ORAL EXAM CASE REVIEWER

HEART FAILURE

A. DESCRIPTION
● Heart failure (HF) is a clinical syndrome caused by structural or functional cardiac disorders that impair the ventricles' ability to fill or eject blood.
Because many patients experience pulmonary or peripheral congestion with edema, HF was previously referred to as congestive heart failure (CHF).
HF is now recognized as a clinical syndrome with signs and symptoms of uid overload or inadequate tissue perfusion. Fluid overload and decreased
tissue perfusion occur when the heart is unable to generate sufficient cardiac output (CO) to meet the body's demands for oxygen and nutrients.
● The term heart failure refers to a myocardial disease in which impaired heart contraction (systolic dysfunction) or filling (diastolic dysfunction) can
cause pulmonary or systemic congestion. Depending on the cause, some cases of HF are reversible. The majority of the time, heart failure is a chronic,
progressive condition that is managed with lifestyle changes and medications to prevent episodes of acute decompensated heart failure.
● For every 1000 Filipino patients admitted due to a medical condition during 2014, 16 cases were because of heart failure. The age at presentation was
younger compared to previously published local data, but was similar in age compared to the latest international study. There was no gender
predilection. Hypertension was possibly the most common etiologic factor. Although overall length of hospital stay was shorter compared to western
and Asia-Pacific countries, mortality rate was still relatively high (Mendoza et al, 2017).
● Acute heart failure symptoms develop quickly. 5 Symptoms of acute heart failure from a heart attack can appear within minutes to hours, whereas
symptoms from a virus or toxic incident can appear within hours to days.
● Common causes of heart failure include coronary artery disease, including a previous myocardial infarction (heart attack), high blood pressure, atrial
fibrillation, valvular heart disease, excess alcohol use, infection, and cardiomyopathy of an unknown cause.
Heart Failure happens when the heart can’t supply enough blood to meet the body’s demands.
● Systolic Heart Failure: when the heart’s ventricles during systole can’t pump enough
○ The heart needs to squeeze a certain amount of blood volume per minute or also known as the cardiac output. [BPM multiplied by the stroke volume
(volume of the blood squeezed heart each heartbeat)].
● Diastolic Heart Failure: when the heart can’t fill enough blood to the ventricles during diastole.
○ When the heart is squeezing enough but not filling (caused by the abnormal filling/reduced pre-load of the ventricle, hence the chamber doesn’t get
fully loaded) or following the demand that the body needs.
● Both cases cause the blood to back up to the lung which can then lead to congestion–a fluid buildup. Hence, this is where the usual term comes in:
congestive heart failure.
● Note: different sides of the heart can have a systolic or diastolic failure.
● Right-sided Heart Failure
○ The impaired ability of the right ventricle to deliver blood flow to the pulmonary circulation and increased right atrial pressures–heart is weakened
and results in fluid in your veins, causing swelling in the legs, ankles, and liver.
● Left-sided Heart Failure
○ Caused usually by systolic dysfunction because of damage to the myocardium–contraction doesn’t perform as it should therefore it doesn’t pump
wblood as efficiently. This may be due to an occurrence of ischemic heart disease (coronary atherosclerosis) that causes a plaque build up →
myocardium damage. A good example situation is if one experiences a heart attack, part of the tissue may be scarred which blocks arteries
completely: the heart can’t contract at all.
○ Long-standing Hypertension is also another cause of Left-sided heart failure, as arterial pressure increases within the systemic circulation the left
ventricle experiences difficulties in pumping blood out. As compensation for the body’s demands on the left ventricle, it bulks up for it to contract
with more force (hypertrophy), increase in muscle mass → greater demand for oxygen. Coronaries get squeezed down by the bulk which causes the
body to have less blood supply. (weaker contractions). More demands, less supply.
● Biventricular Heart Failure (when both sides of the heart fail).
○ Left, Right failure; Systolic/Diastolic
 Terms

● Stroke Volume: volume (mL) of blood pumped by the heart per contraction
● Cardiac Output: volume of blood pumped by the heart per minute (L/min)
● Preload: amount of blood in the ventricle before contraction
● Afterload: stress on the ventricular wall during systole
● Intropy: cardiac contractility
● Ejection Fraction (EF): percentage of blood leaving heart during each contraction
● Frank-Starling mechanism: loading ventricle with blood during diastole, stretching out cardiac muscles → more forceful contraction; increased stroke
volume during systole

