Congestive Heart Failure


NS2: Aging 7 Long-term Care


October 26, 2003


Congestive Heart Failure


Congestive heart failure is a condition in which a weakened heart cannot pump enough blood to body organs resulting in the blood to backing up into body tissues. It is the most common cause of disability in the elderly. “More than 75 percent of patients with congestive heart failure are over the age of 65 years” (Porth, 2004, p. 337). The New York Heart Association classifies CHF into four categories. Class I occurs when a patient is not limited to normal physical activities due to symptoms. Class II is when regular physical activities result in fatigue, dyspnea, or other symptoms. Class III is characterized by an apparent limitation in normal physical activity. In Class IV there are symptoms at rest and any physical activities (Grossman, 2002).


The most recent classification of congestive heart failure divides the pathophysiology into two categories, which are systolic and diastolic dysfunction. Systolic dysfunction occurs when the left ventricle is dilated and contractility is impaired. Diastolic dysfunction takes place in a normal left ventricle with impaired ability to relax and receive and eject blood. Congestive heart failure can also be classified as right-sided or left-sided heart failure. Often, one side of the heart will start to fail before the other. In elderly usually the left ventricle fails first. If the left ventricle fails first the heart is unable to pump all of the blood it receives. As, a result blood backs up into the lungs and peripheral edema occurs. Peripheral edema is accumulation in the lungs that may suffocate a person if untreated. If the right ventricle fails first, blood backs up into the systemic vessels, resulting in pulmonary edema. Peripheral edema is usually most noticeable in the feet and ankles (Tortora & Grabowski, 2000).


The major cause of congestive heart failure is coronary heart disease, which is blockage of the arteries that supply the heart with blood. Damage of the heart muscle from multiple or sever heart attacks can also lead to CHF. Other heart diseases such as, hypertension, congenital heart disease, myocarditis, and valvular heart disease may also initiate congestive heart failure. CHF may also occur because of excessive work demands such as hypermetabolic states or with volume overload such as renal failure. Some risk factors of CHF include alcohol abuse, diabetes, high cholesterol levels, obesity inactive lifestyle, and smoking (“Congestive”).


The manifestations of congestive heart failure depend on the type and severity that is present and how rapid it develops. Increased capillary pressures that develop in the peripheral circulation in right-sided heart failure and in the pulmonary circulation in left-sided heart failure cause many of the manifestations of congestive heart failure. Nocturia is an increase in urine output in the night that occurs early in the course of CHF. It is caused by the return to the circulation of edema fluids from the dependent parts of the body when a person is in the supine position for the night. The result is an increase in cardiac output, renal blood flow, glomerular filtration, and urine output (Porth, 2004).


There are many respiratory manifestations associated with congestive heart failure. A major manifestation of left-sided congestive heart failure is shortness of breath caused by congestion of the pulmonary circulation. There are several types of shortness of breath. Dyspnea is perceived shortness of breath, and dyspnea related to an increase in activity is exertional dyspnea. Shortness of breath when a person is supine is orthopnea. The gravitational forces that cause fluids to accumulate in the lower extremities when a person are standing or sitting are removed when a person with CHF assumes the supine position. Paroxysmal nocturnal dyspnea is a sudden attack of dyspnea that occurs during sleep. A person awakes feeling extreme suffocation that ends when the person sits up. Cardiac asthma is another respiratory manifestation of CHF. It is a bronchospasm caused by congestion of the bronchial mucosa. It may cause wheezing and difficulty breathing. Also, a manifestation that is often overlooked is a chronic dry, nonproductive cough. Another respiratory manifestation is Cheyne-Stokes respiration. It is when a person breathes deeply for a period when arterial carbon dioxide pressure is high and then slightly or not at all when the arterial carbon dioxide pressure decreases. This condition may be