must be used with caution in hypotensive individuals. Intravenous administration of nesiritide (recombinant BNP) also improves preload and contractility. Individuals with severe systolic failure due to myocardial ischemia may benefit from acute coronary bypass or

Over the years there has been some controversy on defining congestive heart failure due to a vast variability of the clinical signs and symptoms (Coronel, 2001). The American Heart Association defines it as “a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood” (Veronique, 2013). In this case report will critically analyse the general information of the giving condition in relation to the patient’s case.

Stroke volume is the amount of blood pumped out from a ventricle in one heartbeat, and is dependent on several factors such as heart size, contraction duration, contractility, preload, and afterload [1]. Stroke volume can be calculated as the difference between the volume of blood in the ventricle just before a heartbeat (end-diastolic volume; EDV) and the volume following contraction (end-systolic volume; ESV) [4].

Left-sided heart failure is the most common type of heart failure, and it is a result of left-ventricular dysfunction. This disease poses a significant threat to patients because the primary function of the left side of the heart is to provide sufficient oxygenated blood to satisfy the metabolic demands of the body’s cells. Understanding the main function of this portion of the heart will help with the understanding of other complications associated with this diseased. Left-sided heart failure is usually the result of the loss of heart muscle function, specifically in the left ventricle secondary to coronary artery disease, prolonged hypertension, or myocardial infection (Lewis et al. 2014, 766). The

Systolic failure: Can be described as a heart failure with reduced ejection fraction. Caused by a not properly contraction of the left ventricle. The heart can’t develop enough force to pump enough blood into the circulation.