Congestive Heart Failure (CHF): Causes, Symptoms, And Treatment Options

Risk factors for Congestive Heart Failure (CHF)

1.Congestive heart failure (CHF) is a cardiovascular condition which is associated with inability of heart to pump adequate amount of blood. Heart pump inadequate amount of blood mainly due to narrowing of arteries and hypertension. Risk factors of CHF include old age, high cholesterol level, diabetes, hypertension and smoking. Age of Mckenzie is 77 years; hence, her age could be the risk factor for CHF in her. 2 and 5 % people of age between 41 – 60 and 61 – 70 respectively are at higher risk of CHF. Alcohol intake, family history, inadequate physical activity and obesity are also responsible for CHF. Hypertension is one of the significant risk factors for CHF. Likewise, Mckenzie is also detected with hypertension. In comparison to the normal females, hypertensive females are 4 times are at higher risk of CHF. Moreover, females (60 %) are at higher risk of CHF in comparison to males (40 %) (Mahmood and Wang, 2013). High levels of low-density lipoproteins and low levels of high-density lipoproteins are risk factors of CHF. Intake of high amount of saturated fat is mainly responsible for CHF. β-type natriuretic peptides at the higher side are also responsible for CHF (Mirkin, Enomoto, Caputo,  and Hollenbeak, 2017). 36 and 20 % people associated with active smoking and obesity respectively are susceptible to CHF (Australian Institute of Health and Welfare (2014).

Cardiovascular disease conditions like coronary artery disease (CAD), myocardial infraction (MI), arrhythmias, cardiomyopathy, defective heart valves and myocarditis are responsible for the occurrence of CHF. MI in case of Mckenzie, might increase chances of CHF.  Consumption of medicines like antidiabetic medicines (rosiglitazone and pioglitazone), nonsteroidal anti-inflammatory drugs (NSAIDs) (rofecoxib and celecoxib), anaesthetic and anticancer might produce CHF (Castillo, Edriss, Selvan, and Nugent, 2017). It has been reported that people with CHF might not survive more than 5 years after its diagnosis. In comparison to the normal people, death rate might be 10 % more in people with CHF (Australian Institute of Health and Welfare, 2014). 

Mckenzie is associated with cardiovascular and respiratory dysfunction. Hence, she might not be able to carry out her daily activities. It is necessary for her to take support from family members. In addition to support her in activities, family members should observe her daily activities. It might extend emotional and psychological strength to her. Family members might experience financial burden and psychological stress due to her diseased condition. Speedy recovery of Mckenzie could be effectively achieved through monitoring her medications, diet and risk factors by family members and care staff. Positive communication is one of the important factors for the recovery of older people; hence, family members and staff members need to develop positive communication with her (Raman, 2016).

Causes and symptoms of Congestive Heart Failure (CHF)

2.

Symptom Save Time On Research and Writing Hire a Pro to Write You a 100% Plagiarism-Free Paper. Get My Paper	Pathophysiology
Dyspnoea	CHF is associated with decreased cardiac output. As a result, there would be less blood supply to different parts of the body including skeletal muscle. Less supply of blood to skeletal muscle results in the improper functioning of the skeletal muscles. It has been established that improper functioning of the skeletal muscles leads to increased left ventricular pressure to improve cardiac output.  Consequently, sequence of events occur like pulmonary diffusion and interstitial oedema and breathlessness. Increased diastolic pressure lead to more expenditure and requirement of energy.  It lead to myocardial ischemia and augmented myocardial oxygen requirement (Pang, Collins, Gheorghiade, and Butler, 2018). Hence, Mckenzie is suffering through shortness of breath due to increased oxygen requirement.
Swollen ankle	Swollen ankle occurs due to swelling in the ankle or leg. Accumulation of fluid is mainly responsible for the swelling in any organ. Swelling is the consequence of increased cardiac output. Increased levels of natriuretic peptide and β-type natriuretic peptide are mainly responsible for the vasodilation and decreased ventricular filling pressure. Vasodilation and decreased ventricular pressure results in the decreased both cardiac preload and afterload. Consequently, it results in the decreased blood back flow to the heart through the veins. Valve narrowing is mainly responsible for the reduced blood back flow which results in the inadequate blood pumping by the heart (Moe, 2016). This cardiovascular dysfunction like reduced cardiac output is mainly responsible for the swollen ankle in McKenzie.
Dizziness	CHF mainly occur due to recued amount of blood to various organs as well brain. Reduced supply of blood to the brain results in the dizziness in the person. Abnormality in the heart rate and rhythm are primarily blamed for the dizziness in the patient. Functioning of the vestibulo-ocular reflex (VOR) depends on the six primary neurotransmitters of three-neuron arc. These neurotransmitters include glutamate, acetylcholine, gamma-Aminobutyric acid (GABA), dopamine, norepinephrine and histamine. Acetylcholine exhibits its action as an excitatory neurotransmitter for both peripheral and central synapses. GABA exhibits its action as an inhibitory neurotransmitter in the VOR, lateral vestibular nucleus and medial vestibular nucleus. Dopamine exhibits its action through accelerating vestibular compensation. Norepinephrine exhibits its action through controlling vestibular stimulation. However, role of histamine in the dizziness is unclear. Thus, cardiovascular dysfunction in the form of reduced cardiac output led to dizziness in McKenzie (Kemp and Conte, 2012).

