Congestive Heart Failure
The heart fails when it loses its ability to pump blood effectively and congestion occurs in the circulatory system. Failure of the left ventricle produces pulmonary edema. There is accumulation of fluid in the tissues and engorgement of the liver. The jugular vein becomes distended. There as fluid and electrolyte imbalance, less cardiac reserve, and a reduced flow of blood to the skeletal muscles and the brain.
Arteriosclerosis, coronary artery disease, myocardial infarction, hypertention, and any other disease or defect that decreases the efficiency of the heart`s pumping action may cause it to fail. Pathologies in other systems, such as the kidneys or liver, can precipate heart failure. Inapropriate drug therapy, malnutrition, and obesity are contributing causes.
The syndrome (or set of symptoms) that result from congestive heart failure may differ from person to person. Symptoms include the following :
- Shortness of breath and dyspnea on exertion
- Orthopnea, the inability to breathe while lying down
- Excessive fatigue and weakness
- Persistent cough that may produce blood-tinged sputum
- Wheezing on exertion
- Edema, especially noticeable in fingers, feet, and ankles; feet and ankles most swollen when standing
- Feeling of heaviness in muscles
- Confusion, anxiety
- Nausea, vomiting. Anorexia
- Right upper quadrant discomfort
Congestive heart failure can be gradual or acute, and it is often the end-stage of heart disease.
The treatment is to reduce the work load on the heart as much as possible. Teaching the patient to plan activiies to avoid exertion is imperative. Weight reduction and dietary sodium restriction are important. Drugs include digitalis, diuretics, and vasodilators. A mild tranquilizet may be helpful.
Reference :
Farrell J : Nursing Care of the Older Person, J.B. Lippincott Company, Philadelphia, 1990
