Pathophysiology of Congestive Heart Failure: Reported By: Jay - Ann M. Cabia BSN II-A

PATHOPHYSIOLOGY OF
CONGESTIVE HEART
FAILURE
Reported By: Jay_Ann M. Cabia BSN II-A

Heart Failure
• Heart failure, sometimes known as congestive heart failure,
occurs when your heart muscle doesn't pump blood as well
as it should.
• Certain conditions, such as narrowed arteries in your heart

(coronary artery disease) or high blood pressure, gradually
leave your heart too weak or stiff to fill and pump efficiently.
Pathophysiology
Schematic Diagram
CAUSES
• HYPERTENSION = If your blood pressure is high, your heart has
to work harder than it should to circulate blood throughout your
body. Over time, this extra exertion can make your heart muscle
too stiff or too weak to effectively pump blood.
• FAULTY HEART VALVES = The valves of your heart keep blood

flowing in the proper direction through the heart. A damaged valve
due to a heart defect, coronary artery disease or heart infection
forces your heart to work harder, which can weaken it over time.
• CARDIOMYOPATHY = Heart muscle damage
(cardiomyopathy) can have many causes, including several
diseases, infections, alcohol abuse and the toxic effect of drugs,
such as cocaine or some drugs used for chemotherapy. Genetic
factors also can play a role.
• MYOCARDITIS = Myocarditis is an inflammation of the heart

muscle. It's most commonly caused by a virus and can lead to
left-sided heart failure.
• CONGENITAL HEART DEFECTS = If your heart and its
chambers or valves haven't formed correctly, the healthy parts of
your heart have to work harder to pump blood through your heart,
which, in turn, may lead to heart failure.
SIGNS AND SYMPTOMS
Heart failure can be ongoing (chronic), or your condition may
start suddenly (acute).
Heart failure signs and symptoms may include:
• Shortness of breath (dyspnea) when you exert yourself or

when you lie down
• Fatigue and weakness
• Swelling (edema) in your legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged
phlegm
• Increased need to urinate at night
• Swelling of your abdomen (ascites)
• Very rapid weight gain from fluid retention
• Lack of appetite and nausea
• Difficulty concentrating or decreased alertness
• Sudden, severe shortness of breath and coughing up pink,
foamy mucus
• Chest pain if your heart failure is caused by a heart attack
DIAGNOSTIC TEST
After the physical exam, your doctor may also order some of these tests:
• Blood tests. Your doctor may take a blood sample to look for signs of
diseases that can affect the heart. He or she may also check for a
chemical called N-terminal pro-B-type natriuretic peptide (NT-proBNP) if
your diagnosis isn't certain after other tests.
• Chest X-ray. X-ray images help your doctor see the condition of your
lungs and heart. Your doctor can also use an X-ray to diagnose conditions
other than heart failure that may explain your signs and symptoms.
• Electrocardiogram (ECG). This test records the electrical activity of your

heart through electrodes attached to your skin. It helps your doctor
diagnose heart rhythm problems and damage to your heart.
• Echocardiogram. An echocardiogram uses sound waves to produce a
video image of your heart. This test can help doctors see the size and
shape of your heart along with any abnormalities. An echocardiogram
measures your ejection fraction, an important measurement of how well
your heart is pumping, and which is used to help classify heart failure and
guide treatment.
• Stress test. Stress tests measure the health of your heart by how it

responds to exertion. You may be asked to walk on a treadmill while
attached to an ECG machine,or you may receive a drug intravenously that
stimulates your heart similar to exercise.
• Sometimes the stress test can be done while wearing a mask that
measures the ability of your heart and lungs to take in oxygen and breathe
out carbon dioxide. If your doctor also wants to see images of your heart
while you're exercising, he or she may use imaging techniques to visualize
your heart during the test.
• Cardiac computerized tomography (CT) scan. In a cardiac CT
scan, you lie on a table inside a doughnut-shaped machine. An X-
ray tube inside the machine rotates around your body and collects
images of your heart and chest.
• Magnetic resonance imaging (MRI). In a cardiac MRI, you lie on

a table inside a long tubelike machine that produces a magnetic
field, which aligns atomic particles in some of your cells. Radio
waves are broadcast toward these aligned particles, producing
signals that create images of your heart.
• Coronary angiogram. In this test, a thin, flexible tube (catheter)
is inserted into a blood vessel at your groin or in your arm and
guided through the aorta into your coronary arteries. A dye
injected through the catheter makes the arteries supplying your
heart visible on an X-ray, helping doctors spot blockages.
• Myocardial biopsy. In this test, your doctor inserts a small,

