3. DEFINITION
• Congestive cardiac failure is the inability of the heart to maintain an output,
at rest or during stress, necessary for the metabolic needs of the body
(systolic failure) and inability to receive blood into the ventricular cavities at
low pressure during diastole (diastolic failure).
• Thus, due to systolic failure it is unable to propel blood into the aorta and in
diastolic failure it receives inadequate amount of blood.
4. TYPES
• Right sided heart failure
• Left sided heart failure
• Biventricular heart failure
CLASSIFIED BY PUMPING ABILITY OF THE HEART
• •Diastolic heart failure.
• •Systolic heart failure.
CLASSIFIED BY COURSE OF DISEASE
• Acute heart failure
• Chronic heart failure
5. 1. Systolic Dysfunction: A Heart failure in which the heart muscle becomes
weak and cannot squeeze as much blood out. Poor contractility leads to
reduction in the amount of blood pumped out of the ventricles which refer
to ejection fraction.
Normal ejection fraction-50-75%
Heart failure due to systolic dysfunction is typically associated with an ejection
fraction less than 40%. For this reason the systolic heart failure is commonly
known as heart failure with reduced ejection fraction.
6. • 2. Diastolic Dysfunction: In diastolic the heart squeezes normally but
become stiff and cannot adequately relax to allow for normal
ventricular filling. As a result patients with diastolic heart failure
relatively normal ejection fraction although stroke volume and cardiac
output is reduced. So diastolic failure is known as heart failure with
preserved ejection fraction. The body try to compensate via two
mechanism
• 1. Sympathetic Nervous system
• 2. Renin Angiotensin Aldosteron System
7. CAUSES
Infants
• Congenital heart disease
• Myocarditis and primary
myocardial disease
• Tachyarhythmias,
bradyarhythmias
• Kawasaki disease with coronary
occlusion
• Persistent pulmonary
hypertension of the newborn
Children
• Arrhythmias
• Congenital heart disease
• Pulmonary and systemic
Hypertension
• Rheumatic fever / rheumatic
heart disease
• Myocarditis
9. SYMPTOMS
• Slow weight gain.
• Difficulty in feeding(poor feeder).
• Shortness of breath or fatigue from feeding results in the baby accepting only
small amounts of milk at a time.
• Often a mother may state that the baby breathes too fast while feeding or that
the baby is more comfortable and breathes better when held against the
shoulder.
• Persistent hoarse crying, wheezing, excessive perspiration
• An irritable infant crying all the time
10. SIGNS
Right sided failure
• Swelling in the legs ,feet ,abdomen
• Weight gain
• Edema(pitting)
• Large neck veins
• Large liver(hepatomegaly)
• Irregular heart beat
• Nausea
• Girth in abdomen
11. SIGNS
Left sided failure
• Shortness of breath
• crackles
• orthopnea
• difficulty breathing at night
• pulmonary edema
• Tachypnea
• Tachycardia
• Cough
• Wheezing
12. NURSING CARE
• Patients with HF require frequent monitoring of vital signs, including oxygen
saturation, heart rate, rhythm ,Blood pressure ,temperature
• Frequent assessment and monitoring for symptoms is also indicated.
• All patients with HF require daily weight monitoring.
• Drug administration of medication like Furosemide.
• Monitor potassium levels and digoxin toxicity
• Reduced patient activity.
• High Fowlers position
• Elevate feet
• Restrict fluid administration
• Restrict sodium intake
13. MANAGEMENT
• Management of heart failure is a four-pronged approach for
correction of inadequate cardiac output. The four prongs are:
(i) reducing cardiac work,
(ii) augmenting myocardial contractility,
(iii) improving cardiac performance,
(iv) correcting the underlying cause. Identification of the cause is
important since it has direct bearing on survival
14. REDUCING CARDIAC WORK
• The work of the heart is reduced by restricting patient activities, sedatives,
treatment of fever, anemia, obesity and by vasodilators. Mechanical
ventilation helps when heart failure is severe by eliminating the work of
breathing.
• Neonates with heart failure are nursed in an incubator.
• They are handled minimally. The baby is kept propped up at an incline of
about 30. The pooling of edema fluid in the dependent areas reduces the
collection of fluid in lungs, thus reducing the work of breathing.
• At a temperature of 36-37°C, the overall circulatory and metabolic needs are
minimal, thus reducing work of heart.
15. AUGMENTING MYOCARDIAL
CONTRACTILITY
• Augmenting myocardial contractility by inotropic agents like digitalis improves
cardiac output. In infants and children, only digoxin is used. It has a rapid
onset of action and is eliminated quickly. It is available for oral and parenteral
administration. Oral digoxin is available as 0.25 mg tablets. Parenteral digoxin
(0.5 mg/2 ml) is available
Note
1) within a 24 hr period; a half of the calculated digitalizing dose is given
initially, followed by a quarter in 6-8 hr and the final a quarter after another
6-8 hr. The maintenance dose is usually one-quarter of the digitalizing dose .
2) Before the third daily dose, an electrocardiogram is done to rule out digitalis
toxicity.
16. • Toxicity can be controlled by omitting the next one or two doses.
The PR interval is a useful indicator; if it exceeds The upper limit of
normal PR interval in infants is O .14 second.
• Digitalis is used with caution in the following situations:
• (i) premature neonates;
• (ii) heart failure due to myocarditis;
• and (iii) very cyanotic patients.
17. IMPROVING CARDIAC PERFORMANCE
BY REDUCING VENOUS RETURN (PRELOAD)
• Diuretics reduce the blood volume, decrease venous return and ventricular
filling. This tends to reduce the heart size. The larger the heart, the more the
wall tension and the poorer is its performance.
• With reduction in heart size and volume, the myocardial function and the
cardiac output improve
• Diuretics reduce the total body sodium thereby, reducing blood pressure and
peripheral vascular resistance. This helps in increasing the cardiac output and
reducing the work of the heart.
18. CORRECTING THE UNDERLYING
CAUSE
• Non-invasive tests (especially echocardiography) allow identification of the
cause in most children with suspected heart disease. Many of these are
managed by curative or palliative operations
• E.g. idiopathic dilated cardiomyopathy requires exclusion of conditions that are
known to cause ventricular dysfunction
