Pathophysiology of Chronic Systolic Heart Failure and Nursing Strategies

Running head: NURSING
NURSING
Name of the Student
Name of the University
Author Note

NURSING
1
1. Pathophysiology
The pathophysiology of chronic systolic heart failure is mainly determined by the failure
of the circulatory system for delivering sufficient oxygen for delivering the metabolic needs.
This is best explained by a complex interplay between the disruptive functioning of the
ventricular pump that restricts the supply of oxygen to the tissue that are metabolically active
(Chatterjee, 2015). The impairment of the ventricular muscles can be caused due to a number
of factors like high blood pressure. In such cases, the heart have to work harder for pumping
more blood through the body. It can also be caused due to chronic coronary heart diseases.
Cardiomyopathies are also responsible for damaging heart muscles. In a systolic heart failure,
dilation of the left ventricle occurs causing an increase in both the left ventricular end –
diastolic and the end systolic volumes (Katz, 2018). But as there is a greater increase in the
end –systolic than in the end diastolic volume, the left ventricular ejection fraction is
generally reduced. Hence, when the increase in the end –diastolic volume is not
proportionate, the ejection fraction can decrease despite of the normal left ventricular end
diastolic volume. Reduced ejection fraction in systolic heart failure may lead to the
backlogging of the fluid in to the lungs that can lead to pulmonary oedema (Macić-Dzanković
& Pojskić, 2017). In a systolic heart failure, a significant change in the shape of the ventricle
is caused. The shape of the left ventricle is normally ellipsoidal which changes to spherical in
a systolic heart failure (Macić-Dzanković & Pojskić, 2017).
It is evident from the case study, that Mrs. Brown had previous history of heart failure
that might have weakened the heart muscles. Contractility of the myocardium decrease with
previous history of myocardial infarction. Dys-functioning of the myocardial sarcomeres
might decrease the contractility, causing the stroke volume to be smaller and ultimately
decreasing the cardiac output. Failure of the left ventricular output leads to dyspnoea
(shortness of breath). Increasing chest tightness and shortness of breath is mainly due to the

NURSING
2
increased workload of the heart. Pulmonary oedema might be another cause of shortness of
breath in the patient as the accumulation of fluid reduces the movement of oxygen through
the lungs. The case study reveals that on diagnosis, the patient had been found to be having
arterial fibrillation. Atrial fibrillation might weaken the heart and cause heart failure
(Kataoka, 2017). This is a condition when circulation of the heart is impaired to meet the
oxygen demands of the body. Arterial fibrillation can be referred to as irregular and rapid
heart rate than can increase the risk of the strokes and other heart related conditions. During
the occurrence of arterial fibrillation, the two upper chambers of the heart beats chaotically
(Kotecha & Piccini, 2015). Clinical manifestations of arterial fibrillation includes palpitation
of the heart, shortness of breath. All these can be related to the symptoms displayed by Mrs.
Brown. The oxygen saturation level of Mrs. Brown is SpO2 85%, on room air which is quite
less than the standard value. As the heart muscles are weak, it is incapable of pumping more
blood causing oxygen deficiency in the cells. This causes the oxygen saturation to be low in
Mrs. Brown. The case study also reveals that the blood pressure of Mrs. Brown is also quite
high. Weka muscles of the heart causes the heart to work harder for pumping more blood
through the body. With this extra work, the muscles of the heart gets thicker and does not
work well.
Bilateral basal crackles can be heard in case of pulmonary oedema. Pulmonary
oedema is often caused by the occurrence of congestive heart failure. When the heart is not
being able to pump blood efficiently, the pressure on the blood vessels increase, which can
lead to the pushing of fluid in to the air spaces. These two factors can cause shortness of
breath and audible bilateral crackles (Kataoka, 2017). These can be related to the clinical
symptoms manifested by the patient.
2. High priority nursing strategies and their rationale