hey everyone it's Sarah register nurse rn.com and in this video I'm going to be going over an inlex review of heart failure this video is part of an inlex series over the cardiovascular system and in this specific video it's going to be part one I'm going to be covering the pathophysiology of heart failure the causes the signs and symptoms the different types what triggers it how it's diagnosed and things like that and I'm going to be giving you some clever pneumonics on how to remember this material for inlex and your nursing lecture exams and in the next video which will be part two I want to be covering specifically the nursing interventions and the pharmacological aspect of heart failure which is another important part that inlex will test you on and then after you watch this video be sure to go to my website register nurse rn.com and take the free inlex quiz that will test you on this material and a card should be popping up so you can access that so let's get started Ed first let's start out talking about what is heart failure heart failure is where the heart is too weak to pump efficiently and because it can't pump efficiently what happens it can't provide the proper cardiac output that your body needs to maintain its metabolic needs so what's really happening with heart failure is that that heart muscle has either messed up with how it can contract and pump that blood up through those valves out through your heart out through the other side of the heart or it's become too stiff and we're mainly talking about the ventricles of the heart we're going to be talking about mainly our right ventricle and our left ventricle and I'll go over that in depth whenever we cover the different types now what are the causes of heart failure to help you remember this remember the pneumonic failure we're talking about heart failure so it's easy to remember failure whenever we're trying to think about what causes this condition so first F heart faulty heart valves what does this mean well you have four different valves in your heart you have your tricuspid and your bicuspid valve also called your mital valve which are your avov ventricular Valves and then you have your pulmonic valve and your adoric valve which are your semi lunar valves now your tricuspid Valves and your tricuspid valve and your bicuspid valve can becom stenos or it can become regurgitated and whenever it becomes stenos it's too narrow and whenever it becomes regurgitated it means it leaks and this can lead to heart failure I have seen this as a nurse in the clinical study patient comes in they have messed up heart valves maybe from endocarditis and they need their heart valves replaced because whenever those heart valves are messed up it causes your heart to overwork and they enter into heart failure but whenever they get those valves replaced it fixes the problem and they're much better okay next a arhythmia um arhythmia like atrial fibrillation or tacac cardia can send you into heart failure and this is where for instance let's talk about atrial fibrillation atrial fibrillation is where your atriums are quivering they're not pumping efficiently so blood is like pulling in there and this can send a patient into heart failure a lot of times I have seen patients come in they didn't even know they were an aib and they had the sign of heart failure and also tacac cardia this is where you have a really fast heart rate patient may not know it it's elevator for a long time that puts a lot of strain on that heart makes that muscle weak and they enter into heart failure all right infarction such as mardial infarction and you will get this with coronary artery disease mardial infarction heart attack what happens is that they have a plaque build up in one of those arteries that feeds that heart muscle all that that nutrients it blocks the all that nutrients go into that heart muscle that heart muscle becomes es schic and dies and it becomes weak so um for instance like left ventricle this happens a lot whenever people get left-sided heart failure the arteries that feed that ventricle become blocked that muscle dies sends them into heart failure L for lineage um this is genetic family history Mom Dad grandmother had it so you're more at risk for developing it congenital you're born with it family history so that can run in families next you uncontrolled hypertension we talked about in the inle review video of hypertension hypertension is a number one it's a silent killer because patients don't know that they have it they don't have signs and symptoms until it's too late till it's affected the organs and what happens is whenever you have such that high pressure beating on that heart it can cause those ventricles to become stiffen so whenever they become stiffen they can that those ventricles will not fill properly with blood and you can enter into heart failure are recreational drug use such as cocaine or alcohol abuse patients who um do cocaine or have alcohol abuse are more susceptible for developing heart failure e evaders such as viruses infections that get in and attack the heart have seen this again a patient will come in um they're relatively healthy some of them are young but they've got some type of virus or infection that has attacked that heart muscle made it weak and now they are in heart failure now let's look at the different types of heart failure you can have you can have left or right-sided or both now