Heart Failure

Nursing School Week by Week

Even as nursing students in clinicals, we see so many patients affected by heart failure. This is definitely a biggie, and one you need to know. Today I'm breaking it down, and hitting the highlights of what you need to know as a nursing student about heart failure.
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So, what is heart failure? Well, it is NOT when the heart stops. That would be cardiac arrest. Heart failure is when the heart isn’t pumping enough blood for your body. And this is either because the heart ventricle isn’t able to fill up all the way, or it’s too weak to pump the blood out once it’s filled up. The main cause of heart failure is hypertension over a long period of time, but it could also be caused by a heart attack that causes part of the heart muscle to die, or a problem with the valves of the heart. There are other causes as well, but you’re probably not gonna be tested on that, so, moving on.

Alright, so if the heart is not pumping as much blood out, that means what essential thing is not getting to the tissues? That’s right, oxygen. And when there’s not enough oxygen circulating throughout your body, there’s one organ that is gonna notice right away. She’s kind of a spoiled little diva, this one. She’s the kidney. And the kidneys are going to sense this lack of oxygen, but interpret it as low blood pressure. So they’re gonna do what they can to increase the blood pressure. What’s one of the main ways we increase blood pressure? By increasing the blood volume. And if you’ll remember back to your anatomy class, the kidneys increase the blood volume by activating the Renin Angiotensin Aldosterone system and this is gonna make the body retain fluids. The kidneys think they’re helping, but they’re really just making things worse, because now the patient is fluid overloaded. So, when you think of heart failure, that starts with an H and an F. I want you to think “high fluids”. HF, Heart Failure equals “high fluids”.

There are two types of heart failure you need to know. Left-sided and right-sided. Left-sided is the most common and this happens when there’s something wrong with the left ventricle. And remember, this means either the ventricle isn’t filling up all the way during diastole, or it isn’t getting all the blood out with that systolic contraction. Either way, it means the blood is gonna back up into the lungs. Because think about how the blood flows through the heart. The unoxygenated blood goes into the right side of the heart, then is pumped to the lungs where it exchanges CO2 for yummy oxygen and then it goes to the left side of the heart to be pumped up through the aorta and out to the whole body. So, if the left ventricle isn’t able to send that blood along that it just got from the lungs, then that blood is gonna back up into the lungs. So I want you to think of the L in Left Sided heart failure like the L for Lungs. Left-sided heart failure equals Lungs, cause we’re gonna see a lot of pulmonary symptoms with left sided heart failure.

The three main signs and symptoms to remember for Left-sided heart failure are: Crackles in the lungs, pink frothy sputum, and orthopnea, which is shortness of breath when lying down flat. So these patients will often tell you they have to prop themselves up on multiple pillows to sleep at night, or they may even sleep in a recliner because it helps them breathe.

The other type of heart failure, Right-sided heart failure is when the right ventricle isn’t contracting effectively. And it’s easy to remember what kinds of signs and symptoms you’re gonna see with right-sided heart failure if you think about where the blood is coming from that goes into the right atrium. It’s coming from