Heart Atau Cardiac Failure

HEART / CARDIAC
FAILURE
dr.Bobi Ahmad S, S.Kep
DEFINITION
INABILITY OF THE HEART TO PUMP

SUFFICIENT BLOOD TO MEET THE
DEMANDS OF THE BODY
DUE TO
1. INCREASED CELLULAR DEMANDS
2. IMPAIRED PUMPING OF THE HEART
HEART FAILS => CARDIAC OUTPUT 

=>PERIPHERAL TISSUE <<
 CONGESTION OF THE LUNGS
 CONGESTION PERIPHERAL
PATOPHYSIOLOGY
COMPESATION MECHANISMS:
• INCREASED HEART RATE
• IMPROVED STROKE VOLUME
• ARTERIAL VASOCONSTRICTION
• SODIUM AND WATER RETENTION
• MYOCARDIAL HYPERTROPHY
CLASSIFICATION
SYSTOLIC vs DIASTOLIC DISFUNCTION
- SYSTOLIC FAILURE : FOWARD
FAILURE
- DIASTOLIC FAILURE : BACK WARD
FAILURE
LEFT vs RIGHT VENTRICULAR F.

TYPICAL CAUSE OF LEFT VENT
FAILURE
1. HYPERTENSION DISEASE
2. CORONARY ARTERY DISEASE
3. VALVULAR DISEASE
CAUSE OF RIGHT VENT.
FAILURE
1. LEFT VENT. FAILURE
2. RIGHT VENT. MYOCARDIAL

INFARCTION
3. PULMONARY HYPERTENSION
LOW-OUTPUT VS HIGH-
OUTPUT SYNDROME
• INCREASED METABOLIC NEEDS
- HYPERTHYROIDISM
- FEVER
- PREGNANCY
• HYPERKINETIC CONDITIONS
- ARTERIOVENOUS FISTULAS
- PAGET’S DISEASE
FUNCTIONAL STATUS
• CLASS I
- CLIENTS WITH CARDIAC DISEASE, BUT
WITHOUT RESULTING LIMITATIONS OF
PHYSICAL ACTIVITY
- ORDINARY PHYSICAL ACTIVITY DOES
NOT CAUSE UNDUE FATIGUE
PALPITATION, DYSPNEA, OR ANGINAL
PAIN
FUNCTIONAL STATUS
• CLASS II
- CLIENTS WITH C.D RESULTING IN
SLIGHT LIMITATION OF PHYSICAL
ACTIVITY
- THEY ARE COMFORTABLE AT REST
- ORDINARY PHYSICAL ACTIVITY
RESULTS IN FATIGUE, PALPITATION,
DYSPNEA, OR ANGINAL PAIN
FUNCTIONAL STATUS
• CLASS III
- CLIENTS WITH CD RESULTING IN
MARKED LIMITATION OF PHYSICAL
ACTIVITY
- THEY ARE COMFORTABLE AT REST
- LESS THAN ORDINARY PHYSICAL ACT
CAUSES FATIGUE, PALPITATION,
DYSPNEA, OR ANGINAL PAIN
FUNCTIONAL STATUS
• CLASS IV
- CLIENTS WITH CD RESULTING IN
INABILITY TO CARRY ON ANY PHYSICAL
ACT WITHOUT DISCOMFORT
- SYMPTOMS OF CARDIAC INSUFFICIENCY
OR OF THE ANGINAL SYNDROME MAY BE
PRESENT EVEN AT REST
- IF ANY PHYSICAL ACT IS UNDERTAKEN,
DISCOMFORT IS INCREASED
ETIOLOGY
VOLUME OVERLOAD: PRESSURE OVERLOAD:
- AORTIC INCOMPETENCE - HYPERTENTION
- MITRAL INCOMPETENCE - AORTIC STENOSIS
- TRICUSPID INCOMPETENCE - HYPERTROPHIC CARDIOMYOPATHY
- OVERTRANSFUSION FILLING DISORDERS :
- LEFT-TO-RIGHT SHUNTS - MITRAL STENOSIS
- HYPERVOLEMIA - TRICUSPID STENOSIS