to help you understand the different types of heart failure because this is a big thing the inux likes to ask and especially your nursing lecture exams because you need to know those different signs and symptoms that a patient with left-sided heart failure may be presenting with that someone with right-sided May so you need to know the different ones and let's look at the blood flow how the blood flow FL flows through the heart and the pathophysiology of it okay first let's get familiar with which side of the heart is which because that is very important when determining if you're in left-sided or right-sided heart failure so this right here is the right side of the heart where the blue unoxygenated blood is draining down into the heart this side is the left side of the heart where the nice rich red oxygenated blood it's went through the lungs it's going to be pumped up through the body and we're specifically remember looking at these ventricles because that's where our problem is with heart failure they're either too stiff or they're not Contracting properly so first let's look at how the blood normally flows through the heart and then we'll go through how it can back up and cause all those signs and symptoms okay so you have your Superior Vena and you have your inferior vena and what these do is they drain all that blood that your body has used to become re oxygenated it wants to send it through the lung lungs that's the goal of your right side to get that blood to the lungs to become oxygenated so it can go back to your body so it does that now note this is important later in your inferior venne it's also connected through those htic veins to the liver so whenever you start getting congestion in your right side of the heart the liver is going to be affected which we'll go over here in a second so it drains down into your right atrium then it flows down through the tricuspid valve then to your right ventricle the right ventricle squeezes it up through your pulmonic valve up through your pulmonary artery and out through your lungs and then it goes through gas exchange through those little sacks it becomes replenished then it's not nice and oxygenated and it shoots through the heart down through the left atrium down through the bicuspid valve which is also called your mital valve then down into that left ventricle and remember the left ventricle has the most pumping power of all four chambers because it has to in order to shoot that blood up through the body so that left ventricle will squeeze that blood shoot it up through your aortic valve up through your aorta and then through your whole body and then the cycle starts all over again now with heart failure like I've said there's either a contraction problem with these ventricles they're not Contracting properly maybe the muscles die become ischemic or they're not feeling properly and this could be due to um uncontrolled hypertension where that ventricle has just become too stiff first let's talk about left-sided heart failure so what's happening in left-sided heart failure why do you get pulmonary symptoms well with left-sided heart failure The ventricle either it's too stiff or it's not Contracting properly and you can have diastolic or systolic left ventrical dysfunction which we'll go over here in a second and what happens is that the blood will back flow up through your Atrium and up into your lungs so the patient will start presenting with pulmonary symptoms because that blood is back back flowing into there so they may um have crackles U shortness of breath uh oropa where they can't even lay down and sleep so they're going to get pulmonary signs and symptoms with left-sided heart failure now with right sided as a side note remember this Left sided because it's over here it can increase the pressure in the right ventricle because of all this back flowing of blood up through here and it can actually cause a patient to go into right um sighted heart failure as well so remember that so you can have both going on at the same times but sometime you can sometimes you can just have right-sided heart failure and whenever that happens on your right side watch where the blood would backf flow where you have too much blood back flowing because your ventricles aren't pumping out properly where is that blood going to go it's going to go up into those Superior and inferior venas out through the peripheral areas so you're going to be seen um peripheral edema um excessive weight gain um they may have increased abdominal girth in their belly acies and again back to the hepatic veins because all this blood is going to congest into the inferior vena it's going to cause hepatomegaly and cause your liver to become enlarged and then you'll get the large abdomen and just really uncomfortable so that is why you would see the certain signs and symptoms with each side so again just to recap your left side you are going to see pulmonary issues because it's back flowing into your lungs on the right side you're going to see peripheral edema and issues like that okay as I was talking about before you can have left-sided systolic dysfunction or you can have left-sided diastolic dysfunction and we're talking about the left side of the heart the left ventricle so let's go over systolic and you can also see it as left ventricular systolic dysfunction okay now let's think about to what systolic is we talked about this in the other video