Heart Failure and Management Strategies

The provided assignment details cover various aspects of heart failure management, including the effects of ivabradine on outcomes, the role of beta-blockers, and the use of diuretics and ultrafiltration. It also discusses the epidemiology of heart failure, recommendations for pre-hospital and early hospital management, and guidelines for the management of heart failure. The assignment includes references to various studies and papers, making it a valuable resource for students and professionals in the field of cardiology.

Running head: NURSING ASSIGNMENT
Nursing assignment
Name of the Student
Name of the University
Author note

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Answer one
Congestive heart failure (CHF) affects the pumping capacity of the heart muscles and is a
chronic progressive condition. CHF refers to the specific stage where the fluids build up around
the heart resulting in ineffective pumping. The blood is unable to move efficiently through the
circulatory system, increases the pressure in the blood vessels and as a result, forces fluid out of
blood vessels into the body tissues (Roger, 2013). The symptoms depend on the body area that is
mostly involved in the reduction of pumping action. CHF is caused by health conditions that
direct affect the cardiovascular system like coronary heart disease, hypertension, cardiomyopathy
and abnormal heart rhythms (Damasceno et al., 2012). The patient has high blood pressure
(170/110 mmHg) that forces the heart to work harder for circulating the blood. This extra
exertion makes the heart muscles become too weak or stiff in order to pump blood effectively.
The damage to the heart or cardiomyopathy makes the heart muscle become thick, enlarged or
rigid making it hard for the heart to pump blood throughout the body (Hall, Levant & DeFrances,
2012).
In the given case study, the patient has a history of myocardial infarction (MI) that
caused sinus bradycardia making the heart weak. CHF is frequent in patients who have a history
of MI and is a clear manifestation of acute alternations that occur in left ventricular functioning.
The individuals who have acute myocardial infarction with no complications are likely to be
prone to CHF. The left ventricular dysfunction causes the heart failure progression and this left
ventricular dysfunction contributes to arrhythmic substrate (Heusch et al., 2014). Therefore, in
the given case study, the risk factors for the patient are high blood pressure and myocardial
infarction that contributed to the CHF condition. As mentioned in the case study, Mrs. Mckenzie
forgets to take her medicines that aggravated the MI condition resulting in CHF.

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CHF is a significant burden for the Australian healthcare system where ~50-75% is
diagnosed with the disease and 1-3% healthcare spending. Cardiovascular diseases (CVDs)
affect every one in six Australians that is equivalent to 4.2 million resulting in 490,000
hospitalizations during the year 2014-2015. About 30% of the deaths that occurred during the
year 2015 were largely preventable (Atherton et al., 2012).
CHF is a personal tragedy for the patients and their families. The individuals with CHF
have impaired Quality of Life (QOL) as compared to a healthy population. This poor QOL has a
multidimensional impact on the daily living and treatment of the patients (Yeh & Bull, 2012).
The unpredictable symptoms leave patients helpless and dependent on others with lack of
motivation. There is lack of control over the illness and a burden on the healthcare system. There
is burden on the family members while taking care of the patients with heart failure, as there is a
great responsibility for care. There is also financial burden on the family members due to
expenditures related to patient’s care. These factors greatly have a psychological and economic
impact on the patient and their family members. In addition, these factors affect the patient’s
well-being and family functioning (Burton et al., 2012).
Answer two
The symptoms of cardiac failure are seen when the heart is unable to pump enough blood
to the rest parts of the body. This does not mean that heart is not working rather pumping power
is weak than normal. The blood moves to the body at slow rate and as a result, the blood pressure
increases. In this situation, the heart is unable to pump enough nutrients and oxygen to meet the
needs of the body. The chambers of the heart stretch hard to hold more blood for pumping
through the body and as a result, the heart walls become eventually weak and stiffness prevails