3.Angiotensin-converting-enzyme inhibitor (ACE inhibitor) is a choice of drug in patients like McKenzie.

ACE inhibitor is primary selection of drug for CHF patients. ACE inhibitors produce its action through inhibiting angiotensin-converting enzyme. Angiotensin-converting enzyme in a vital constituent of the physiological system renin–angiotensin- aldosterone (RAAS) system. Abnormal working of the RAAS is one of the main cause responsible for hypertension. ACE inhibitors produce its antihypertensive effect by inhibiting conversion of Angiotensin I (ATI) to Angiotensin II (ATII). ACE inhibitors produce different physiological effects like reduced resistance in blood vessels, reduced arteriolar resistance, increased excretion of sodium in the urine, decreased resistance in blood vessels and reduced cardiac output and volume (Opie and Gersh, 2011). ACE inhibitors produce its antihypertensive effect through relaxation of the blood vessels and reduced amount of blood volume. It results in the reduced blood pressure and reduced oxygen demand and consumption by the heart (Sayer and Bhat, 2014). Hence, ACE inhibitors are considered as the first line of treatment for cardiovascular patients like Mckenzie. In case of Mckenzie, ACE inhibitor like enalapril is being used. Enalapril is useful in various cardiovascular abnormalities like asymptomatic left ventricular dysfunction, hypertension and symptomatic heart failure. All these cardiovascular conditions are associated with CHF. Enalapril is also proved useful in renal diseases like chronic kidney failure and psychogenic polydipsia. Management and treatment of all these cardiovascular and related conditions are required in patients like Mckenzie because all these are the risk factors for CHF. Examples of ACE inhibitors include benazepril, enalapril, ramipril, captopril, perindopril, zofenopril, trandolapril and lisinopril (Sayer and Bhat, 2014).

Following are the pharmacokinetic parameters of enalapril: onset of action is 1-hour, peak effect between 4 – 6 hours, total duration of action 12 – 24 hours and oral bioavailability 60 %.  Enalapril is a prodrug and it exhibit its ACE inhibitory potential through its metabolite Enalaprilat (Opie and Gersh, 2011).

4.Nursing Intervention for Mckenzie within first 8 hours of her admission.