B. FOCUS ASSESSMENT (SIGNS AND SYMPTOMS)

SUBJECTIVE OBJECTIVE

● Fatigue, general weakness ● Shortness of Breath

● Chest pain ● Swelling/Edema
● Nausea ○ Abdomen
● Lack of appetite ○ Leg
○ Ankles
○ Feet
● Rapid or irregular heartbeat
● Persistent cough or wheezing, congestion
○ Productive with secretions: white or pink-blood tinged mucus
● Weight gain
C. DIAGNOSTIC AND LABORATORY TESTS
DIAGNOSTIC TESTS LABORATORY TEST

1. Echocardiogram Rationale 1. Troponin 1 Rationale

● An echocardiogram checks how your heart's ● A troponin test measures the levels of
chambers and valves are pumping blood troponin T or troponin I proteins in the
through your heart blood. These proteins are released when
Range Values the heart muscle has been damaged, such
● Normal as occurs with a heart attack. The more
○ Between 50% to 70% normal ejection damage there is to the heart, the greater
fraction the amount of troponin T and I there will
● Abnormal be in the blood.
○ Ejection fraction of < 40% on left Range Values
ventricle ● Normal
Indication ○ 0.40 ng/ L
● Normal ● Abnormal
○ A normal result is when the heart’s ○ Having a result between 0.04 and
chambers and valves appear typical 0.39 ng/ml often indicates a
and work the way they should. problem with the heart.
● Abnormal ○ Above 0.40 ng/ml
○ Blood clot(s) in the heart. Blood clots Indication
in one of the chambers of the heart are ● Abnormal
often due to atrial fibrillation. ○ Heart Failure
○ One or more heart valves are not ○ Heart Infection
opening or closing properly. This might ○ Pulmonary Embolism
be a sign of heart valve disease, which ○ Myocarditis
can damage the heart muscle. ○ Heart damage from using
○ Heart walls are too thin or thick, or recreational drugs, such as
heart chambers are too large. This cocaine
might indicate decreased blood flow to
the heart, or a bulge in the heart’s wall.
2. Electrocardiogra Rationale 2. Cholesterol Test Rationale
m ● It records the electrical signal from the heart to ● A cholesterol test, also called a lipid panel
check for different heart conditions or lipid profile, measures the fats in the
Range Values blood. The measurements can help
● Normal determine the risk of having a heart attack
○ Heart rate: 60 to 100 beats per minute or other heart disease.
○ Heart rhythm: Consistent and even Range Values
● Abnormal ● Normal
○ Heart rate: <60 to 100> beats per ○ <200 milligrams per deciliter
minute (mg/dL) or 5.2 millimoles per
○ Heart rhythm: Inconsistent and not liter (mmol/L).
even ● Abnormal
Indication ○ >200 milligrams per deciliter
● Normal (mg/dL) or 5.2 millimoles per
○ If the test is normal, it should show that liter (mmol/L).
your heart is beating at an even rate of Indication
60 to 100 beats per minute. ● Abnormal
● Abnormal ○ Higher risk of heart disease.
○ Defects or abnormalities in the heart’s
shape and size
○ Electrolyte imbalances
○ Heart attack or ischemic
○ Heart rate abnormality
○ Heart rhythm abnormalities

