Congestive Heart Failure: Symptoms, Causes, And Management

Symptoms of Congestive Heart Failure

Congestive heart failure mainly takes place when the muscles in the heart cannot pump blood successfully. Koene et al. (2016) opine that conditions like narrowed arteries in the heart or high blood pressure make the heart weak or stiff and for this reason they cannot be filled with blood successfully and hence cannot undertake pumping action efficiently.  In cases of heart failure, the pumping chambers of the heart mainly the ventricles might become stiff and not fill properly in between beats. In other cases, the heart muscles become damaged and weakened and here, the ventricles are seen to get stretched to a particular point where they can no longer pump blood efficiently throughout the body causing the disorder. The patient named Sharon Mckenzie has also been found to be suffering from congestive heart failure because she was having the same physiological issues that had been mentioned in the parapgraph. 

The different signs and symptoms are shortness of breath, swelling in the legs ankles and feet, rapid or irregular heartbeat are some of the symptoms. Others are increased urination at night, persistent cough, and wheezing of white or pink phlegm, rapid weight gain from fluid retention, lack of appetite and nausea are some other signs (Anderson et al., 2016).  Sharon is also seen to suffer many of these symptoms like swelling of ankles, shortness of breath, dizziness and others and hence nurses can state that she is suffering from congestive heart failure

Cardiovascular disorder is one of the major causes of death in the nation of Australia with around 43477 deaths attributed to cardiovascular disorders in 2017. This disorder is killing about one Australian in every 12 minutes and is affecting one in six Australians of 4.2 million people. Heart failure is present 1 to 2 % of the Australian population and is predominantly a disorder that affects mainly the elderly with around 10% being present among the elderly (Messerli et al., 2017).

Varieties of risks factors are seen to be intricately associated with the disorder. High blood pressure and coronary artery disease are two such factors. Sharon suffers from high blood pressure issues which might be a cause of her congestive heart disorder. Besides, heart attack, diabetes and some diabetic medications, sleep apnea and congenital heart defects can also increase the chances of an individual to suffer from congestive heart failure (Piepoli et al., 2016). Valvular heart disorders, viruses, excessive use of alcohol, use of tobacco, irregular heartbeats, and obesity are also believed to increase the chances of the disorder. 

Causes of Congestive Heart Failure

The patient suffering from congestive heart failure may suffer from a large number of healthcare complications. They may suffer from kidney damage or failure. Heart failure might reduce the flow of blood to the kidneys, which eventually leads to cases of kidney failures when not treated. It may also result in heart valve problems. The valves of the heart, which actually work by making the blood flow in one direction, might no more function properly when heart is enlarged or when blood pressure is high due to heart failure (Mozaffarian et al.,  2016). Heart rhythm problems and liver damages are also other physical complications that the patients may also suffer due to heart failure. Moreover, the patients might also suffer from stress and anxiety because of the suffering they have to o through because of the symptoms of the disorder. They have to lead restricted lives which might make them feel frustrated. The family members can also suffer from stress and depression seeing their patients suffers. They may feel guilty thinking that they might have not taken enough care of the patients. Moreover, financial crisis might also impact the quality of lives of both patients and family members because of the healthcare expenditures. Sharon has developed symptoms of congestive heart failure and she and her family is highly vulnerable of experiencing the same issues because of her disorder.

Symptoms	pathophysiology
Edema that occurred in the patient named Sharon is one symptom of congestive heart failure.	When an individual suffer from congestive heart failure, one or both sides of the lower chambers of the heart lose their capability in pumping blood sufficiently. Because of this factor, blood can get backed up in the legs, feet and ankle and this results in causing edema (Iwagami et al, . 2018) Congestive heart failure can also cause swelling in the abdomen. Therefore, Sharon is also seen have swollen ankles.
When pulmonary edema occurs, the body is seen to struggle in order to get enough oxygen and this causes shortness of breath.  Sharon is also suffering from shortness odd breath	Pulmonary edema is a condition where the lungs get filled up with fluid.   During the times of heart failure, heart can no longer pump blood throughout body thereby creating a backup of pressure in the small blood vessels of the lungs. These cause the vessels in leaking fluid (Ter Maaten et al., 2015). When the fluid fills up the lungs, they cannot put oxygen into the blood system and thus causes deprivation of oxygen to the rest of the body. This causes shortness of breath. Sharon has been found to be suffering from such symptoms.
Dizziness especially when standing up too quickly of feeling of fainting are also found to be common symptoms in people suffering from congestive heart failure. Sharon is also seen to feel dizzy.	Many of the studies opine that these might be due to abnormal heart function or rhythm or due to narrowing of the valves. Blood flow to the brain might get reduced when the heart rate or rhythm becomes abnormal or when the heart cannot pump blood sufficiently because blood flow gets blocked like because of narrowing of the valve due to heart failure. Feeling dizzy, light-headed and fainting might be mainly because of reduction of the blood flow to the brain. Studies opine that sudden loss of consciousness usually means that supply of blood to the brain is seriously reduced (Buck et al., 2015).

One of medicine that had been used for treating congestive heart failure of Sharon is enalapril. This drug belongs to the class of Angiotensin-converting enzyme inhibitors or the ACE inhibitors.

This class of drugs is seen to inhibit the activity of ACE competitively for prevention of the formation of active octapeptide, angiotensin II, from that of the inactive decapeptide angiotensin I. This occurs in blood as well as different tissues that include kidney, heart, blood vessels as well as adrenal glands and brain. Studies have shown that Angiotensin II is a potent vasoconstrictor and is successful in promoting aldosterone release. It also helps in facilitating sympathetic activities and has many harmful effects on the cardiovascular systems (Rickenbacher et al., 2017). It has been found that the reduction in the blood pressure secondary to that of the process of vasodilatation following that of ACE inhibition in the greatest when the rennin-angiotensin system gets stimulated like during the times following salt-restriction, renal artery stenosis and diuretic therapy. However, Ace inhibitors also lower the blood pressure when there is normal or low activity of that of the renin-angiotensin system.  

