This is an NCLEX review for heart failure. The previous NCLEX review of heart failure concentrated on the nursing interventions and medication treatments. This review will concentrate on the pathophysiology, signs and symptoms, causes, and different types of heart failure.
Patients who have heart failure have a heart muscle that is unable to pump efficiently and this can lead to mild/severe complications. There are different types of heart failure, such as left or right-sided failure and each type presents with different signs and symptoms. It is important for the NCLEX exam that the student is aware of the different signs and symptoms, causes of heart failure, treatments, and pathophysiology of the condition.
Don’t forget to take heart failure quiz.
In this NCLEX review for heart failure, you will learn the following:
- Definition of heart failure
- Causes of heart failure
- Signs and Symptoms of heart failure
- Pathophysiology of heart failure
- Tests used to diagnose heart failure
- Causes of heart failure exacerbation
NCLEX Lecture on Heart Failure Part 1
Definition: the heart is too weak to pump efficiently so it can’t provide proper cardiac output to maintain the body’s metabolic needs.
- Results on the body: organs and tissues will suffer from the decreased blood flow, pressure in the heart increases which over works the ventricles, body can become congested with fluids (enter into congestive heart failure) that can cause life-threatening complications.
Note: the left ventricle is the largest of all four chambers which allows for maximum pumping power.
Causes of Heart Failure:
Mainly due to the heart muscle (specifically the ventricles) becoming damaged or too stiff.
Remember the mnemonic: Failure
Faulty heart valves: AV and SL valve problems (due to congenital issues or infection (endocarditis) that causes blood to back flow (regurgitation) or stenosis (narrowing of the valves that increases pressure of blood flow through the valves). This causes the heart to work harder and become weak over time.
Arrhythmias: atrial fibrillation or tachycardia
Infarction (myocardial)…coronary artery disease: part of the heart muscle dies due to a blockage in the coronary arteries…muscle become ischemic and can die (main cause of left ventricular systolic dysfunction)
Lineage (congenital)…family history
Uncontrolled Hypertension: overtime this can lead to stiffening of the heart walls because with untreated HTN the heart has to work harder and this causes the ventricles to become stiff.
Recreational Drug Use (cocaine) or alcohol abuse
Envaders (instead of Invaders): viruses or infections that attack the heart muscle
Types of Heart Failures:
Left & Right Side Heart Failure (can have both at the same time as well)
Left-Sided Heart failure: the left side of the heart cannot pump blood out of the heart efficiently so blood starts to back-up in the lungs.
- Most common type of heart failure.
- Left-sided heart failure is likely to lead to right-sided heart failure.
The left ventricle becomes too weak and doesn’t squeeze blood out properly….the heart failure can be either SYSTOLIC OR DIASTOLIC.
- Systolic: “Left ventricular systolic dysfunction” remember systolic is the contraction or “squeezing” phase of the heart. In systolic dysfunction, there is an issue with the left ventricle being able to eject blood properly out of the ventricle and the organs can’t get all that rich-oxygenated blood it just received from the lungs. Patients will have a low ejection fraction.
- What is ejection fraction? Ejection fraction is a calculation used to determine the severity of heart failure on the left side. A normal EF is 50% or greater meaning that more than half of the blood that fills inside the ventricles is being pumped out. An EF can be measured with an echocardiogram, heart cath, nuclear stress test. An EF of 40% or less is a diagnosis for heart failure.
- Diastolic: “left ventricular diastolic dysfunction” remember diastole is the filling or resting phase of the heart. In diastolic dysfunction, the ventricle is too stiff to allow for normal filling of blood. Since there isn’t an issue with contraction but filling the ejection fraction is usually normal.
Left-sided heart failure will present with PULMONARY Signs and Symptoms.
Right-Sided Heart Failure: the right side of the heart cannot pump the “used” blood it received from the body efficiently so it can’t get the blood back to the lungs to get replenished with oxygen. The causes the blood to back up peripherally (legs, hands, feet, abdomen).
- Right-sided heart failure causes congestion of blood in the heart and this increases the pressure in the inferior vena cava (which normally brings “used” blood back to the heart for re-oxygenation). This built-up pressure causes the hepatic veins to become very congested with blood which leads to hepatomegaly and swelling peripherally.
- Right-sided heart failure is usually caused from left-sided heart failure because of the increased fluid pressure backing up from the left side to the right. This causes the right side of the heart to become overworked.
- Other causes: pulmonary heart disease “cor pulmonale” as a complication from pulmonary hypertension or COPD.
Right-sided heart failure presents with PERPHIERAL SIGNS AND SYMPTOMS.
Signs and Symptoms of Heart Failure
Know the difference between the signs and symptoms of left vs. right sided heart failure.
Left-sided heart failure:
Remember the mnemonic DROWNING (these patients are literally drowning in their own fluid from the heart’s failure to pump efficiently)
Orthopnea (cannot tolerate lying down…must sit-up to breath, especially while sleeping)
Weakness (extremely tired and fatigued due to shortness of breath and heart can’t compensate for increased activity)
Nocturnal Paroxysmal dyspnea (awaking during sleep with extreme dyspnea)
Increased heart rate (due to fluid overload and the heart is trying to get the blood to organs but it can’t because of muscle failure)
Nagging cough (can be frothy or blood-tinged sputum from fluid overload in the lungs…very bad sign)
Gaining weight from the body retaining fluid…2 to 3 lb in a day or 5 lbs in a week
Right-Sided Heart Failure:
Remember the mnemonic SWELLING (fluid is backing up in the right side of the heart which causes fluid to back-up in the hepatic veins and peripheral veins)
Swelling of legs, hands, liver, abdomen
Large neck veins (jugular venous distention)
Lethargic (weak and very tired)
Irregular heart rate (atrial fibrillation)
Nocturia (frequent urination at night) lying down elevates the legs and allows the extra fluid to enter into the vascular system which allows the kidneys to eliminate the extra fluid.
Girth of abdomen increased (from swelling of the liver and building up fluid in the abdomen)…can’t breathe well and this causes nausea and anorexia.
Tests used to Diagnose Heart Failure:
- BNP (b-type natriuretic peptide) blood test: a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure.
- <100 pg/mL no failure
- 100-300 pg/mL present
- 300 pg/mL mild
- 600 pg/mL moderate
- 900 pg/mL severe
- Source ClevelandClinic.org
- Chest x-ray
- Heart cath
- Nuclear stress test
Heart failure can be acute or chronic and can be triggered/exacerbated with:
- High salt intake or fluid (watch fluids)
- Uncontrolled atrial fibrillation
- Renal failure
You may be interested in more cardiovascular NCLEX reviews.