Understanding Congestive Heart Failure in 1, 2, 3

If you understand where blood is coming from into the heart it greatly impacts your understanding of right or left sided heart failure.

So let’s start with reviewing blood flow through the heart.

Incoming blood into the RIGHT heart is from the venous system via major veins: the Superior Vena Cava (SVC) and the Inferior Vena Cava (IVC). The SVC drains blood from the head, right shoulder and arm. The IVC drains blood from the rest of the body. Blood enters the right atrium, goes through the tricuspid valve into the right ventricle during diastole. Blood is then pumped during systole through the pulmonary artery to the lungs where the blood exchanges carbon dioxide for oxygen.

Incoming blood into the LEFT heart comes from the pulmonary system (lungs). During diastole this blood rich in oxygen enters the left atrium, flows through the bicuspid valve into the left ventricle. During systole, oxygenated blood is pumped through aortic valves to the aorta then through the aorta out to the systemic circulation.

Side Note: The pulmonary artery carries de-oxygenated blood, and the pulmonary veins are the veins in the body that carry oxygenated blood. (This is an exception to the rule and also occurs in the umbilical cord).

Now that we reviewed where blood flows through the heart. We understand Heart failure causes a congestion of blood in the vessels taking blood into the heart.

Take RIGHT side heart failure for example:

The heart is unable to pump blood out of right ventricle into the lungs effectively. A backup of fluid occurs causing systemic venous congestion as pressure builds up in smaller veins. This congestion causes the characteristic manifestations of Fluid overload, peripheral edema/swelling in the trunk, ankles, and thighs. Other symptoms include Ascites (beer belly), hepatomegaly, splenomegaly, weight gain, oliguria, Jugular Vein Distention, polydipsia, increased central venous pressures and elevated liver function enzymes.

Now let’s examine LEFT Side Heart Failure:

The heart is unable to pump or eject blood from the left ventricle due to failure of the left side of the heart. This causes backup of blood/fluid going to the lungs from the left heart. The patient then manifests pulmonary edema, difficulty breathing, moist cough, crackles, wheezing, anxiety and increased pulse. (The key is to remember left side = lung symptoms). Left side heart failure is generally seen with history of Myocardial Infarction and Coronary Artery Disease

Management of Congestive Heart Failure

Nursing Management:

Bed rest, HOB up 45°

0ygen therapy

Morphine sulfate especially in acute phase to control pain and anxiety

Vasodilators (NTG)

ACE inhibitors (captopril or enalapril)

Monitor B/P closely

Diuretics (Diuril, Lasix)

DIGOXIN

Fluid restriction

Check I & 0, weigh daily to monitor fluid retention

Treat any underlying cause

Medical Management:

Intra - aortic balloon pump (IABP) Intra-aortic balloon catheter is threaded thru femoral artery to descending aorta. Balloon inflates during diastole and deflates during systole. The pump improves circulation to the coronary arteries and reduces the workload of the left ventricle.

Ventricular assist device (VAD) cannula takes blood from left atrium to aorta bypassing the left ventricle.

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