Healthcare Complications of Congestive Heart Failure

This drug is absorbed by 55 to 75% where absorption remains unaffected by food. All ACE inhibitors are found to bind with that of the tissue and plasma proteins and free drug is eliminated rapidly mainly by the kidney predominantly by the glomerular filtration. It has been found that they bind with the tissues sites and the plasma concentration time profile shows a long lasting terminal elimination phase (Inamdar et al., 2016). Enalapril is an inactive pro drug. It is found to require hydrolysis during or active absorption to general the active acid form called enalaprilat.

Goals	Interventions with rationale
Nursing goal: management of edema, blood pressure	Pharmacological management is one of the most important nursing interventions that need to be taken. The nurses should provide diuretics to Sharon. It helps in relieving congestive symptoms as well as fluid retention and this will help managing the symptoms of edema and fluid accumulation in lungs as well. Another set of intervention that should be given to Sharon would be the beta-blockers, which mainly act by countering the effects of the sympathetic nervous system. These are the medications that help in reduction of the blood pressure. They mainly work by blocking the effects of the hormone epinephrine. When beta blocker would be provided to Sharon, her heart would beat slowly and with less force and this would help in reduction of her blood pressure which is found to be quite high above the normal level (Ouwerkerk et al., 2017). Beta blockers also help the blood vessels in opening up and improving the blood flow. Another group of drug that should be also provided to Sharon is the Angiotensin Converting Enzyme inhibitors. These drugs mainly help in relaxing the blood vessels. These drugs help on preventing the enzyme in the body that produces angiotensin II. This substance in the body narrows the blood vessels and it releases hormones that can raise the blood pressure. This narrowing causes the occurrence of high blood pressure and force the heart to work harder. Hence, this drug helps in preventing the action of the enzyme and hence blood pressure comes under control.
Nursing goal: management of shortness of breath	Oxygen therapy is an important nursing intervention that can also prove to be helpful for Sharon. During heart failure, the heart muscles might become weaker and may not pump enough blood the way they normally would. In such conditions, the body does not get oxygen it requires. In such cases, nurses need to initiate oxygen therapy. This therapy helps the patients to breathe in extra oxygen for making sure that the whole body is getting oxygen. It can help in prevention of failures of organs that might take place due to inability of oxygen to reach the other organs. This would help in preventing damages to kidney, brain and even heart itself (Shen et al., 2017). This would be very helpful for the symptoms of shortness of breath and swelling of ankles. Sharon would be benefitted from this intervention as well.  To manage her breathing problems in the night, nurse should use more pillows, allow her to sleep in a recliner chair and provide her a cushion for support so that Sharon might rest upright.
Nursing goal: to prevent any further deterioration of the condition of the patient and relapse into severe phases again.	Nurses need to monitor the vital signs of Sharon in regular intervals to monitor the condition of the patient. Studies have stated that monitoring the vital signs at regular intervals can help in acting as important strategy for not only early detection but also treatment of the alteration in the vital signs that denote the deteriorating situations of the patient or their relapse into severe stages of heart failure.  The basic sets of vital parameters that need to be conducted would mainly comprise of ECG, SpO2, Blood Pressure and Weight, respiration rate, and others. All these should be documented from time to time in order to study the trend and understand whether the person is responding to the treatment and whether she is coming out of danger (Bnagalore et al., 2016)

References:

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Bangalore, S., Fakheri, R., Toklu, B., Ogedegbe, G., Weintraub, H., & Messerli, F. H. (2016, January). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in patients without heart failure? Insights from 254,301 patients from randomized trials. In Mayo Clinic Proceedings(Vol. 91, No. 1, pp. 51-60). Elsevier.

Buck, H. G., Harkness, K., Wion, R., Carroll, S. L., Cosman, T., Kaasalainen, S., … & Strachan, P. H. (2015). Caregivers’ contributions to heart failure self-care: a systematic review. European Journal of Cardiovascular Nursing, 14(1), 79-89.

Inamdar, A., & Inamdar, A. (2016). Heart failure: diagnosis, management and utilization. Journal of clinical medicine, 5(7), 62.

Iwagami, M., Tomlinson, L. A., Mansfield, K. E., Douglas, I. J., Smeeth, L., & Nitsch, D. (2018). Clinical codelist-Read codes for congestive heart failure.

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Messerli, F. H., Rimoldi, S. F., & Bangalore, S. (2017). The transition from hypertension to heart failure: contemporary update. JACC: Heart Failure, 5(8), 543-551.

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Ouwerkerk, W., Voors, A. A., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., … & Ng, L. L. (2017). Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study. European heart journal, 38(24), 1883-1890.

Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., … & Graham, I. (2016). 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European heart journal, 37(29), 2315-2381.

Rickenbacher, P., Kaufmann, B. A., Maeder, M. T., Bernheim, A., Goetschalckx, K., Pfister, O., … & TIME?CHF Investigators. (2017). Heart failure with mid?range ejection fraction: a distinct clinical entity? Insights from the Trial of Intensified versus standard Medical therapy in Elderly patients with Congestive Heart Failure (TIME?CHF). European journal of heart failure, 19(12), 1586-1596.

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Ter Maaten, J. M., Valente, M. A., Damman, K., Hillege, H. L., Navis, G., & Voors, A. A. (2015). Diuretic response in acute heart failure—pathophysiology, evaluation, and therapy. Nature Reviews Cardiology, 12(3), 184.