Saturday, January 14, 2006

congestive heart failure (heart failure, cardiac decompensation, cardiac insufficiency, cardiac incompetence, CHF)

Congestive heart failure (CHF) develops when the heart is unable to pump an adequate supply of blood to meet the demands of the body. This condition affects three to four million Americans. Seventy-five percent of affected people are older than 60. There are about 45 cases of congestive heart failure per 1,000 after the age of 65. Congestive heart failure can be caused by a variety of things, including arteriosclerosis, myocardial infarction, myocarditis, ventricular aneurysm, mitral or aortic regurgitation, atrial or ventricular septal defects, hypertension, pericarditis, constrictive cardiomyopathies, and hyperthyroidism. Frequently, in the elderly, congestive heart failure is caused by a combination of factors.
Symptoms may develop acutely and include syncope (fainting), shock, acute pulmonary edema, cardiac arrest, or sudden death. Acute congestive heart failure may be seen following a myocardial infarction. Chronic congestive heart failure symptoms develop gradually and include pitting edema of the feet and ankles (which disappears during the night), fatigue, confusion, weight gain, persistent cough, abnormal respirations, difficulty breathing while lying flat, and dyspnea (shortness of breath) on exertion. The primary goals of treatment for congestive heart failure are to restore a balance between the supply and demand for blood by the body and to remove excessive fluid.
In the acute phase of congestive heart failure the person may require bed rest, supplemental oxygen, diuretics, and digitalis.
Treatment of congestive heart failure should involve identifying the underlying condition and correcting it, if possible. If the underlying condition cannot be controlled, congestive heart failure may become a chronic problem. Therapy for chronic congestive heart failure includes a salt restricted diet, diuretics, heart stimulants, and sometimes a change in lifestyle. Generally the person can continue his or her activities with moderation. Diuretics combined with a salt-restricted diet remain the mainstay of therapy in older people. Potassium supplements will probably be necessary to counteract the potassium loss caused by diuretics. Digitalis may be prescribed to help the heart to be more effective in pumping blood. Treatment is not curative and recurrences are frequent, especially when the person deviates from his or her medication and diet.
People with congestive heart failure are particularly vulnerable to infection, especially pneumonia and influenza. An infection often aggravates the underlying heart disease and leads to rapid, frequent recurrences of the congestive heart failure. If possible, the older person with congestive heart failure should weigh daily. If a sudden weight gain is detected, prompt consultation with a physician may prevent an acute attack of congestive heart failure.
Phipps, W. J., et al. Medical Surgical Nursing. St. Louis: C. V. Mosby Co., 1983.
Rogers, C. S., and McCue, J. D. Managing Chronic Disease. Oradell, N.J.: Medical Economics Books, 1987.
Scherer, J. C. Introductory Medical-Surgical Nursing, Philadelphia: J. B. Lippincott Co., 1982.


Post a Comment

<< Home