Congestive Heart Failure

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Scientific Basis
Congestive Heart Failure is a disease in which the heart is unable to properly keep up with the amount of blood being sent to the heart. The heart muscle itself, in the case of heart failure, is unable to sufficiently pump the blood away from the heart and to the body to keep up with the incoming deoxygenated flow. This failure to pump blood can build up pressure and cause additional pumping resistance. The decreased cardiac output of heart failure causes the circulation to become backed up, and this is where the term “congested” comes into description. In respect to recognizing this condition in a physical assessment, some signs detected are from pulmonary congestion and an increased presence of blood retained in the pulmonary vessels. Air sacs that are dependent may become deflated, the pulmonary capillaries may become engorged, and the bronchial mucosa can experience edema. Upon inspection, the presence of Congestive Heart Failure will procure signs of an increase in resting respiratory rate, shortness of breath on exertion, orthopnea, paroxysmal nocturnal dyspnea, nocturia, edema of the ankles and legs, ascites of the abdomen, and unusual pallor in fair skinned individuals. Through the method of palpation, signs of heart failure include moist, clammy skin, yet the tactile fremitus tends to be normal. Percussion in the physical assessment will produce a resonant sound upon striking. Auscultation of the thorax and lungs with the presence of heart failure will present a normal vesicular sound over the lungs, and a third galloping heart sound. Adventitious lung sounds upon assessment may include crackling at the lung bases from the deflated alveoli. (Jarvis 2011). Other abnormal findings in the physical assessment of a patient suffering from Congestive Heart Failure may include anxiety from the inability to breathe easily with pulmonary congestion, and hypoxia of the systemic blood circulation which can lead to confusion when the brain feels the effects of a lack of oxygen. The jugular vein may be more visible on inspection from venous edema, and the patient may appear to suffer from fatigue from the lowered cardiac output. (Jarvis 2011)

There are numerous causes for Congestive Heart Failure. Significant predisposing factors for the heart’s inability to pump the preload of blood volume may result from restrictions upon pumping or an increased presence of afterload blood volume. Restrictions on the myocardium being able to normally pump blood may result from muscle weakness in the myocardium itself. This weakness may stem from stenosis of the coronary arteries, thrombosis within the coronary arteries, or by other contributing factors such as myocarditis or certain cardiomyopathies. Additional physical factors can contribute to pumping restriction in a functional myocardium. Such factors may include: valve malfunction which allows a backflow of blood within the heart, congenital internal obstructions of the heart, tumor related obstruction of blood flow within the heart, cardiac dysrhythmia and electrolyte imbalances that interfere with electrical stability, chronic constrictive pericarditis or pericardial effusion, and cardiac tamponade.

As previously mentioned, the presence of an increased afterload volume of blood may interfere with the heart’s capability to pump out the blood that the body demands. This higher afterload may occur when the heart muscle is under constant physical exertion and strain. This may be from pulmonary hypertension which strains the right ventricle and, in turn, decreases cardiac output. Hypertension can contribute to increased resistance that the left ventricle must overcome in order to successfully pump the afterload. Similar to the restrictions on pumping discussed, increased afterload can result from congenital defects of the valves and vessels. A high demand of cardiac output on a patient suffering from Congestive Heart Failure may induce complications...
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