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(Kemp & Conte, 2012). Although, the blood keeps moving, the heart wall muscles become
unstable and weak to cause efficient blood pumping. As a result, the kidneys causes retention of
water and fluid by responding to this situation that builds up in the ankles, legs, lungs, feet and
other organs. Eventually, the body comes in a congested state and heart failure describing CHF.
During the early stages, the patient may feel tired with shortness of breath, dizziness,
mild nausea, swollen ankles and irregular heartbeats. Mrs McKenzie manifested these
symptoms in the given case scenario. In CHF, the fluid backs up in the lungs that interfere with
the oxygen uptake into the blood that may result in shortness of breath or laboured breathing.
This lung congestion can also cause wheezing or hacking cough (Ambrosy et al., 2013). Nausea
or loss of appetite is another symptom that is caused by water and fluid retention as less blood
flows to the kidneys (Marti et al., 2012). This results in swollen ankles or oedema as Mrs. Sharon
reported that she has to wear bed socks as she complains about her cold feet. There is less
pumping of blood to the major organs and muscles that makes the patient feel weak and tired. In
addition, there is also less blood reaching brain that causes confusion or dizziness.
Answer three
The class of drugs used for heart failure are shown to be effective in many ways where
one drug treats a different contributing factor or symptom. Among all, ACE inhibitors
(angiotensin converting enzyme) are the best medicines for hypertension treatment and
extensively used for CHF. The drug has the potentiality to blocks the Angiotensin II formation as
it has adverse effects on heart and its circulation. ACE inhibitors can be helpful for Mrs.
McKenzie as it demonstrates remarkable improvement in symptoms, prevention of the clinical
deterioration and survival prolongation (McMurray et al., 2013). ACE inhibitors are

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vasodilators that relax the smooth muscles in blood vessels and make them dilate. The dilation of
arterial vessels results in reduction of systemic vascular resistance that in turn results in arterial
blood pressure fall. The dilation of venous vessels significantly decreases the venous pressure.
ACE inhibitors cause vasodilation by inhibiting the vasoconstrictor, Angiotensin II formation.
ACE breaks the vasodilator, bradykinin by blocking its breakdown and increasing its levels
contributing to vasodilation action (Yancy et al., 2016). In CHF, AC inhibitors reduce the after
load that enhances the stroke volume and ejection fraction improvement.
Captopril, benazepril and drugs like lisinopril are used widely for CHF. These drugs also
reduce the preload that in turn decreases the systemic and pulmonary congestion. There is also
reduction in sympathetic activation that is deleterious in CHF. The cardiac remodeling is reduced
through angiotensin II prevention and as a result, oxygen supply is improved by decreasing
demand in preload and after load (Lapi et al., 2013).
Cardioinhibitory drugs are another class of drugs that contains beta-blockers. This class
of drugs depresses cardiac function that decreases heart rate, myocardial contractibility that in
turn decreases the arterial pressure and cardiac output. Although, it may be counterintuitive that
this class of drugs is used in CHF, clinical studies have shown that beta-blockers improve cardiac
function. The benefit of this drug is that it is derived from their blockade of sympathetic
influences on heart that is harmful to the failing cardiac condition. Beta-blockers are beta-
adrenoceptor antagonists that bind to these receptors that are located in the cardiac nodal tissue,
contracting myocytes and conducting system (Swedberg et al., 2012). Beta1 (β1) and beta2 (β2)
adrenoceptors are present in the heart, although, Beta1 (β1) is the predominant receptor type that
binds to norepinephrine released from sympathetic adrenergic nerves. They also bind to
epinephrine and norepinephrine circulating in the blood and thus, preventing their normal ligand

