The Heart Of Heart Failure

Heart failure may convey that the heart isn’t working anymore, but what it really means is that the heart isn’t pumping as well as it should be (REF). Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood through to meet the body’s needs for blood and oxygen (REF). At first, the heart tries to make up for this by enlarging, developing more muscle mass, and pumping faster. As this happens, the blood vessels narrow to keep blood pressure up and the body diverts blood away from less important tissues and organs to maintain flow to the heart and brain (REF). Eventually, the body and heart cannot keep up and the patient begins to feel fatigue, breathing problems, weight gain with swelling in the feet, legs, ankles or stomach, and other symptoms that eventually leads to a hospital visit. The body’s coping mechanisms give us better understanding on why many are unaware of their condition until years after the heart declines (REF).

The prevalence of congestive heart failure is on the increase both in the United States and all over the world, and it is the leading cause of hospitalization in the elderly population. Congestive heart failure is a progressive disease generally seen in the elderly, which if not properly managed, can lead to repeated hospital admissions or death. Heart failure means that the heart muscle is weakened. A weakened heart muscle may not be strong enough to pump an adequate amount of blood out of its chambers. To compensate for its diminished pumping capacity, the heart may enlarge. Commonly, the heart's pumping inefficiency causes a buildup of blood in the

Heart failure is a syndrome where the heart lacks the ability to pump blood effectively throughout the body for a prolonged period. It often co-exists with other diseases or related illnesses that causes damage to the heart, such as atrial

The left side of the heart brings oxygen-rich blood from the lungs through the left atrium to the left ventricle, then out into body. When the left side of the heart is damaged or can’t pump as well, it has to work harder to send blood through the body. This causes fluid to build up in the body, especially the lungs. That’s why shortness of breath is one of the most common symptoms of heart failure. Systolic failure happens when the heart doesn’t pump out blood the way it should. Diastolic means the heart doesn’t fill back up with blood as it should. The symptoms of left sided heart failure are tachypnea, increased work of breathing, crackles initially heard in lung bases, but when severe, heard throughout the lung fields, pulmonary edema, and dullness in lung fields to finger percussion, pleural effusion detectable by reduced breath sounds at the bases of the lungs, and cyanosis.

Congestive heart failure is a chronic condition that is responsible for the highest number of hospitalizations among adults. Readmission rates after hospitalization also remain high, with 50% of patients being readmitted within 6 months of discharge. (Desai & Stevenson, 2012). The Affordable Care Act penalizes hospitals with readmissions within 30 days after discharge, making readmissions a focus of hospitals nationwide. Several factors including discharge planning, patient education, diet restrictions, and early follow up appointments can help to reduce readmissions, but continuous monitoring is necessary to catch early signs of decompensation. (Desai & Stevenson, 2012).

Heart failure is when the heart cannot keep up with the immense demands placed on it by the body, and it starts to compensate causing remodeling of the cardiac cells due to stronger cardiac contractions. The heart chambers expand so they can fill with more blood to pump to the rest of the body, and the heart rate will increase to meet these demands (American Heart Association, 2015). Heart failure is the inability of the heart to fill and pump effectively enough to meet the metabolic demands of the body resulting in pulmonary and venous congestion (Lam et al., 2007). Over time the body can no longer compensate, and the person becomes symptomatic and progresses into worsening heart failure. The pulmonary and venous congestion or “fluid overload” will manifest itself in the form of lower extremity edema, shortness of breath, fatigue and even chest pain, which interferes with quality of life (Colucci, 2015).

Left sided heart failure causes a decrease in cardiac output and can be further classified as systolic or diastolic. When the cardiac output is decreased and can not get enough oxygen to important organs, it is from an imbalance of stroke volume and heart rate. When a person experiences a myocardial infarction or continuous hypertension, the contractility of the heart decreases which directly influences the stroke volume. The stroke volume is the amount of blood pumped out of the heart per contraction so if that decreases, so does the cardiac output which decreases perfusion of the organs (Huether and McCance, 2012). Diastolic heart failure in the left side is when the ventricle has trouble filling to its full capacity which is usually caused by a stiffening or loss of contractility of the ventricle.

The heart’s moves oxygen-rich blood from the lungs to the left atrium onto the left ventricle which then pumps it to the rest of the body. The left ventricle generates the heart’s pumping power therefore it is larger than the other chambers. In left-sided heart failure, the left side of the heart works harder to pump the same amount of blood that is normally pumped. There are two types of left-sided heart failure- the systolic and the diastolic. In systolic failure, the left ventricle is not able to normally contract and the heart cannot push enough blood into the circulation. In systolic failure, the left ventricle is not able to relax because the muscle has become stiff. As a result, the heart cannot properly fill with blood during resting period between each beat. Right-sided heart failure is another type of heart failure that results from the failure of the left-side. The heart’s pumping action moves blood that returns to the heart though the veins through the right atrium and then onto the right ventricle which pumps the blood back out of the heart into the lungs to be replenished with oxygen. When the left ventricle