3. Chest X-Ray Rationale Additional Tests Results & Indication

● It records the electrical signal from the heart to
check for different heart conditions BNP Levels BNP < 100 pg/mL - HF highly improbable
Range Values BNP 100 - 500 pg/mL - HF probable
● Normal BNP > 500 pg/mL - HF Highly probable
○ Lungs
■ Clear The higher the result, the more likely heart failure
■ No masses, nodules, is present and more severe it is.
consolidation or collapse ● Low BNP levels mean you likely don’t
visible have heart failure. Your doctor can rule
○ Heart that diagnosis out and look at other
■ Not enlarged reasons why you may have symptoms
■ Cardiac & mediastinal such as shortness of breath.
contours are normal ● High levels mean that your doctor may
 ● Abnormal make a diagnosis of heart failure. Also,
○ Lungs levels are higher when heart failure is
■ Haziness in the bilateral lower worse, and they go down when the heart
hemithoraces which may is stable
represent pulmonary edema.
■ Infections
■ Pneumonia
○ Heart
■ Concomitant pleural effusion
cannot be entirely ruled out.
■ True cardiac size cannot be
ascertained.
■ Fluid in the lungs
■ Air pockets and enlarged heart
Indication
● Normal
○ There are no masses, nodules,
consolidation or collapse visible and
lung fields are clear.
○ Heart is not enlarged and its cardiac
and mediastinal contours are normal
● Abnormal
○ Lungs
■ Haziness in the lungs indicates
a fluid build up accumulating
on its tissue. In turn, the blood
is not properly circulated to the
system that can create a
pressure in the small vessels of
the lungs. Thus, causing the
fluid to leak on the tissues and
progress to pulmonary edema.
○ Heart
■ Atherosclerotic aorta is a
condition caused by hardened
plaques of cholesterol and fat
materials that form on the
inside of the border of the
aorta. This can be a factor in
 having a reduced blood flow
and oxygen level in the heart.
Thus, could lead to myocardial
infarction or heart attack.

D. RISK FACTORS
MODIFIABLE NON MODIFIABLE

● High Blood Pressure, Hypertension

● Heart Problems
● Substance Abuse: Alcohol, Nicotine, Drug
● Lung Diseases
● Lifestyle
● Old Age
● Obesity
● Diabetes
● Sleep Apnea
● Family History of Heart Diseases
E. PATHOPHYSIOLOGY
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F. NURSING DIAGNOSES
1. Ineffective Breathing Pattern related to pulmonary congestion secondary to congestive heart failure as evidenced by tachypnea and tachycardia
2. Excess Fluid Volume related to increased venous pressure and decreased renal perfusion secondary to cardiac failure as evidenced by rapid weight gain,
edema, adventitious breath sounds, and oliguria
3. Decreased Cardiac Output related to altered heart rate as evidenced by dysrhythmias and difficulty of breathing
4. Impaired Gas Exchange related to pulmonary congestion from fluid retention as evidenced by changes in RR and abnormal ABGs
5. Activity Intolerance related to fatigue secondary to cardiac insufficiency and pulmonary congestion as evidenced by dyspnea, SOB, weakness, increase in
heart rate on exertion.
6. Risk Diagnosis: Risk for Impaired Skin Integrity related to altered circulation as evidenced by presence of edema
 G. NURSING CARE PLAN (3 PRIORITY PROBLEM)
NCP 1

ASSESSMENT DIAGNOSIS RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Ineffective Failure of the left SHORT TERM NIC: Airway Management NOC: Respiratory
> Facial grimace Breathing ventricle Within 30 Status: Airway
> Patient’s Pattern related to ↓ minutes to 1 INDEPENDENT Patency, Ventilation
verbalization of, “I pulmonary Blood backs up into hour of nursing
really find it hard to congestion lungs, increase intervention, the To gain baseline data. It’s SHORT TERM
breathe.” secondary to pulmonary vascular patient will be important to take action when After 30 minutes to 1
Assess and record respiratory
congestive heart pressure able to: there is an alteration in the hour of nursing
rate and depth at least every 4
Objective failure as ↓ ● Perform pattern of breathing to detect intervention, the
hours
> Productive cough evidenced by Forces fluid out of diaphragmat early signs of respiratory patient was able to:
> Frothy sputum tachypnea and capillaries ic pursed-lip compromise ● Perform
> Tachypnea tachycardia ↓ breathing diaphragmatic
Decrease blood ● Manifest Inspect the thorax for pursed-lip
Determine adequacy of
oxygenation gradual symmetry of respiratory breathing
breathing
↓ improvemen movement ● Manifest gradual
Respiratory centers t in improvement in
Measure tidal volume and Indicate the volume of air
try to compensate breathing breathing pattern
vital capacity moving in and out of the lungs
↓ pattern as as evidenced by
Increase respiratory evidenced vital signs
Most patients will have the
rate and heart by vital specifically
optimal vital capacity,
activity signs Position patient in optimal respiratory rate
oxygenation, and reduced
↓ specifically body alignment in semi- and pulse rate near
dyspnea when upright with
Tachypnea and respiratory fowler’s position for breathing normal range
arms elevated on pillows or a
tachycardia rate and without causing
bedside table
pulse rate fatigue
near normal Encourage the client to take Deep breathing helps to get
range deep breaths at prescribed more oxygen to the body’s
without intervals and do controlled cells; Reduces muscle tension, LONG TERM
causing coughing decreases work of breathing After 1 day of nursing
fatigue intervention, the
patient was able to
Small feedings are given to maintain normal
LONG TERM Provide small, frequent avoid compromising breathing pattern as
Within 1 day of feedings ventilatory effort and to evidenced by free from
nursing conserve energy. tachypnea and
intervention, the This will promote rest and tachycardia
Provide adequate rest periods
patient will be conservation of energy to
and plan activities ahead
able to maintain prevent breathing effort
normal
breathing Observe the presence of These may be indicative of a
pattern as sputum for amount, color, and cause for the alteration in
evidenced by consistency. breathing patterns.
free from
tachypnea and The incapability to mobilize
Check on the patient’s ability
tachycardia secretions may contribute to a
to mobilize secretions.
change in breathing patterns.