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from binding to beta-adrenoceptor. They act as competitors for the binding site and significantly
reduce the sympathetic influences. Moreover, it reduces the elevated sympathetic activity and is
relatively selective β1 or non-selective (β1/β2) blockers (Vanhoutte & Gao, 2013). Therefore,
these classes of drugs are shown to improve the heart’s function and prolong life in case of Mrs.
McKenzie.
Answer four
The main nursing priorities within first 24 hours post emergency department (ED)
admission of Mrs. Mckenzie is aimed at alleviation of symptoms by accurately recognizing the
signs and symptoms and managing the exacerbated state. Immediate assessment and triage is
required as there is acute shortness of breath, nausea, dizziness, weakness and irregular
heartbeats. The nursing goals for the patient comprises of management of acute breathlessness or
instability in cardiopulmonary status through ongoing monitoring and management. After the
diagnosis of CHF, diuretics can be given to the patients for relieving dyspnoea (Shchekochikhin
et al., 2013). The diuretic is given at the lowest dose for the reduction of fluid congestion and
balancing the positive action with negative effect on the functioning of kidney.
Careful monitoring of renal functioning, urine output and fluid is required. Most
importantly, there is need for ongoing monitoring of patient response to treatment, stability in
cardiopulmonary status and need for close monitoring of haemodynamic parameters. During the
immediate stabilization period, the vasodilators and diuretics may lead to hypotension and
therefore, monitoring of early warning scores and vital signs need to be summed and monitored
to get a single composite score (Hung et al., 2014).

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For arrhythmia, the cardiovascular functioning analysis is important along with
monitoring of patient’s exertion. The regularity and frequency of pulse need to be observed for
any sort of alterations. The level of consciousness of the patient also needs to be observed for
verifying the signs of arrhythmia (Bardy, 2013). The patient needs to be appropriately positioned
on the bed and reduction in physical exertion. The fluid volume need to be controlled and
monitoring of cardiac rate.
For stabilizing the functional dyspnoea, the nurse should monitor the respiratory rate
(abnormal 30 breaths per minute) and hemodynamic status. The pulmonary conditions need to be
examined and the nurse should observe the pulse oximetry levels if less than 90%. There should
be monitoring of level of consciousness, pulse, body temperature, arterial pressure and breathing
pattern to look for any abnormal vital signs (Yancy et al., 2013). As she is having cold and
swollen feet, the nurse should control water intake and evaluate the extent of water retention in
the body. The signs like oedema, cold skin and pulmonary congestion need to be monitored and
the nurse should warm the limbs and reduce the risk of injury.
The nurse should look for the signs of dizziness, weakness and hypoperfusion along with
monitoring of presence of sudden dyspnoea. The patient needs to be positioned properly in bed
with monitoring of oxygen saturation levels above 92%. Most importantly, the water intake of
the patient needs to be reduced to avoid further congestion. The inter-disciplinary team
comprises of skilled heart failure team like nurse specialist, cardiologist and ward nurses
(Mebazaa et al., 2015). They perform close monitoring and management of CHF of the patient to
stabilize his condition, reduce hospitalization length and prolong survival providing a better
quality of life. The systematic care by nurses that is based on evidence-based practices can help

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to reduce the negative impact of CHF and other cardiovascular complications on the patient
outcomes.

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References
Ambrosy, A. P., Pang, P. S., Khan, S., Konstam, M. A., Fonarow, G. C., Traver, B., ... &
Grinfeld, L. (2013). Clinical course and predictive value of congestion during
hospitalization in patients admitted for worsening signs and symptoms of heart failure
with reduced ejection fraction: findings from the EVEREST trial. European heart
journal, 34(11), 835-843.
Atherton, J. J., Hayward, C. S., Ahmad, W. A. W., Kwok, B., Jorge, J., Hernandez, A. F., ... &
Krum, H. (2012). Patient characteristics from a regional multicenter database of acute
decompensated heart failure in Asia Pacific (ADHERE International–Asia
Pacific). Journal of cardiac failure, 18(1), 82-88.
Bardy, G. H. (2013). U.S. Patent No. 8,366,629. Washington, DC: U.S. Patent and Trademark
Office.
Burton, A. M., Sautter, J. M., Tulsky, J. A., Lindquist, J. H., Hays, J. C., Olsen, M. K., ... &
Steinhauser, K. E. (2012). Burden and well-being among a diverse sample of cancer,
congestive heart failure, and chronic obstructive pulmonary disease caregivers. Journal of
pain and symptom management, 44(3), 410-420.
Damasceno, A., Mayosi, B. M., Sani, M., Ogah, O. S., Mondo, C., Ojji, D., ... & Yonga, G.
(2012). The causes, treatment, and outcome of acute heart failure in 1006 Africans from 9
countries: results of the sub-Saharan Africa survey of heart failure. Archives of internal
medicine, 172(18), 1386-1394.