In the valvular disease the regurgitation of blood back to the ventricles occurs when the valves fail to close tightly and this will result in ventricular overload and increased muscle stretching. This increases the heart muscles need for oxygen and energy resulting in the cardiac muscles to contract harder (Karch, 2013). The failure of the left ventricle to pump efficiently will lead to pulmonary vessel congestion and in severe cases, pulmonary edema whereas the inefficient pumping of right ventricle will lead to liver congestion and peripheral edema (edema of the legs and feet). The cardiovascular system works as a closed system and therefore, if one-sided failure left untreated, will eventually lead to failure of both sides (Karch, 2013). The American College of Cardiology (ACC)/ American Heart Association (AHA) has incorporated a classification system of heart failure that include four stages. This staging system (stage A to stage D) recognizes that there are established risk factors and structural abnormalities that are characteristics of the four stages of heart failure.

Based on Goodman and Fuller (2015), it was estimated that the annual population in the United States with (CHF) congestive heart failure is about five hundred fifty thousand, and approximately five million male and female elderly individual (65 years old and above) is the leading cause of hospital admission. Moreover, heart failure has a significant twenty percent of an estimated death rate and fifteen percent survival rate of patients diagnosed with CHF (Bocchi, Vilas-Boas, Perrone, Caamaño, Clausell, Moreira et al., 2005; Hunt, Abraham, Chin, Feldman, Francis, Ganiats et al., 2005).

Heart failure is a serious medical condition that is brought by the failure of the heart to pump sufficient blood throughout the body at the right pressure. Generally, this condition is a progressive and chronic disease in which the heart muscle is incapable to pump adequate blood for all blood and oxygen needs of the body. Since the heart cannot keep up with its workload under this condition, it attempts to make up for the failure through enlarging, developing more muscle mass, and pumping faster. Enlarging involves stretching the heart chamber more in order to pump more blood while developing more muscle mass occurs because of increase in size of the contracting cells and pumping faster helps to enhance the heart’s output (“About Heart Failure”, n.d.). As a major health problem, potential solutions for heart failure is a nursing focused plan that incorporates identifying nursing goals, monitoring the patient, and specific nursing interventions.

There are two main types of heart failure. Left sided heart failure and right sided heart failure. The left ventricle is the largest chamber of the heart, and is also the most common site that fails in heart failure. When the left ventricle starts to fail it allows the blood that is normally pumped out into the circulatory system to back up into the left atrium due to the weekend left ventricle not pushing all the blood out. This leads to a cascade of events that lead to a backup in the pulmonary system allowing fluid to accumulate in the lungs which in turn causes shortness of breath. Right sided heart failure is less common than left sided heart failure and is usually caused by the problems associated with left sided heart failure over time. When the right

“HF [heart failure] is a common, expensive, severe, and progressive disease state in which routinely adjusted treatments are required to lower morbidity and mortality, and reduce overall health care costs” (Dendale & Coauthors, 2012, p. 1). Due to the severity of HF, readmission rates of HF patients are an area of great concern because HF is the leading cause of hospital admissions and readmission in patients older than 65 years (Stamp, Machado, Allen, Correspondence, 2014). Not only is it the leading cause of hospital admissions and readmissions, it is also one of the most costly diagnoses in the United States (Stamp et al., 2014). Heart failure has become an increasing issue among a variety of patients especially those that have other underlying health conditions and especially those who are older. Heart failure has many troublesome symptoms that may reduce a patient’s quality of life. “Frequently experienced symptoms by HF patients such as shortness of breath and extreme fatigue significantly restrict an individual’s ability to perform self-care and daily activities…” (Stamp. et al., 2014). Readmission rates for HF patients is becoming a growing concern especially due to the “baby boomer” population getting older, which in return will increase the number of first time admissions and readmissions for patients with heart failure (Betihavas, 2013). According to Cykert (2012), “The ACA penalizes hospitals with a high rate

CHF suffers 1.5-2% of the world's population [74]. The prevalence of CHF in the European population reaches 2.0%, in US - 2.2%, and in Russia - 6% and significantly increases with age [34, 63]. Currently, the number of patients with heart failure is increasing in all developed countries. This is due to an increase in survival in patients with cardiovascular disease, in particular, acute coronary syndrome, and thus objectively predisposed to the development of heart failure, as well as the steady trend to an increase in the population share of older age groups [79,

The purpose of this paper is to synthesize a comprehensive review of the evidence based relevant factors to the morbidity and mortality associated with increasing risk factors of heart failure-HF as well as the pathophysiology of the heart and diseases associated with physiological and social behavior risks in the process of cardiovascular disease- CVD’s, by discussing the implications of the age, gender, and progression of the disease associated with major comorbidities, and possible intervention approaches to preventing and promoting healthy life. By decreasing risk factors and enhancing understanding to promote positive outcomes.