Systolic Heart Failure With Reduced Ejection Fraction ( Hfref )

Mr. Javier Escobar, U.S Army Veteran, 50-year-old Latino male and divorced claiming to “not having anyone in his life due to Combat Post Traumatic Stress Disorder”. Mr. Escobar is a newly patient diagnosed with Congestive Heart Failure (CHF). Patient claims to smoke 1 pack of cigarettes a day, also the consumption of 1 bottle (750mls) per night of alcohol. Congestive Heart Failure is due to Chronic high blood pressure that puts great stress on the heart muscle. The muscle of the heart weakens and fails to push the normal amount of blood around the body leading to Congestive Heart Failure. There are multiple symptoms that could by identified before heart failure such as anxiety, restlessness, cyanotic (blue

The Canadian Heart and Stroke Foundation defines heart failure (HF) as “a common condition that develops after the heart becomes damaged or weakened by diseases of the heart including heart attacks and other medical conditions. (Heart Failure, 2013)” HF is a chronic medical condition causing the body’s heart to weaken and become unable to pump and supply enough blood and nutrients to the meet the body’s needs. There are four different types of HF: left-side, right-side, systolic and diastolic heart failure (Heart Failure, 2015). Left-side heart failure causes shortness of breath due to fluid backing up in the lungs. Right-side heart failure causes fluid retention in abdomen, legs and feet causing swelling. Systolic heart failure is when the left ventricle can’t contract fast enough, indicating a pumping issue and diastolic heart failure is when the left ventricle can’t relax enough to fill properly, indicating a filling problem (Heart Failure, 2015). These abnormalities in heart function can result a homeostatic imbalance in the kidneys responding by causing the body to retain fluid and salt. The term congestive heart failure (CHF) is used when the heart failure has worsened causing a backup of fluid and congesting extremities and other organs (Heart Failure, 2015). Often, you can control heart failure by taking medicine, changing your lifestyle, and treating the condition that caused it but there is no cure at this time.

The cardiac muscle cells can be affected by heart disease through the inability to maintain its homeostasis through the calcium pump. If there is excess calcium within the heart it results in the in ability of the heart muscle to relax. As a result, the ADP/ATP ratio increases, phosphocreatine decreases, and energy stores are depleted. Furthermore, this imbalance affects the energy needed to relax the left ventricle. Secondly, diastolic heart failure can occur from changes in preload, afterload, renin-angiotension-aldosterone system, and the sympathetic nervous system. These changes affect the fibrillar collagen within the extracellular matrix that affects the ability of the ventricular to relax. These changes along with those compensatory mechanisms results in continuous resistance that results in increased in left ventricular end-diastolic pressure (McCance & Huether, 2010).

Heart failure (HF) is a chronic, progressive condition defined as the hearts inability to efficiently pump an adequate amount of blood to meet the demands of the body (Naab, 2011). Heart failure may be the result of the heart chambers not adequately filling, also known as diastolic HF or the decreased contractility of the valves to perfuse blood to the body, also known as systolic HF. “Heart Failure is a progressive disease which arises as a consequence of an abnormality in cardiac structure, function, rhythm or conduction” (Naab, 2011).

The Cardiovascular system – The left ventricle undergoes remodelling consisting of left ventricular dilation and hypertrophy (enlargement), such that stroke volume is increased without an actual increase in the ejection fraction. Cardiac changes that occur following heart failure are:      Decreased stroke volume and cardiac output Increased end diastolic pressure Ventricular dilation or hypertrophy (enlargement) Impaired filling (diastolic dysfunction) Reduced ejection fraction (systolic function)

Heart failure (HF) is a complex syndrome in which structural or functional cardiac disorders impair the ability of one or both ventricles to fill with or eject blood. HF is considered to be a chronic condition with periods of worsening symptoms that may require medical attention. It may present acutely within just 24 hours in the form of pulmonary edema or even cardiogenic shock. To diagnose HF, three criteria need to be present: including shortness of breath at rest or during exertion and/or fatigue, signs of fluid retention such as pulmonary congestion and/or ankle swelling, and objective evidence of a decrease in myocardial performance at rest which is demonstrated using echocardiography.(1)

Intro- Heart Failure is a multifactorial disease due to significant diminishing of heart pumping action. This is occurs in response to many underlying disease such as diabetes, hypertension, myocardial infarction and cardiac myopathies. These conditons lead to hemodynamic instability, neuroendocrine imbalances and structural remodeling of cardiac myocytes. Early less sever hf allows for compensatory mechanisms such as neuroendocrine stimulation- (beta adrenbergic r endothelin norepinephrine r), and hypertrophy which allow for sufficient left ventricular pumping action. However as hf develops these mechanisms become unable to compensate for the progressive underlying disease which results in further loss of contraction and relaxation efficiency and loss of regulation.

