HeartFailure PandemicThe purposeof this paper is to review left sided heart failure. This will includestatistics, predisposing factors, signs and symptoms, diagnostic studies,medical and surgical treatments including nursing care.
Description of Left Sided Heart Failure.Left sided heartfailure is a condition that does not allow the heart to fill or pumpeffectively, therefore, the heart can not provide or meet the needs of thebody. There are two types of left sided heart failure, systolic and diastolic.These conditions lead to a decrease in cardiac output and pulmonary congestion.During systolic heart failure, the heart is unable to contact forcefully and cannoteject enough blood into the circulation system. As a result, there is adecrease in tissue perfusion and a buildup of blood in the pulmonary vessels.During diastolic heart failure the left ventricle is unable to relax andbecomes stiff. The stiffening of the left ventricle prevents it from filling,leading to a decrease in cardiac output.
Left sided Heartfailure is the most predominant diagnosis in the United States and it is alsothe leading cause of death amongst all ethnicities. Over six hundred thousand Americans die fromheart failure each year, with left sided heart failure being the most commontype of heart disease. According to the Washington state department of health,heart failure is the second leading cause of death in the state. Worldwide, there is a forty percent mortalityrate for patients that have been hospitalized with left sided heart failure inthe last five years. Regardless of advances in medicine,treating heart failure has been challenging forphysicians and medical teams (Inamdar.
, 2016). Leftsided Heart failure and its risk factors affect most of the population. The most common risk factors that can betreated or controlled are having high blood pressure, a high cholesterol count,having a sedentary lifestyle, being overweight and following an unhealthy dietwith most of the dietary intake being fats. Smoking, using drugs and consuming alcoholdaily are also risk factors that can be controlled. Factors that can’t becontrolled or treated include age, gender, race, and history of diabetes,anemia, valvular and coronary disease. African American males and people 65 andolder have the highest incidence of heart failure (Dunley, Weston, Jacobsen,and Rogers 2009).
Dueto heart failure being a slow, debilitating disease many Americans ignore thecommon signs and symptoms. A person inthe initial stages of left sided heart failure will lack signs and symptoms dueto the bodies compensation mechanism. The bodies compensation mechanism includesstimulation of the sympathetic nervous system, the activation of Renin-Angiotensinsystem, and myocardial hypertrophy. Due to a decrease in cardiac output aperson in an advance stage of left sided heart failure will experience,fatigue, excessive amounts of urine output during the day with a decrease atnight, confusion, restlessness, dizziness, a high heart rate, palpitations,pallid skin color, weak peripheral pulses, cool extremities and chest pain. Signsand symptoms that indicate pulmonary congestion are a hacking cough that’susually more severe at bed time, shortness of breath, frothy pink sputum, a lowrespiration rate, and crackles in the lungs on auscultation. Psychosocially, apatient is prone to Anxiety and depression due to the slow progression of thedisease.
If a patientpresents with signs and symptoms of left sided heart failure, a physician andmedical team will start by completing a full assessment including medicalhistory, vital signs, a head to toe assessment, laboratory studies, diagnostictests and if needed hemodynamic monitoring. Electrolytes, hemoglobin andhematocrit, B-type natriuretic peptide, urine analysis, and arterial bloodgasses are common laboratory tests drawn if heart failure is suspected. An imbalance ofElectrolytes such as potassium, sodium, calcium, and magnesium can indicate complicationsdue to left sided heart failure or medications that are used to treat thecondition. To rule out anemia as a causeof heart failure a Hematocrit and hemoglobin can be drawn. A B-Type natriureticpeptide will be elevated due to myocardial injury; however, it is not specificto left sided heart failure. Regardless of specificity it is a lab that is usedperiodically in conjunction with treatment as it will decrease if treatment isworking, A normal range for BNP is 0-100 pg/ml. A urine analysis will show microalbuminuria ifthere is renal function decline due to the decrease in cardiac output andtissue perfusion.
Microalbuminuria will usually be present before the elevationof BNP. Arterial blood gasses are important laboratory studies that can showhypoxemia, respiratory and metabolic acidosis or alkalosis. During left sidedheart failure arterial blood gases will usually show hypoxemia as the heart is failingto supply the body with sufficient oxygenated blood.
Imaging studiesare helpful when diagnosing left sided heart failure. X-Ray, CT, and MRI are some of the imaging studiesused. On an X-Ray the heart will appearenlarged or there might be fluid present in the lungs. Liquid contrast might be used before a CT orMRI, as the contrast will help healthcare providers see images better. After a patient receives contrast for a CT or MRIit is important for nursing staff to encourage fluids to help the kidneys flushthe contrast out. An echocardiogram is atype of ultrasound where soundwaves are used to show the function and structureof the heart. This test is considered thebest diagnostic study when diagnosing left sided heart failure. Hemodynamic monitoringis a more invasive way to assess cardiac function.
This type of monitoring allows for direct assessmentof cardiac output and volume status by monitoring blood pressure and oxygen in theveins, arteries and heart.