flexible biopsy cord into a vein in your neck or groin, and small
pieces of the heart muscle are taken. This test may be performed
to diagnose certain types of heart muscle diseases that cause
heart failure.
MEDICAL INTERVENTIONS
Surgery and medical devices
In some cases, doctors recommend surgery to treat the
underlying problem that led to heart failure. Some treatments being
studied and used in certain people include:
• Coronary bypass surgery. If severely blocked arteries are

contributing to your heart failure, your doctor may recommend
coronary artery bypass surgery. In this procedure, blood vessels
from your leg, arm or chest bypass a blocked artery in your heart
to allow blood to flow through your heart more freely.
• Heart valve repair or replacement. If a faulty heart valve causes
your heart failure, your doctor may recommend repairing or
replacing the valve. The surgeon can modify the original valve to
eliminate backward blood flow. Surgeons can also repair the
valve by reconnecting valve leaflets or by removing excess valve
tissue so that the leaflets can close tightly. Sometimes repairing
the valve includes tightening or replacing the ring around the
valve (annuloplasty).
• Heart transplant. Some people have such severe heart failure

that surgery or medications don't help. They may need to have
their diseased heart replaced with a healthy donor heart.
PROGNOSIS
• Factors determining prognosis in 100 patients with recent onset of
congestive heart failure (CHF) were evaluated. The 1 year, 3 year, 5 year,
and 10 year survival rates in the entire CHF group were 78.5%, 59.8%,
50.4% and 14.7%, respectively. No correlations between age, sex, heart
rate and cardiothoracic ratio, and the cumulative survival rate were found.
The prognosis of patients with CHF due to underlying coronary artery
disease or primary cardiomyopathy was poor compared with that of
patients with other types of heart disease. Patients whose NYHA
classification was class III or VI had a significantly lower survival rate than
those in class II. Patients with lower left ventricular stroke work and
consecutive ventricular premature depolarization also had a significantly
lower survival rate. These results suggest that functional status, underlying
heart disease, left ventricular stroke work, and the presence of ventricular
tachycardia provide important information regarding the long-term
prognosis in patients with congestive heart failure.
NURSING DIAGNOSIS
• Activity intolerance (or risk for activity intolerance) related to
imbalance between oxygen supply and demand because of
decreased CO
• Excess fluid volume related to excess fluid or sodium intake and
retention of fluid because of HF and its medical therapy
• Anxiety related to breathlessness and restlessness from
inadequate oxygenation
• Powerlessness related to inability to perform role responsibilities
because of chronic illness and hospitalizations
• Noncompliance related to lack of knowledge
NURSING INTERVENTIONS
• Auscultate apical pulse, assess heart rate, rhythm. Document
dysrhythmia if telemetry is available.
Rationale: Tachycardia is usually present (even at rest) to
compensate for decreased ventricular contractility. Premature atrial
contractions (PACs), paroxysmal atrial tachycardia (PAT), PVCs,
multifocal atrial tachycardia (MAT), and atrial fibrillation (AF) are
common dysrhythmias associated with HF, although others may
also occur.
• Check vital signs before and immediately after activity, especially
if patient is receiving vasodilators, diuretics, or beta-blockers
Rationale : Orthostatic hypotension can occur with activity because
of medication effect (vasodilation), fluid shifts (diuresis), or
compromised cardiac pumping function.
• Provide assistance with self-care activities as indicated.

Intersperse activity periods with rest periods.
Rationale : Meets patient’s personal care needs without undue
myocardial stress and excessive oxygen demand.
• Instruct patient in effective coughing, deep breathing.
Rationale : Clears airways and facilitates oxygen delivery.
• Place patient in Fowler’s position and give supplemental oxygen.

Rationale : To help patient breath more easily and promote
maximum chest expansion.
• Observe breathing pattern for SOB, nasal flaring, pursed-lip

breathing or prolonged expiratory phase and use of accessory
muscles
Rationale : Identifies increased work of breathing.
Thank you !

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PATHOPHYSIOLOGY OF

Reported By: Jay_Ann M. Cabia BSN II-A

• Certain conditions, such as narrowed arteries in your heart

• FAULTY HEART VALVES = The valves of your heart keep blood

• MYOCARDITIS = Myocarditis is an inflammation of the heart

Heart failure signs and symptoms may include:

• Shortness of breath (dyspnea) when you exert yourself or

• Electrocardiogram (ECG). This test records the electrical activity of your

• Stress test. Stress tests measure the health of your heart by how it

• Magnetic resonance imaging (MRI). In a cardiac MRI, you lie on

• Myocardial biopsy. In this test, your doctor inserts a small,

• Coronary bypass surgery. If severely blocked arteries are

• Heart transplant. Some people have such severe heart failure

• Provide assistance with self-care activities as indicated.

• Place patient in Fowler’s position and give supplemental oxygen.

• Observe breathing pattern for SOB, nasal flaring, pursed-lip

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