MYOCARDIAL DYSFUNCTION: - CARDIAC TEMPONADE
- CARDIOMYOPATHY - RESTRICTIVE PERICARDITIS
- MYOCARDITIS INCREASED METABOLIC DEMAND :
- CORONARY ARTERY DISEASE - ANEMIAS
- ISCHEMIA - FEVER
- INFARCTION - BERIBERI
- DYSRYTHMIAS - PAGET’S DISEASE
- TOXIC DISORDERS - ARTEROVENOUS FISTULA
INCIDENCE / PREVALENCE
• 75 % HEART FAILURE OLDER THAN 60
YEARS
• 60 / 1000 POPULATION IN THE AGE
GROUP 65 & OLDER
• INCREASES TO 100 / 1000 IN THE AGE 7
5 YEARS & OLDER
• MEN > WOMEN
• ± 50 % WITH MODERATE SEVERE
HEART FAILURE SURVIVE 2 YEARS
ASSESSMENT
HISTORY :  KEEP IN MIND :
MANY CONDITIONS CAN LEAD TO
HEART FAILURE
CAREFULLY QUESTIONS THE CLIENT
ABOUT PAST MEDICAL HISTORY
ASK CLENT’S PERCEPTION OF HIS/HER
ACTIVITY TOLERANCE, BREATHING &
URINARY PATTERN, FLUID VOLUME
STATUS, CLIENT’S KNOWLEDGE ABOUT
HEART FAILURE
ASSESSMENT
LEFT VENTRICULAR FAILURE :
 REPORT UNUSUAL FATIGUE
 DESCRIBE THE COUGH AS IRRITATING, NOCTURNAL,
USUALLY NON-PRODUCTIVE
 CONFUSION MAY OCCUR
 REPORT CHEST DISCOMFORT
 DESCRIBE PALPITATION, SKIPPED BEATS, FAST
HAERTBEAT
 PRESENCE OF DYSPNEA, ORTHOPNEA
 DESCRIBE SUDDEN AWAKENING WITH A FEELING
OF BREATHLESSNESS 2 – 5 HOURS AFTER FALLING
ASLEEP HAVE PAROXYSMAL NOCTURNAL DYSPNEA
ASSESSMENT
RIGHT VENTRICULAR FAILURE :
 WEIGHT GAIN (EDEMA)
 GASTROINTESTINAL COMPLAINTS
(NAUSEA & ANOREXIA)
 DIURESIS AT REST
EXPERIENCE INCREASED THIRS &
TAKE IN EXESSIVE FLUID (4000-5000 ml)
 ALDOSTERON SECRETION
PHYSICAL ASSESSMENT / CLINICAL
MANIFESTATIONS OF
LEFT SIDED HEART FAILURE :
1. DECREASED CARDIAC OUTPUT :
* FATIGUE
* OLIGURIA DURING THE DAY
* ANGINA
* CONFUSION
* DIZZINESS
* TACHYCARDIA, PALPITATIONS
2. PULMONARY CONGESTION :
* HACKING COUGH, WORSE AT NIGHT
* DYSPNEA
* CRACKLES IN LUNGS
* FROTHY PINK-TINGED SPUTUM
* TACHYPNEA
PHYSICAL ASSESSMENT / CLINICAL
MANIFESTATIONS OF
RIGHT SIDED HEART FAILURE :
• JUGULAR VENOUS DISTENTION
• ENLARGED LIVER
• ANOREXIA & NAUSEA
• DEPENDENT EDEMA (LEGS & SACRUM)
• POLYURIA AT NIGHT
PSYCHOLOGICAL ASSESSMENT
FEELINGS OF :
• REJECTION
• INSECURITY
• FRUSTRATION
• RAGE
LABORATORY ASSESSMENT
ELEVATED :
• BLOOD UREA NITROGEN
• SERUM CREATININE LEVEL
• CREATININE CLEARANCE LEVEL
• PROTEINURIA
• HIGH SPECIFIC GRAVITY
• HYPOXIA
• RESPIRATORY ALKALOSIS
• RESPIRATORY ACIDOSIS
RADIOGRAPHIS ASSESSMENT
• CHEST X-RAY  ENLARGE,