Hypoxia triggers the drive to

breathe in the chronic CO2
Keep away from a high
retainer patient. When
oxygen concentration in
administering oxygen, close
patients with chronic
monitoring is critical to avoid
obstructive pulmonary disease
hazardous risings in the
(COPD).
patient’s PaO2, leading to
apnea.

DEPENDENT

Oxygen administration has

been shown to correct
Administer oxygen as ordered
hypoxemia, which causes
dyspnea

Suction secretions, as Suctioning helps to clear the

necessary. blockages in the airway.

Ambulate patient as tolerated Ambulation can further break

with doctor’s order three times up and move secretions that
daily. block the airways.

COLLABORATIVE

Send specimen for culture and

sensitivity testing if sputum To rule out risks for infection.
appears to be discolored.
 Good nutrition can strengthen
Consult a dietitian for dietary
the functionality of respiratory
modifications.
muscles.

To monitor and evaluate the

Refer the patient to additional
effectiveness of the treatment
laboratories such as ABGs and
and provide proper
Chest X-ray
interventions.

Consulting and referring

Collaborate with other physicians or students after
healthcare professionals shift is important to maintain
present. provision on the patient’s
continuity of care.
 NCP 2

ASSESSMENT DIAGNOSIS RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Excess Fluid Right ventricle fails SHORT TERM NIC: Fluid Management NOC: Fluid Balance
> “Nananaba po ang Volume related to ↓ Within 1-2 SHORT TERM
aking mga binti” increased venous Develops hours of nursing INDEPENDENT After 1-2 hours of
pressure and congestion in the intervention, the nursing intervention,
Objective decreased renal peripheral tissues patient will be May indicate pulmonary the patient was able to
Auscultate breath sounds for
> rapid weight gain perfusion and the viscera able to maintain edema secondary to cardiac maintain fluid balance
presence of crackles.
> edema secondary to predominates fluid balance as decompensation. as evidenced by BP
> adventitious breath cardiac failure as ↓ evidenced by within patient’s normal
sounds evidenced by The right side of the BP within Decreased cardiac output limits
Measure I&O, noting decrease
> oliguria rapid weight gain, heart cannot eject patient’s normal results in impaired kidney
in output, concentrated
edema, blood and cannot limits perfusion, sodium and water
appearance. Calculate fluid
adventitious accommodate all retention, and reduced urine
balance.
breath sounds and the blood that output. LONG TERM
oliguria normally returns to LONG TERM After 8 hours of
Sudden changes in weight
it from the venous Within 8 hours nursing intervention,
Weigh daily. reflect alterations in fluid
circulation of nursing the patient was able to
balance.
↓ intervention, the be free of peripheral/
Increased venous patient will be venous distension and
Sodium enhances fluid
pressure able to be free dependent edema, with
retention and should therefore
↓ of peripheral/ Provide a low-sodium lungs clear and stable
be restricted during active MI
JVD and increased venous diet/beverages. weight.
phase and/or if heart failure is
capillary distension and
present.
hydrostatic pressure dependent
throughout the edema, with Hypokalemia can limit the
venous system lungs clear and Monitor potassium as effectiveness of therapy and
stable weight. indicated. can occur with use of
potassium-depleting diuretics.

