Systolic Heart Failure: Causes, Symptoms, and Treatment

Pathophysiologic Alterations 

According to the information given, the patient is suffering from left heart failure. Based on the description given, it can be argued that the patient is explicitly suffering from systolic heart failure. According to McCance & Huether (2014), “Heart failure with reduced ejection fraction (systolic heart failure) is defined as an ejection fraction of <40% and an inability of the heart to generate an adequate cardiac output to perfuse vital tissues” (p.1175). In this case, the patient is experiencing an ejection fraction of 30% from the left ventricle. Additionally, it can also be noted that the patient has had a history of cardiomyopathy, which may result in a decreased contractility. The outcome of this is that the patient’s heart experiences a decrease in stroke volume, which contributes to the need for compensation; thus, paving the way for an increase in left ventricular end-diastolic volume resulting in dilation of the heart. Ross, Ohlsson, Blomberg, & Gustafsson (2015) take note of the fact that cardiac dysfunction is often associated with ventricular remodelling resulting from a disruption in the structure of the myocardial extracellular within the heart.

Yancy et al. (2016) indicate the possibility of a disruption in the heart function helps in the instigation of the renin-angiotensin-aldosterone system (RAAS), as well as, the sympathetic nervous system (SNS). The activation is essential, as it allows for the release of neurohormones into the body. Both the RAAS and SNS play a critical role in seeking to ensure that the body can compensate for the reduction in cardiac output by contributing to an increase in heart rate. On the other hand. RAAS and SNS also contribute to the rise in peripheral vascular resistance (PVR) with the aim being towards ensuring that the left ventricle would work harder in its bid towards emptying while considering the strength that it is experiencing (Jorsal, Wiggers, & McMurray, 2018).

The activation of the RAAS, as part of the heart’s way of compensating for the reduced functionality, results in a significant alteration of the renal perfusion; thus, resulting in an increase in plasma volume within the heart (Toback & Clark, 2017). With the size of plasma increasing, the outcome is that it contributes to a subsequent increase in the preload and afterload on the heart, which serves as a trigger for vasoconstriction. Vasoconstriction refers to the constriction of the blood vessels, which may have a severe implication resulting in the release of the antidiuretic hormone (Afsin Oktay & J Shah, 2015). The hormone is mainly attributed to fluid retention, which, in turn, decreases sodium and edema, both of which are common when dealing with heart failure patients. In this case, the patient is experiencing a significant decrease in capacity for the left ventricle to function attributed to resistance. The outcome is that the patient is exposed to the possibility of systolic heart failure.

Heart Failure Checklist 

The development of a heart failure checklist is essential, as it helps in promoting compliance for the patient involved taking into consideration that it allows for a proper analysis of the patient’s approach to managing the condition (Atherton et al., 2018). In this case, the following is the heart failure checklist that will be considered for the patient, who has been diagnosed with congestive heart failure:

Has an LVF assessment been undertaken (EF%)

Current or a Recent Echocardiogram included as part of the report

Does the patient have an ACE or ARB prescription (Cases where EF% is less than 40%)

If no prescription, are there any contraindications listed or documented

The patient is a cigarette smoker within a period of the last 12 months, smoking cessation, referrals sent

CHF discharge instruction forms have been used (for all patients)

Showing a CHF video as part of patient education

Medication reconciliation completed and discharge medication has been provided

Activity

CHF diet and fluid restrictions indicated

Follow-up appointments have been prescribed to help in determining whether the approached used as part of treatment have any form of success

Weight monitoring

The checklist seeks to highlight some of the critical expectations when embarking on a process through which to enhance overall efficiency in monitoring the patient. The hope is that this will be of value in seeking to create a standard approach through which to minimize exposure to risks associated with heart failure. That would, in turn, help towards reducing overall demand for readmission considering that this will be of great value towards promoting compliance on the part of the patient.

Preventing Heart Failure Exacerbations and Hospital Admission/Readmission 

Compliance, when it comes to the regimen as per the prescriptions were given, might be of great value towards preventing heart failure. The expectation is that this will be of benefit towards reducing the possibility of exacerbations, which would increase in cases of hospital admission/readmission. The prescribed regimens allow for efficiency in dealing with temporary conditions likely to result in heart failure. One of the critical challenges that a majority of patients encounter when dealing with heart failure exacerbations is the fact that there exists a lack of compliance with the prescribed regimen. The outcome is that these patients often find themselves being exposed to temporary conditions that serve as risk factors for their exposure to heart failure. The result is that the majority of these patients often face a high risk of hospital admission/readmission. That seeks to highlight the importance of promoting compliance as one of the ways through which to minimize some of these underlying risks.

References

Afsin Oktay, A., & J Shah, S. (2015). Diagnosis and management of heart failure with preserved ejection fraction: 10 essential lessons. Current cardiology reviews ,  11 (1), 42-52.

Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S., Hopper, I., ... & Thomas, L. (2018). National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the prevention, detection, and management of heart failure in Australia 2018. Heart, Lung and Circulation ,  27 (10), 1123-1208.

Jorsal, A., Wiggers, H., & McMurray, J. J. (2018). Heart failure: epidemiology, pathophysiology, and management of heart failure in diabetes mellitus.  Endocrinology and Metabolism Clinics ,  47 (1), 117-135.

McCance, K. L., & Huether, S. E. (2014).  Pathophysiology-E-Book: The Biologic Basis for Disease in Adults and Children . Elsevier Health Sciences.

Ross, A., Ohlsson, U., Blomberg, K., & Gustafsson, M. (2015). Evaluation of an intervention to individualize patient education at a nurse‐led heart failure clinic: a mixed‐method study. Journal of clinical nursing ,  24 (11-12), 1594-1602.

Toback, M., & Clark, N. (2017). Strategies to improve self-management in heart failure patients.  Contemporary Nurse ,  53 (1), 105-120.

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Colvin, M. M., ... & Hollenberg, S. M. (2016). 2016 ACC/AHA/HFSA focused update on new pharmacological therapy for heart failure: an update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.  Journal of the American College of Cardiology ,  68 (13), 1476-1488.