where we went in depth about blood flow what is syy systolic is the squeezing phase of your heart remember s systolic squeezing so it's the Contracting phase of your heart so there is an issue with the left ventricle Contracting and squeezing that blood up through the heart now with this patients are going to have a low ejection fraction usually less than 40% a less than 40% ejection fraction is a diagnosis for heart failure and whenever that happens the heart cannot squeeze that nice fresh oxygenated blood up through all those um tissues everything that needs it those vital organs so they don't get it and it backs up into the lungs as you just seen now what is ejection fraction what does it mean it's a calculation tool that is used to D agnos the Contracting ability of your left ventricle so it's the amount of blood that fills inside the left ventricle that is actually being contracted out of that ventricle now for instance say that you seen that a patient had an echo cardiogram because that's one of the tools used to diagnose ejection fraction and it said an EF of 38% what does that mean that means that only 38% of the blood that filled inside the left ventricle is being pumped out that is bad so they are in heart failure now a normal EF is an ejection fraction of greater than 50% that's a normal healthy heart and um like I said it can be diagnosed with an echocardiogram remember this this is really important not only for inlex but whenever you work as a nurse whenever you're reading test results so an echocardiogram can give you an ejection fraction a heart catherization can give you an ejection fraction and a nuclear stress test can as well give you that now let's look at left-sided diastolic dysfunction we just looked at systolic and that was the squeezing part of the heart there was an issue with the left ventricle being able to squeeze properly with diastolic dysfunction it is an issue with the ventricle being able to F properly because the diastolic diaso is the filling SL resting phase of the heart so The ventricle this left ventricle has probably became too stiff to fill with blood so not all the blood that's supposed to get in there gets in there but it contracts normally so it gets just a little bit of blood and it contracts beautifully so because it's not an issue with contraction it's an issue with it actually feeling your ejection fraction is usually going to be normal on these patients so they'll go over an echocardiogram and their EF comes back normal because there's not an issue with contraction just feeling now with your left-sided heart failure just because of where that left ventricle is you are going to have pulmonary symptoms with your left-sided heart failures now let's look at right-sided the other type of heart failure right-sided heart failure is not as common as left-sided heart failure funny enough left-sided heart failure is one of the main causes of why people would enter into to right-sided heart failure along with it's also caused by a pulmonary heart disease coal called core pulmonol as a complication of the patient either has pulmonary hypertension or COPD so that can be other causes of it now just the recap with the right side remember on the right ventricle just where it's located and where the anatomy is and everything that's going to be affected it just Mak sense if that if this ventricle is not Contracting properly blood is back flowing it's going to go peripherally so you're going to see peripheral signs and symptoms with this with Left sided you're going to see pulmonary so now let's look at the signs and symptoms side by side and let me give you some clever pneumonics on how to remember them okay for rided heart failure let's remember the pneumonic swelling and why swelling because remember these patients are going to have peripheral swelling everywhere so it's just an easy pneumonic to help you remember the typical signs and symptoms and then for left ided heart failure we're going to remember the word drowning because remember our lungs the pulmonary system is majorly involved in this and they are literally drowning in their own fluid so let's remember the word drowning okay so let's start with right sided for the s in swelling we're going to remember swelling of the hands the legs the liver they're going to have a lot of congestion lot of fluid going on with that W weight gain this is going to be present with both of them but especially with right-sided heart failure um you want to tell the patients to monitor their weights daily any fluctuation between 2 to three pounds in one day or 5 lounds in a week is something to be alarmed about because they could be going into heart failure exacerbation edema these patients not only will have swelling but they could have pitting edema in their legs and um this is where you can press on the tibia of the leg and it will actually pit in I have seen three four plus pitting edema it's very very interesting how much swelling these patients can have L for large neck veins this is um the jugular veins if you have a video on how to do this but if you turn the patient's neck to the right side they're setting up you or laying back a little bit you can actually see um jugular Venus distension L for lethargic these patients are going to be extremely tired extremely they can't tolerate it's hard for them to even get up from the bed to the bedside chair they get very winded because of all this