DEPENDENT

Administer diuretics: May be necessary to correct

furosemide (Lasix), fluid overload. Drug choice is
spironolactone with usually dependent on the acute
hydrochlorothiazide or chronic nature of
(Aldactazide), hydralazine symptoms.
(Apresoline) as per doctor’s
order.

COLLABORATIVE

To monitor and evaluate the

Refer patient to additional
effectiveness of the treatment
laboratories such as ABGs and
and provide proper
Chest X-ray
interventions
 NCP 3

ASSESSMENT DIAGNOSIS RATIONALE PLANNING INTERVENTION RATIONALE EVALUATION

Subjective Risk for Fluid exchange SHORT TERM NIC: Tissue Integrity: Skin and Mucous NOC: Skin and
> Patient’s Impaired Skin interruption ● Within 2 Mucous Membranes
verbalization, “my Integrity related hours of the INDEPENDENT
daughter told me to to altered ↓ nursing SHORT TERM
not move so much circulation as intervention, Inspect skin, noting skeletal Skin is at risk because of ● After 2 hours of
because of this evidenced by Disturbance within the patient prominences, presence of impaired peripheral the nursing
swelling.” presence of edema intravascular and will edema, areas of altered circulation, physical intervention, the
interstitial verbalize circulation, or obesity and/or immobility, and alterations in patient verbalized
compartments understandi emaciation. nutritional status. understanding and
Objective ng and complied with
> Poor skin turgor ↓ comply on Provide gentle massage following the
Improves blood flow,
> Weakness the needs around reddened or blanched needs for
minimizing tissue hypoxia.
> Swelling on the left Supply of oxygen for areas. treatment in order
leg and nutrient treatment in to prevent skin
Provide frequent skincare: Excessive dryness or moisture
reduction order to breakdown.
minimize contact with damages skin and hastens
prevent skin
moisture and excretions. breakdown.
↓ breakdown.
Encourage frequent position Reduces pressure on tissues,
Removal of waste LONG TERM
changes, assist with active and
improves circulation, and
products from LONG TERM ● After a day of the
passive range of motion reduces time in any area is
blood functions less ● Within a nursing
(ROM) exercises. deprived of full blood flow.
efficiently than day of the intervention, the
normal nursing Provide alternating pressure, patient will
intervention, Reduces pressure on the skin, experience a
egg-crate mattress, sheepskin
↓ the patient may improve circulation. reduction of
elbow, and heel protectors.
will swelling.
Fluid exchanges experience a DEPENDENT
overfills due to reduction of
hydrostatic pressure swelling. Administer antidysrhythmic,
To alleviate symptoms and
anticholinergic, and pain
↓ reduce the risk of furthering
medications prescribed if
the patient’s condition.
needed.
Plaque build up
within the Administer prescribed To ensure that the body
 capillaries supplemental oxygen as receives its supposed demand
ordered by the physician. for oxygen.
↓
COLLABORATIVE
Risk for impaired
skin integrity Collaborate with other This is done in order to look
healthcare providers such as through possible underlying
medical technologies and conditions of the patient and
other physicians in confirming avoid worsening of patient’s
the patient’s lab results. health.
 H. NURSING MANAGEMENT/INTERVENTION
● Promoting activity tolerance
○ A total of 30 minutes of physical activity every day should be encouraged, and the nurse and the physician should collaborate to develop a schedule
that promotes pacing and prioritization of activities.
● Managing fluid volume
○ The patient’s fluid status should be monitored closely, auscultating the lungs, monitoring daily body weight, and assisting the patient to adhere to a
low sodium diet.
● Controlling anxiety
○ When the patient exhibits anxiety, the nurse should promote physical comfort and provide psychological support, and begin teaching ways to control
anxiety and avoid anxiety-provoking situations.
● Minimizing powerlessness
○ Encourage the patient to verbalize their concerns and provide the patient with decision-making opportunities.

I. MEDICAL/SURGICAL MANAGEMENT

MEDICAL MANAGEMENT SURGICAL MANAGEMENT

1. ACE inhibitors Angiotensin-converting enzyme 1. Coronary Angiogram Where a thin, flexible tube (catheter) is
a. Ramipril (ACE) inhibitors work by relaxing inserted into a blood vessel, usually in the
b. Catopril and opening up your blood vessels, groin, and guided to the heart arteries. A dye
c. Enalapril which makes it easier for your heart to (contrast) is injected through the catheter to
d. Lisonopril pump blood around the body. make the arteries show up more clearly on an
X-ray, helping the doctor spot blockages.

