Congestive Heart FailureCongestive Heart Failure(CHF)(CHF)

Kathy Green, MS, RNKathy Green, MS, RN

Patient Health EducationPatient Health Education

Heart Failure Incidence Heart Failure Incidence and Prevalenceand Prevalence

♥ ♥ PrevalencePrevalence Worldwide – 22 millionWorldwide – 22 millionUnited States – 5 millionUnited States – 5 million

♥ ♥ IncidenceIncidenceWorldwide – 2 million new cases yearWorldwide – 2 million new cases yearUnited States – 500,000 new cases yearUnited States – 500,000 new cases year

♥ ♥ Afflicts 10 out of every 1,000 people Afflicts 10 out of every 1,000 people over age 65 in the United States over age 65 in the United States

(Stats from American Heart association - 2002)(Stats from American Heart association - 2002)

Normal Healthy HeartNormal Healthy Heart

♥ ♥ MuscleMuscle

♥ ♥ Four ChambersFour Chambers

♥ ♥ Four ValvesFour Valves

♥ ♥ Vena Cava – O2 poorVena Cava – O2 poor

♥ ♥ Pulmonary Veins – O2 Pulmonary Veins – O2 richrich

♥ ♥ AortaAorta

What Is CHF ? What Is CHF ?

♥♥ The heart does not pump efficientlyThe heart does not pump efficiently

♥ ♥ The heart is not able to move as The heart is not able to move as much blood as it should with each much blood as it should with each beatbeat

♥ ♥ Organs in the body do not get Organs in the body do not get enough oxygen rich blood that they enough oxygen rich blood that they need to work wellneed to work well

Diagnostic EvaluationDiagnostic Evaluation

What Causes Heart What Causes Heart Failure?Failure?

♥♥ Coronary Artery DiseaseCoronary Artery Disease♥♥ Untreated High Blood PressureUntreated High Blood Pressure♥♥ Faulty Heart ValvesFaulty Heart Valves♥ ♥ CardiomyopathyCardiomyopathy♥ ♥ Lung DiseaseLung Disease♥ ♥ DiabetesDiabetes♥ ♥ InfectionsInfections♥♥ AlcoholismAlcoholism♥♥ Toxic DrugsToxic Drugs

2 Types of Heart 2 Types of Heart FailureFailure

Systolic Systolic DysfunctionDysfunction

(Contraction) 2/3 of Patients(Contraction) 2/3 of Patients

♥ ♥ The heart becomes The heart becomes weak and enlargedweak and enlarged

♥ ♥ The weakened heart The weakened heart muscle can’t contractmuscle can’t contract

♥ ♥ Not enough blood is Not enough blood is pumped from the pumped from the chamberschambers

Diastolic Diastolic DysfunctionDysfunction

(Relaxation)(Relaxation)

♥ ♥ Chambers don’t fill up Chambers don’t fill up so less blood goes to so less blood goes to the lungs and bodythe lungs and body

♥ ♥ Stiff heart muscle Stiff heart muscle can’t relaxcan’t relax

♥ ♥ Not enough blood fills Not enough blood fills the chambers the chambers

What is an Ejection What is an Ejection Fraction? (EF)Fraction? (EF)

The amount of blood that The amount of blood that pumps out of the heart with pumps out of the heart with each beateach beat

♥ ♥ Normal EF = 50 – 65%Normal EF = 50 – 65%

♥ ♥ Damaged Heart Muscle EF = 40%Damaged Heart Muscle EF = 40%

♥ ♥ Potential Heart Transplant EF = 20%Potential Heart Transplant EF = 20%

When the EF is Abnormal When the EF is Abnormal What Happens in the What Happens in the

Body?Body?♥ ♥ Less blood goes to the brain that may Less blood goes to the brain that may

make you feel confused or dizzy make you feel confused or dizzy

♥♥ Your lungs may fill up with fluid making Your lungs may fill up with fluid making you feel short of breath you feel short of breath

♥ ♥ Your kidneys may not be able to get rid Your kidneys may not be able to get rid of the fluid of the fluid

♥ ♥ Your belly, ankles and feet may swell up Your belly, ankles and feet may swell up

Other Signs and Other Signs and Symptoms of CHFSymptoms of CHF

♥♥ Extreme FatigueExtreme Fatigue

♥♥ Frequent CoughingFrequent Coughing

♥♥ Sudden Weight GainSudden Weight Gain

♥♥ Chest Pain or PressureChest Pain or Pressure

♥ ♥ Nausea, Loss of Appetite or BloatingNausea, Loss of Appetite or Bloating♥ ♥ Decreased Urination Decreased Urination

Do You Know Your EF and Do You Know Your EF and Class of CHF?Class of CHF?

♥ ♥ Why do I need to know my EF and Why do I need to know my EF and Class of CHF?Class of CHF?