HYPERTROPHY, OR DILATATION
OTHER DIAGNOSTIC ASSESSMENT

• ECG : VENT. HYPERTROPHY,
DYSRHYTMIAS, MYOCARDIAL
ISCHEMIA, INJURY, INFARCTION
COMMON NURSING
DIAGNOSES
1. DECREASED CARDIAC OUTPUT RELATED TO A
REDUCTION IN STROKE VOLUME AS A RESULT OF
MECHANICAL MALFUNCTIONS
2. IMPAIRED GAS EXCHANGE RELATED TO ALTERED
OXYGEN SUPPLY
3. ACTIVITY INTOLERANCE RELATED TO AN
IMBALANCE BETWEEN OXYGEN SUPPLY AND
DEMAND, FATIGUE, OR AN ELECTROLYTE
IMBALANCE
4. HIGH RISK FOR INABILITY TO SUSTAIN
SPONTANEOUS VENTILATION RELATED TO
PULMONARY EDEMA & RESPIRATORY MUSCLE
FATIGUE
ADDITIONAL NURSING
DIAGNOSES
• INEFFECTIVE INDIVIDUAL COPING RELATED TO
PHYSICAL INACTIVITY, MAJOR CHANGES IN
LIFESTYLE, LOSS OF CONTROL OVER BODY
FUNCTION, OR FEAR OF DEATH
• ALTERED SEXUALITY PATTERNS RELATED TO THE
EFFECTS OF ILLNESS
• HOPELESSNESS RELATED TO THE EFFECTS OF
DETERIORATING PHYSICAL STATUS
• ALTERED THOUGHT PROCESSES RELATED TO
IMPAIRED GAS EXCHANGE OR FEAR OG THE
UNKNOWN
• IMPAIRED PHYSICAL MOBILITY RELATED TO
FATIGUE & ACTIVITY INTOLERANCE
PLANNING &
IMPLEMENTATION
DECREASED CARDIAC OUTPUT
PLANNING : CLIENT GOALS : THE PRIMARY
GOAL IS THAT THE CLIENT WILL RESUME &
MAINTAIN AN ADEQUATE CARDIAC OUTPUT
AS EVIDENCED BY :
• A HEART RATE WITHIN THE BASELINE VALUE
• NO SIGNS OF IMPAIRED TISSUE PERFUSION
• NO DEPENDENT EDEMA
• CLEAR LUNGS
• NO NECK VEIN DISTENTION
• NORMAL BLOOD PREASURE
INTERVENTIONS
AIMED AT IMPROVEING CARDIAC OUTPUT
1. OPTIMIZE STROKE VOLUME :
* REDUCING PRELOAD :
- DIIT THERAPY :
> SODIUM RESTRICTION
> FLUID VOLUME RESTRICTION
- DRUG THERAPY :
> DIURETICS
> VENOUS VASODILATORS
* REDUCING AFTERLOAD :
- RELAXING ARTERIOLES
- ARTERIAL VASODILATORS
* IMPROVING CONTRACTILITY
- ACTION OF DIGITALIS
- DIGITALIS TOXICITY : DIGOXIN
PLANNING &
IMPLEMENTATION
IMPAIRED GAS EXCHANGE
PLANNING : CLIENT GOALS :
• HAVE A NORMAL RATE, RHYTHM, &
DEPTH OF RESPIRATION
• HAVE NORMAL ARTERIAL BLOOD GAS
VALUES
INTERVENTIONS
• MONITOR THE CLIENT’S RESPIRATORY
RATE, RHYTHM, & CHARACTER EVERY 1
– 4 HAOURS
• AUSCULTATING BREATH SOUNDS
• ADMINISTER SUPPLEMENTAL OXYGE
• PLACE THE CLIENT IN HIGH FOWLER’S
POSITION
PLANNING &
IMPLEMENTATION
ACTIVITY INTOLERANCE
PLANNING : CLIENT GOALS :
• WILL NOT EXPERIENCE SHORTNESS OF
BREATH WITH EXERTION
• WILL BE ABLE TO PERFORM ACTIVITIES
OF DAILY LIVING
INTERVENTIONS
• ORGANIZED TO ALLOW PERIODS OF
UNINTERRUPTED REST
• IDENTIFY THE CLIENT RESPONSE TO
MILD EXERCISE
• TAKE THE CLIENT’S BLOOD PRESSURE
& PULSE (BEFORE, DURING, AFTER
ACTIVITY)
PLANNING &
IMPLEMENTATION
HIGH RISK FOR INABILITY TO SUSTAIN
SPONTANEOUS VENTILATION
PLANNING : CLIENT GOALS : THE CLIENT
WILL CONTINUE TO MAINTAIN
VENTILATION OF ADEQUATE RHYTHM,
RATE, & DEPTH
INTERVENTIONS
• ASSESS CLIENTS FOR ACUTE
PULMONARY EDEMA, A LIFE-
THREATENING EVENT
• PRESCRIBE RAPID-ACTING (LASIX)
• PLACE THE CLIENT IN HIGH FOWLER’S
POSITION
EVALUATION
EXPECTED OUTCOMES : THE CLIENT WILL :
• DEMONSTRATE AN ADEQUATE C.O. AS EVIDENCED BY BLOOD
PRESSURE & PULSE
• DEMONSTRATE AN ACCEPTABLE FLUID BALANCE AS
EVIDENCED BY ADEQUATE URINARY OUTPUT, NORMAL LUNG
SOUNDS, ABSENCE OF EDEMA, MAINTENANCE OF WEIGHT,
GOOD SKIN TURGOR, MOIST MUCOUS MEMBRANES
• TOLERATE GRADUAL INCREASES IN ACTIVITY WITHOUT
DYSPNEA, CHEST PAIN, FATIGUE, OR CHANGES IN VITAL SIGNS
• DEMONSTRATE NORMAL AIR CHANGE AS EVIDENCED BY
NORMAL RATE, RHYTHM, DEPTH OF RESPIRATION & ARTERIAL
BLOOD GAS VALUES WITHIN ACCEPTABLE LIMITS
• ADMINISTER MEDICATIONS SAFELY & RECOGNIZE POSSIBLE
SIDE & TOXIC EFFECTS
• IDENTIFY WHEN HE/SHE SHOULD CONTACT THE HEALTH
CARE PROVIDER

Heart Atau Cardiac Failure

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Heart Atau Cardiac Failure

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HEART / CARDIAC

INABILITY OF THE HEART TO PUMP

HEART FAILS => CARDIAC OUTPUT 

LEFT vs RIGHT VENTRICULAR F.

2. CORONARY ARTERY DISEASE

2. RIGHT VENT. MYOCARDIAL

• CHEST X-RAY  ENLARGE,

OTHER DIAGNOSTIC ASSESSMENT

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