explain 4

Heart Failure

“My version”

In HF, the chambers are not able to either squeeze (due to stiffness) or relax totally (decreased tone). This has occurred due to some type of injury- genetic condition, myocardial infarction, hypertension, etc. When the chambers are not able to squeeze or relax, blood is not able to be forced through the body at that constant, hemodynamically, smooth flow. Think of the perfect system “healthy system”.

The defect in the left ventricles prevents it (the ventricle) from being able to pump the blood through the circulatory system. So, this means, the body, the organs and tissues are not able to receive the oxygenated blood (decreased perfusion).

Because the left side ventricle of the heart is unable to handle the blood that is being forced into it, the pressure starts to build up in the veins of the lungs causing the fluid to leak into the lungs. Think about when something starts to swell and become tight causing fluid to leak into the lung tissue. So, then you will see the pink-tinged sputum, you will have the shortness of breath when performing activities, lack of the adequate oxygen- causing you confusion. If you try to lie down, you will not be able to breath (orthopnea) -definitely because of this fluid backup (the squeezing pressure of the veins) around the lungs. Those are the crackles you would hear. The lack of oxygen. If you can’t breathe you can definitely turn blue- cyanosis!! I’m sure you would probably breath fast to because you can’t get the oxygen tachypnea. All of this would have happened because of pulmonary congestion-backing up of blood because of this faulty left-side ventricle that is receiving blood from the lungs (oxygenated blood).

This is how I differentiate the patient with left-side failure from the patient with right-side heart failure:

My Left-sided HF patient talking- “I can’t breathe. I have shortness of breath. I’m too tired. Fluid backing up and I keep coughing and can’t cough anything up but this “pink frothy stuff”? I can’t sleep either because when I try to lay down, I can’t breathe. Who are you by the way? I’m so confused right now. What are we talking about again?”

***We know that one of them has “lower extremity edema”. So…we already know what’s going on with the left-sided HF patient.

It has to be the person with- You guessed it!!—the person with the right-side failure!!! (and the audience is screaming cheering!!). Let’s talk about it.

RIGHT-SIDED HF

Everything from the lower portion of the body is swelling- belly (ascites) and legs(edema). Who wants to eat when their belly is full?? Loss of appetite. And, if they do---they won’t do much activity---weight gain (along with the extra fluid weight)! I would be tired trying to move all of that weight—fatigue (Hello…. another symptom). The increased peripheral venous pressure ---What about those jugular veins?? Venous- veins …making the connection yet? They swell also---Jugular Vein Distention “JVD”!!

Sum it up- Right side- swelling from the belly down (including the legs), which means weigh gain, tired from moving(fatigue) this new weight, jugular veins swelling (JVD) from the venous pressure?

To sum up the left-side-- I am sure you got the picture. If not, we can discuss further!

NOTE: HF usually starts in the Left ventricle and the right side starts to fail after prolonged hard work because it has had to work SOOO hard and the left ventricle is just out of commission.

You instructor may discuss- systolic failure and diastolic failure-these 2 are a subtype of left-sided HF.

Systolic “contraction/squeezing of the heart- inability to contract efficiently

Diastolic- relaxing of the heart- weak, flaccid, loss of tone- relaxes, but really cannot do much

Good luck!