Heart Failure is a chronic Heart Failure is a chronic progressive disease that is not progressive disease that is not

curable but is treatablecurable but is treatable

New York Heart New York Heart Association Functional Association Functional

ClassificationClassificationClass IClass I

No symptoms No symptoms with ordinary with ordinary activityactivity

Class IIClass II

Slight limitation Slight limitation of physical of physical activity results in activity results in fatigue, fatigue, shortness of shortness of breath, chest breath, chest pain or irregular pain or irregular heart beatheart beat

New York Heart New York Heart Association Functional Association Functional

ClassificationClassificationClass IIIClass III

Marked limitation Marked limitation of physical activity.of physical activity.

Comfortable at Comfortable at rest, but less than rest, but less than ordinary physical ordinary physical activity results in activity results in fatigue, irregular fatigue, irregular heart beat, pain or heart beat, pain or shortness of breathshortness of breath

Class IVClass IV

Unable to carry Unable to carry out any physical out any physical activity without activity without discomfortdiscomfort

All symptoms in All symptoms in class III even at class III even at restrest

What Can I Do To Prevent What Can I Do To Prevent Progression of the Progression of the

Disease?Disease?

♥ ♥ Become Conscious of Lifestyle Choices!Become Conscious of Lifestyle Choices!

♥ ♥ Make Better Choices…Make Better Choices…

☺ ☺ Quit SmokingQuit Smoking

☺ ☺ Reduce WeightReduce Weight

☺ ☺ Avoid Excess Alcohol and DrugsAvoid Excess Alcohol and Drugs

☺ ☺ ExerciseExercise

☺ ☺ Take MedicationTake Medication

Self Care StrategiesSelf Care Strategies

♥ ♥ Take an active part in your careTake an active part in your care♥ ♥ Communicate with your healthcare Communicate with your healthcare

team team (Healthwise for Life)(Healthwise for Life)♥ ♥ Be knowledgeable about your healthBe knowledgeable about your health♥ ♥ Take your medication as prescribed Take your medication as prescribed * Never run out of medications* Never run out of medications♥ ♥ Treat high cholesterol, diabetes and Treat high cholesterol, diabetes and

irregular heart beatirregular heart beat

Self Care StrategiesSelf Care Strategies

♥ ♥ Keep high blood pressure under Keep high blood pressure under controlcontrol

♥ ♥ Salt restrictionsSalt restrictions

♥ ♥ Daily weights and recordDaily weights and record

♥ ♥ Health BuddyHealth Buddy

♥ ♥ Look for swellingLook for swelling

♥ ♥ ImmunizationsImmunizations

♥ ♥ Manage stressManage stress

Early Symptoms of Heart Early Symptoms of Heart FailureFailure

♥ ♥ A weight gain or loss of 2 or more A weight gain or loss of 2 or more pounds in 1 day, or 4 pounds in 1 weekpounds in 1 day, or 4 pounds in 1 week

♥ ♥ Confusion, restlessness or lightheadedConfusion, restlessness or lightheaded♥ ♥ A feeling of fullness or bloating in your A feeling of fullness or bloating in your

stomachstomach♥ ♥ Cough, shortness of breath, swellingCough, shortness of breath, swelling♥ ♥ Fatigue, lose of appetite, or nauseaFatigue, lose of appetite, or nausea

Urgent Symptoms of Urgent Symptoms of Heart FailureHeart Failure

♥ ♥ Increased shortness of breath while Increased shortness of breath while resting or trouble sleepingresting or trouble sleeping

♥ ♥ Waking up suddenly at night due to Waking up suddenly at night due to difficulty breathingdifficulty breathing

♥ ♥ A need to sleep sitting up or a need for A need to sleep sitting up or a need for more pillows than usualmore pillows than usual

♥ ♥ A fast irregular heart beat, a racing A fast irregular heart beat, a racing heart that makes you feelheart that makes you feel dizzy, or like dizzy, or like you are going to pass outyou are going to pass out

♥ ♥ Coughing up pink frothy mucusCoughing up pink frothy mucus

Time Is LifeTime Is Life

♥ ♥ Know the warning signsKnow the warning signs♥ ♥ Heart disease is the leading Heart disease is the leading

cause of death in womencause of death in women♥ ♥ Take one aspirin unless you are Take one aspirin unless you are

allergic to itallergic to it♥ ♥ Make a plan and share it with Make a plan and share it with

your familyyour family

♥ ♥ Don’t delay call 911Don’t delay call 911

Symptoms of Heart Symptoms of Heart FailureFailure

Call 911 Call 911 ♥ ♥ Chest discomfort or pain that Chest discomfort or pain that

lasts more than 15 minutes lasts more than 15 minutes that is not relieved with rest or that is not relieved with rest or nitroglycerinnitroglycerin

♥♥ Severe, persistent shortness Severe, persistent shortness of breathof breath

♥ ♥ Loss of consciousnessLoss of consciousness

Question?Question?

Post Quiz Introduction to Heart Post Quiz Introduction to Heart FailureFailure

Evaluation FormEvaluation Form

The EndThe End