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Hall, M. J., Levant, S., & DeFrances, C. J. (2012). Hospitalization for congestive heart failure:
United States, 2000–2010. age, 65(23), 29.
Heusch, G., Libby, P., Gersh, B., Yellon, D., Böhm, M., Lopaschuk, G., & Opie, L. (2014).
Cardiovascular remodelling in coronary artery disease and heart failure. The
Lancet, 383(9932), 1933-1943.
Hung, S. C., Kuo, K. L., Peng, C. H., Wu, C. H., Lien, Y. C., Wang, Y. C., & Tarng, D. C.
(2014). Volume overload correlates with cardiovascular risk factors in patients with
chronic kidney disease. Kidney international, 85(3), 703-709.
Kemp, C. D., & Conte, J. V. (2012). The pathophysiology of heart failure. Cardiovascular
Pathology, 21(5), 365-371.
Lapi, F., Azoulay, L., Yin, H., Nessim, S. J., & Suissa, S. (2013). Concurrent use of diuretics,
angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-
steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control
study. Bmj, 346, e8525.
Marti, C. N., Gheorghiade, M., Kalogeropoulos, A. P., Georgiopoulou, V. V., Quyyumi, A. A.,
& Butler, J. (2012). Endothelial dysfunction, arterial stiffness, and heart failure. Journal
of the American College of Cardiology, 60(16), 1455-1469.
McMurray, J. J., Packer, M., Desai, A. S., Gong, J., Lefkowitz, M. P., Rizkala, A. R., ... & Zile,
M. R. (2013). Dual angiotensin receptor and neprilysin inhibition as an alternative to
angiotensin‐converting enzyme inhibition in patients with chronic systolic heart failure:
rationale for and design of the Prospective comparison of ARNI with ACEI to Determine

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Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM‐
HF). European journal of heart failure, 15(9), 1062-1073.
Mebazaa, A., Yilmaz, M. B., Levy, P., Ponikowski, P., Peacock, W. F., Laribi, S., ... &
McDonagh, T. (2015). Recommendations on pre‐hospital & early hospital management
of acute heart failure: a consensus paper from the Heart Failure Association of the
European Society of Cardiology, the European Society of Emergency Medicine and the
Society of Academic Emergency Medicine. European journal of heart failure, 17(6),
544-558.
Roger, V. L. (2013). Epidemiology of heart failure. Circulation research, 113(6), 646-659.
Shchekochikhin, D., Al Ammary, F., Lindenfeld, J. A., & Schrier, R. (2013). Role of diuretics
and ultrafiltration in congestive heart failure. Pharmaceuticals, 6(7), 851-866.
Swedberg, K., Komajda, M., Böhm, M., Borer, J., Robertson, M., Tavazzi, L., ... & Shift
Investigators. (2012). Effects on outcomes of heart rate reduction by ivabradine in
patients with congestive heart failure: is there an influence of beta-blocker dose?:
findings from the SHIFT (Systolic Heart failure treatment with the If inhibitor ivabradine
Trial) study. Journal of the American College of Cardiology, 59(22), 1938-1945.
Vanhoutte, P. M., & Gao, Y. (2013). Beta blockers, nitric oxide, and cardiovascular
disease. Current opinion in pharmacology, 13(2), 265-273.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., ... & Hollenberg,
S. M. (2016). 2016 ACC/AHA/HFSA focused update on new pharmacological therapy
for heart failure: an update of the 2013 ACCF/AHA guideline for the management of

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heart failure: a report of the American College of Cardiology/American Heart
Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of
America. Journal of Cardiac Failure, 22(9), 659-669.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., ... & Johnson,
M. R. (2013). 2013 ACCF/AHA guideline for the management of heart failure: executive
summary. Circulation, 128(16), 1810-1852.
Yeh, P. M., & Bull, M. (2012). Use of the resiliency model of family stress, adjustment and
adaptation in the analysis of family caregiver reaction among families of older people
with congestive heart failure. International journal of older people nursing, 7(2), 117-
126.