extra fluid they're carrying and their heart is just so weak it can't pump efficiently to get that blood going everywhere I for irregular heart rate a lot of times whenever patients come in with congestive heart failure they can flip into um a regular heart rate like atrial fibrillation another thing is no Noca the n and this is very interesting this is where they have all of a sudden frequent urination in the middle of the night at the time they don't want to have it and this is because normally a patient people are up moving around but at night whenever you're laying down your legs are elevated it allows that fluid to enter back into the vascular system goes to the kidneys so your kidneys try to start putting out that fluid so that's why they may have excessive urination at night with this and G for girth the abdominal girth of their belly can be increased and this is because remember of the hepatomegaly where all this congested fluid is going to the liver so they can have that whenever they have that they have this big belly of extra fluid it can cause them not to breathe very well they'll have difficulty breathing because it's pushing on those lungs um it's also going to be pushing on the stomach so they could have anorexia just don't feel like eating and they can feel nauseous with this now left-sided heart failure we're drowning because we got pulmonary issues going on first D remember dpia this is because of all that fluid backing up into that lungs causing that patient not to breathe very well R for rails this is another word for crackles this is when you listen with your stethoscope and you can hear in the lungs this crackling noise how I like to do is take your hair and take it by your ear and that's what it sounds like o for oropa this is one of the telltale signs if a patient tells you and they have a mystry of congestive heart failure at night I've been having to use some pillows to set up to sleep and breathe because I just can't breathe that is a warning find them they may be going into SE to heart failure exacerbation so that's um what that is and then W for weakness again just like with right-sided heart failure they're going to be extremely weak just because that heart cannot put out the cardiac output it needs to to me meet your body's metabolic needs and for nocturnal proximal dispan this is where at night they will just wake up all of a sudden with extreme breathing difficulty just can't breathe at all it's very frightening for them and this is one of the things that can happen left-sided heart failure because you're having those pulmonary issues I for increased heart rate and the reason they have increased heart rate is because they have the heart the body sense is hey we have all this blood in the heart but we need to get out to the organs so it's just staying there so that heart will increase that heart rate and make it become tacky so it can p pump it out to get to those bottle organs and for nagging cough again that's you have the lung issues going on they'll have this persistent nagging cough and sometimes it can become frothy or blood tinged sputum and if this happens this is a really really bad sign that um something horrible is going on and you need to get them diares fast because they have some major fluid overload so if you see that that's usually a late sign G for gaining weight again just with right sided heart failure um they if they gain more than 2 to three pounds in a day or 5 lbs in a week that is a red flag okay let's look at real fast how heart failure is diagnosed in the hospital setting okay A lot of times Physicians will order a lab result called a BNP it stands for B type natur remic peptide we call it BMP and what it is it's a biomarker that's released by your ventricle when there's excessive pressure pressure on the heart due to heart failure and um typical readings if you have less than 100 there's no heart failure going on um if you have a 100 to 300 reading it's present greater than 300 it's mild greater than 600 it's moderate and greater than 900 it's severe and I have seen these in the 2000s with heart failure patients other things that are used to diagnose this a chest x-ray looking to see if there's any congestion in in those lungs looking at the heart to see if it's enlarged um an echo cardiogram a heart cath and a nuclear stress test which is what we talked about earlier with ejection fraction now heart failure can be maintained for patients um they can take medications they can do diet regimen and um other treatments so they can maintain it however um heart failure can go into exacerbation where it comes out in full force and some things that can trigger that are um maybe the patient isn't compliant with their diet they eat a lot of fast food a lot of sodium they don't restrict their fluids they drink a lot of soda a lot of water that can trigger them to go into heart failure infection they get really sick stresses the heart out go to heart failure uncontrolled atrial fibrillation or renal failure because renal patients have issues with fluid overload already and that can put more stress on the heart that already is more susceptible to heart failure so in the next video be sure to check out part two because I'm going to be going over nursing interventions and all those medications to use to treat heart failure so thank you so much for watching this video and please consider subscribing to this YouTube channel