There are two types of heart failure: systolic heart failure and diastolic heart failure. In systolic heart failure, left ventricle have 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 chamber rigidity increase, which then causes inadequate filling of blood and slows down the ability to eject blood efficiently. Calcium is not

Heart failure is defined as “ the pathophysiologic condition in which the heart is unable to generate an adequate cardiac output such that there is inadequate perfusion of tissues or increased diastolic filling pressure of the left ventricle, or both, so that pulmonary capillary pressures are increased.” Congestive Heart Failure (left heart failure) is categorized as “heart failure with reduced ejection fraction or heart failure with preserved ejection fraction” (McCance & Huethe, 2014, p. 1175). According the American Heart Association, this patient has Stage C Heart Failure with Reduced Ejection Fraction (HFrEF) since his left ventricular ejection fraction is 30% (Yancy et al., 2013, p.

Hypertrophic cardiomyopathy (walls of ventricles become thick) with thickening of the walls also come stiffness resulting in the heart being unable to fill adequately also reducing the stroke volume

Systolic and diastolic are two different forms of left-sided heart failure. During systolic heart failure, the cardiac muscle loses its capability to contract normally. The opposite happens during diastolic heart failure; the muscle becomes rigid and fails to relax normally (“Types of Heart Failure,” 2015). Angiotensin converting enzyme inhibitors (ACEI) and Angiotensin II Receptor Blockers (ARBs) have been the go to drugs after these life changing events to assist with the quality of life. At times, a diuretic is also prescribed to the client depending on the situation. The plan of action would be different for both the systolic and diastolic heart failure clients.

The rapid degeneration of myocardial fibers and diffuse inflammation lead to ventricular dilation and hypertrophy which cause atrial enlargement and stasis of blood in the left ventricle (Park, 2008). The enlargement of the remaining heart chambers is mainly due to left ventricular failure, but it may also be secondary to the primary cardiomyopathic process. Dilated cardiomyopathy is associated with both systolic and diastolic dysfunctions, with decreased systolic function being the predominant abnormality (Parker, 2008). This dysfunction leads to decreased contractility and general contractile dysfunction (Parker, 2008). Progressive dilation can lead to significant mitral and tricuspid regurgitation, which may further decrease the cardiac output and increase end-systolic volumes and ventricular wall stress. In turn, this leads to further dilation and myocardial dysfunction (Friedberg, 2008). Dilated cardiomyopathy is the most common type of heart muscle disease in pediatrics (Chow, Ateah, Scott, Ricci, & Kyle, 2013). Dilated cardiomyopathy can be a life threatening condition and can decrease life expectancy if severe damage occurs. Currently, the five-year survival rate for children diagnosed with dilated cardiomyopathy is between forty and eighty percent. The survival rate decreases if they child is diagnosed at five years or older (Friedberg, 2008).

There are two types of the LSHF. Systolic failure occurs when the left ventricle loses its ability to contract normally. Therefore, the heart can’t generate enough force to push an adequate amount of blood into circulation, resulting in increased afterload. The heart also does not eject all the blood delivered to the left ventricle. The percentage of blood that is ejected from the heart compared to the amount of blood at the end of the ventricular filling is expressed in a percentage called the ejection fraction (Burns, 2016; Yelle & Chaudhry, 2016).

The pathophysiology of congestive heart failure is that the heart has a loss of contractibility. This causes a lack of cardiac output which can’t meet the demands of the body. CHF can be caused by multiple different factors such as loss of muscle, abnormal rhythm or volume overload. CHF often occurs in patients who have multiple comorbidities such as hypertension or diabetes

Left Ventricular Systolic Dysfunction (LVSD) is an abnormal cardiovascular symptom characterized by a reduction in the left ventricular ejection fraction (LVEF), a measurement of the percentage of blood leaving the heart with each contraction. LVEF is commonly measured using echocardiography and calculated as the ratio between the blood volume exiting the left ventricle over the volume filling the left ventricle. A higher ejection fraction (EF) indicates better strength and contractility of the heart. Recent guidelines from the American and European society of echocardiography have defined an abnormal LVEF as any EF <40-55%.