Congestive heart failure (CHF) is defined as “an abnormal clinical syndrome involving impaired cardiac pumping and/or filling (Lewis, et al, 2011.)” The primary causes of heart failure include: coronary artery disease, hypertension, congenital heart defects, cardiomyopathy, hyperthyroidism, and valvular disorders. Heart failure can be categorized into left and right sided (Lewis, et al, 2011).
Left Sided Heart Failure
Let’s take a look closer into left sided failure. In left sided heart failure, the left ventricle doesn’t pump effectively. This causes blood to back up into the left atrium and into the pulmonary circulation. As the blood backs up, the pressure rises and causes fluid to escape, which may manifest itself as pulmonary edema. Left sided heart failure is the most common type of failure (Lewis, et al, 2011).
Clinical manifestations that occur during left sided heart failure include: increased heart rate, decreased PaO2 with slightly elevated PaCO2, crackles in the patient’s lungs as well as pleural effusions. Mental status changes and restlessness may also occur. Symptoms that the patient may complain about are weakness, fatigue, anxiety, depression, shortness of breath, shallow, fast respirations, dry, hacking cough, nocturia and paroxysmal noctural dyspnea (Lewis, et al, 2011).
Right Sided Heart Failure
Right-sided heart failure occurs when blood backs up into the right atrium and into the venous circulation. This results in venous congestion, which causes hepatomegaly, splenomegaly, vascular congestion of the gastrointestinal tract as well as peripheral edema. The most common cause of right-sided heart failure is left sided heart failure (Lewis, et al, 2011).
Clinical manifestations that occur during right sided heart failure include: heart murmur, jugular vein distention, edema, weight gain, increased heart rate, ascites, and anasarca. Symptoms that the patient may complain about are fatigue, anxiety, depression, dependent edema of the lower extremities, anorexia and nausea (Lewis, et al, 2011).
The physician, along with complete history and physical examination, will order some diagnostic tests to aid in the correct diagnosis. A chest x-ray will be ordered, along with a 12 lead EKG, an echocardiogram as well as blood chemistries including a B-type natriuretic peptide (BNP), liver function test and cardiac enzymes (Lewis, et al, 2011).
When auscultating the client’s heart you may hear tachycardia and murmurs. When listening to lung sounds you may hear crackles, rhonchi and even wheezes. You may also notice they are tachypneic (Lewis, et al, 2011).
When palpating the client’s skin you may notice the skin is cool and diaphoretic. You may also notice cyanosis or pallor. When palpating the lower extremities, they may have a pitting edema (Lewis, et al, 2011).