2. Angiotensin-2 receptor blockers (ARBs) Angiotensin-2 receptor blockers 2. Myocardial Biopsy Done by the assigned physician to insert a a
a. Candesartan (ARBs) work in a similar way to ACE small, flexible cord into a vein in the neck or
b. Losartan inhibitors by relaxing blood vessels groin, and removes very small pieces of the
c. Telmisartan and reducing blood pressure. heart muscle for examination. This test may be
d. Valsartan done to diagnose certain types of heart muscle
They tend to be used as an alternative diseases that cause heart failure.
to ACE inhibitors because they don't
usually cause a cough, although they
may not be quite as effective as ACE
inhibitors.

3. Beta blockers Beta blockers work by slowing your 3. Pacemaker You may need to have a pacemaker fitted if
a. Bisoprolol heart down and protecting your heart your heart beats too slowly.
 b. Carvedilol from the effects of adrenaline and
c. Nebivolol noradrenaline, "fight or flight" A pacemaker monitors your heart rate
chemicals produced by the body. continuously, and sends electrical pulses to
your heart to keep it beating regularly and at
the right speed.

The pacemaker is implanted under the skin by

a cardiologist, usually under local anesthetic.

4. Mineralocorticoid receptor antagonists MRAs make you pass more urine, and 4. Cardiac resynchronization therapy A special type of pacemaker that can correct
(MRAs) help lower blood pressure and reduce the problem by making the walls of the left
a. Spironolactone fluid around the heart, but they don't ventricle all contract at the same time. This
b. Eplerenone reduce potassium levels. makes the heart pump more efficiently.

Most pacemakers only have 1 or 2 wires to the

heart, but CRT requires an extra wire.

5. Diuretics Diuretics (water pills) make you pass 5. Implantable cardioverter People who have, or are at high risk of
a. Furosemide more urine and help relieve ankle defibrillators (ICDs) developing, an abnormal heart rhythm may
b. Bumetanide swelling and breathlessness caused by need to have a device known as an implantable
heart failure. cardioverter defibrillator (ICD) fitted.

An ICD constantly monitors the heart rhythm.

If the heart starts beating dangerously fast, the

ICD will try to bring it back to normal by
giving it a small, controlled electrical shock
(defibrillation).

If this fails, the ICD will deliver a larger shock.

As with pacemakers, ICDs are implanted in

hospital, usually under local anaesthetic.

6. Ivabradine Ivabradine is a medicine that can help 6. Heart Valve Surgery If the valves of your heart are damaged or
slow your heart down. It's a useful diseased, your doctor may suggest valve
alternative to beta blockers if you surgery.
can't take them or they cause
troublesome side effects. It can also There are 2 types of valve surgery: valve
 be used alongside beta blockers if replacement and valve repair.
they don't slow the heart enough.
The type of surgery you have will depend on
what's wrong with the valve and how serious
the problem is.

7. Sacubitril valsartan A single tablet that combines an ARB 7. Coronary Angioplasty / Bypass If your heart failure is related to coronary heart
and a medication called a neprilysin disease, your doctor may recommend a:
inhibitor. ● coronary angioplasty – where a tiny
balloon is used to stretch open a
It's suitable for people with more narrowed or blocked artery
severe heart failure, whose heart is ● coronary artery bypass graft (CABG) –
only able to pump a reduced amount where a blood vessel from another part
of oxygenated blood around the body of the body is used to divert blood
despite taking other medication. around narrowed or clogged parts of
an artery
These procedures will help make it easier for
your heart to pump blood around your body.

8. Hydralazine with nitrate Hydralazine in combination with 8. Left Ventricular Assist Device Left ventricular assist devices (LVADs) are
nitrate can help relax and open up the mechanical pumps that can help if your left
blood vessels. ventricle isn't working properly and medication
alone isn't helping.
These medicines are sometimes
prescribed by heart specialists They may be used as a permanent treatment if
(cardiologists) for people who are you can't have a heart transplant, or as a
unable to take an ACE inhibitor or temporary measure while you wait for a
ARB. transplant.

In addition to the pump, LVADs also include

an external battery. A wire connecting this to
the pump will need to be placed under your
skin during the operation.