Goals	Intervention	Rationale
To maintain normal cardiovascular parameters like hear rate, hear sound, peripheral pulse and heart beat rhythm. To maintain normal blood pressure. To maintain normal urine output and urine concentration. To provide medication to McKenzie on regular basis.	Monitor and record cardiovascular parameters like heart rate and heart beat rhythm. Observe heart sound. Record and note peripheral pulses. Measure and record blood pressure. Measure and note urine output and observe urine concentration. Monitor medicine consumption by McKenzie and ensure regular consumption of furosemide and enalapril by her.	Heart rate need to be maintained between 60 – 100 bpm in McKenzie. McKenzie is associated with bradycardia. Due to her CHF; there could be dysrhythmias like premature atrial contractions, paroxysmal atrial tachycardia, premature ventricular contractions, multifocal atrial tachycardia, and atrial fibrillation (Suter, Gorski, Hennessey, and Suter, 2012).   Since, McKenzie is a CHF patient; there would be reduced pumping action in her. It leads to weak S1 and S2 sounds.  Valvular incompetence produces murmurs in the heart sound (Suter, Gorski, Hennessey, and Suter, 2012).  Patients with CHF produce pulse like popliteal, post tibial pulse, radial and dorsalis pedis. Blood pressure need to be maintained in McKenzie between 120/80. Systemic vascular resistance might produce hypertension in patients with CHF (Suter, Gorski, Hennessey, and Suter, 2012).     Normal urine output need be maintained in McKenzie to 2000 millilitres per day. CHF patients are usually associated with lessened cardiac output which is mainly responsible for reduced urine output. Concentration of urine usually alters as a result of sodium and water retention (Suter, Gorski, Hennessey, and Suter, 2012).     Furosemide is a class of loop diuretic. It exhibits its action through maintaining normal cardiac output and reducing preload (Paul and Hice, 2014). Enalapril is an antihypertensive drug which exhibit its action through inhibiting ACE. ACE inhibitors exhibit its action through augmenting cardiac output and ventricular filling pressure (Paul and Hice, 2014).
To maintain normal respiratory parameters in McKenzie. To maintain normal ABG levels in McKenzie. To ensure consumption of medications by McKenzie. To maintain normal breathing pattern in McKenzie.	Measure and record respiratory rate after every four hours. Measure and record ABG levels.  With the physicians consultation, provide oxygen 4L by nasal prone. Ensure McKenzie is consuming bronchodilator medicines. To observe breathing pattern. Demonstrate deep breathing technique to McKenzie and ensure she is following it on regular basis. Following are the deep breathing techniques : passive exhalation, slow inhalation and end respiration holds	In adults normal respiratory rate is 10 – 20 bpm. Respiratory rate outside this normal range reflects dysfunction of respiratory system which include  irregular breathing pattern (Suter, Gorski, Hennessey, and Suter, 2012).  Abnormal breathing pattern indicate dysfunction of respiratory system (Paul and Hice, 2014).   ABG measurement include different parameters like HCO3, pH, PaCO2 and PaO2. Hence, ABG levels measurement is useful in determining acidosis and hypoxia in the patient. ABG levels measurement is helpful in assessing oxygen saturation level and ventilation pattern. Altered ventilation pattern mainly occur due to shortness of breath. Normal oxygen saturation is 95 – 100 % (Suter, Gorski, Hennessey, and Suter, 2012). Bronchodilator medicines produce bronchodilation and airway passage opening (Paul and Hice, 2014). Abnormal breathing pattern indicate dysfunction of respiratory system (Paul and Hice, 2014).  Deep breathing facilitates deep respiration which improves oxygen saturation level.  Extended expiration is useful in preventing air trap (Suter, Gorski, Hennessey, and Suter, 2012).

References:

Australian Institute of Health and Welfare (2014). Cardiovascular disease, diabetes and

chronic kidney disease— Australian facts: Prevalence and incidence. In: Cardiovascular, diabetes and chronic kidney disease series no. 2. Cat. no. CDK 2.

Canberra. Retrieved from https://www.aihw.gov.au/reports/heart-stroke-vascular-disease/cardiovascular-diabetes-chronic-kidney-prevalence/contents/table-of-contents on 14.03.2019.

Castillo, A., Edriss, H., Selvan, K., and Nugent K. (2017). Characteristics of Patients With Congestive Heart Failure or Chronic Obstructive Pulmonary Disease Readmissions Within 30 Days Following an Acute Exacerbation. Quality Management in Healthcare, 26(3), 152-159.

Kemp, C.D., and Conte, J.V. (2012). The pathophysiology of heart failure. Cardiovascular  Pathology, 21(5), 365-71.

Mahmood, S. S., and Wang, T. J. (2013). The epidemiology of congestive heart failure: the Framingham Heart Study perspective. Global Heart, 8(1), 77–82.

Mirkin, K.A., Enomoto, L.M., Caputo, G.M., and Hollenbeak, C.S. (2017). Risk factors for 30-day readmission in patients with congestive heart failure. Heart Lung, 46(5), 357-362.

Moe, G. (2016). Heart failure with multiple comorbidities. Current Opinion in Cardiology, 31(2), 209-16.

Opie, L. H., and Gersh, B. J. (2011). Drugs for the Heart E-Book. Elsevier Health Sciences. New York. United States.

Pang, P.S., Collins, S.P., Gheorghiade, M., and Butler, J. (2018). Acute Dyspnea and Decompensated Heart Failure. Cardiology Clinics, 36(1), 63-72.

Paul, S., and Hice, A. (2014). Role of the acute care nurse in managing patients with heart failure using evidence-based care. Critical Care Nursing Q, 37(4), 357-76.

Raman, J. (2016). Management of Heart Failure (2nd ed.). Springer. Berlin, Germany.

Sayer, G., and Bhat, G. (2014). The renin-angiotensin-aldosterone system and heart failure. Cardiology Clinics, 32(1), 21-32.

Suter, P.M., Gorski, L.A., Hennessey, B., and Suter, W.N. (2012). Best practices for heart failure: a focused review. Home Healthcare Nurse, 30(7), 394-405.