9. Digoxin Improves your symptoms by 9. Heart Transplant A heart transplant may be necessary if you
strengthening your heart muscle develop severe heart failure that can't be
contractions and slowing down your treated effectively with medication or other
heart rate. types of surgery.
 It's normally only recommended for A heart transplant is a complex procedure that
people who have symptoms despite carries serious risks, so it's not suitable for
treatment with ACE inhibitors, ARBs, everyone with severe heart failure.
beta blockers and diuretics.
There's also a shortage of hearts for
transplantation, so some people have to wait
years for a suitable donor heart to become
available.

10. SGLT2 inhibitors SGLT2 inhibitors are tablets that can

a. Empagliflozin help lower your blood sugar levels.
b. Dapagliflozin They can be used to treat some types
of heart failure, as an add-on to other
medicines.
 J. DRUG ANALYSIS
Drug Classification Examples (Generic Name) Indication Mechanism Of Action Contraindications Nursing Responsibilities

Angiotensin-II ● Losartan Help relax your veins and Blocking receptors that the HF patients should 1. Monitor BP at drug trough (prior to
Receptor Blockers ● Telmisartan arteries to lower your hormone acts on, specifically not be given ARBs a scheduled dose).
● -SARTAN blood pressure and make AT1 receptors, which are if they have: 2. Inadequate response may be
it easier for your heart to found in the heart, blood Experienced improved by splitting the daily
pump blood vessels and kidneys. life-threatening dose into twice-daily dose.
Angiotensin II receptor (type adverse reactions 3. Lab tests: Monitor CBC,
AT1) antagonist acts as a (angioedema or electrolytes, liver & kidney
potent vasoconstrictor and anuric renal failure) function with long-term therapy.
primary vasoactive hormone during previous 4. For heart failure: weight, edema,
of the exposure to the lung sounds, dyspnea
renin–angiotensin–aldostero drug. Pregnancy.
ne system. Very low systemic
blood pressures
(systolic blood
pressure less than
80 mm Hg).

Digitalis Glycosides ● Digoxin For the treatment and It reversibly inhibits the Contraindicated in 1. Monitor ECG during IV
management of ATPase resulting in conditions in which administration and 6 hr after each
Congestive cardiac increased intracellular there is obstruction dose. Notify health care
insufficiency, arrhythmias sodium levels. The build-up to ventricular professionals if bradycardia or new
and heart failure. of intracellular sodium leads outflow, for arrhythmias occur.
to a shift of sodium example 2. Observe IV site for redness or
extracellularly through hypertrophic infiltration; extravasation can lead
another channel in exchange obstructive to tissue irritation and sloughing.
for calcium ions. cardiomyopathy, 3. Monitor intake and output ratios
constrictive and daily weights. Assess for
pericarditis, and peripheral edema, and auscultate
cardiac tamponade. lungs for rales/crackles throughout
therapy.
Acute myocarditis
may also increase
the risk of toxicity.

Loop Diuretics ● Furosemide Diuretics are used to treat A powerful loop diuretic that Use of a higher 1. Give early in the day so that
● Torsemide fluid retention and increases Na+ and water than the increased urination will not disturb
● Bumetanide swelling caused by excretion by the kidneys by recommended dose sleep.
congestive heart failure, inhibiting reabsorption from of furosemide or a 2. Administer with food or milk to
liver disease, kidney the proximal and distal fast infusion rate of prevent GI upset.
disease, or other medical tubules, as well as the loop the drug, 3. Observe older adults closely during
conditions. This also aids of Henle. It also reduces the periods of brisk diuresis. Sudden
in increasing urine flow. reabsorption of sodium, Hypoalbuminemia alteration in fluid and electrolyte
chloride, and potassium from comorbid illnesses. balance may precipitate significant
the tubule. These ions are adverse reactions. Report
then retained in the renal The concomitant symptoms to a physician.
tubule and delivered to the use of ethacrynic 4. Monitor BP during periods of
distal nephron. Because acid, diuresis and through periods of
water is retained in the aminoglycosides, dosage adjustment.
tubule when it reaches the or other ototoxic 5. Note to make position changes
distal tubule, dilute urine is drugs. slowly because high doses of
produced. antihypertensive drugs taken
Patients with concurrently may produce episodes
underlying severe of dizziness or imbalance.
renal impairment.