The Left-Sided Heart Failure

Question: Discuss about The Left-Sided Heart Failure. Answers: Concept map on chronic left-sided heart failure The pathogenesis of acute exacerbation of chronic heart failure of the left side is accompanied by reduced cardiac output transferred to the circulatory system and affects the pulmonary system of the body. The heart functions by pumping from lungs the oxygenated blood and push the blood into the left atrium. The blood then moves into the left ventricle and finally gets distributed throughout the whole body (Fung, 2013). The left ventricle is usually larger than the other chambers of the heart and it provides the power to pump the blood providing the normal functioning of the organ. The normal functioning of the left ventricle is disrupted the heart fails to provide required amount of blood into the entire system of the body. The left-sided heart failure forces the heart to pump the blood harder to accomplish the amount. The two mechanisms responsible for the left-sided heart failure are: i) dysfunction and ii) systolic dysfunction of the heart. In case of the failure of the diastolic function of the heart, the left ventricle becomes stiffer and thicker, inhibiting the filling of the lower part of the left chamber sufficiently (Guazzi, Cahalin Arena, 2013). This reduces the amount of blood to be pumped out. In the later stage, the blood starts to from congestion in the left ventricle further proceeding to the lungs causing abnormal sounds called the crackles which was reported in the clinical examination of Mrs. Brown. In case of systolic dysfunction, the heart is restricted to pump out the blood into the circulatory system (Lilly, 2012). The clinical manifestation of left-sided heart failure with severe dyspnoea, development of bilateral cackle sound in the lungs, increased blood pressure are related to chronic exacerbation of the failure of heart that was diagnosed in Mrs. Brown aged 78 years old. The pressure gets elevated in the left atrium and pulmonary system due to uncertain increase in the blood of left ventricle. The normal drainage in alveoli of the lungs are affected which also effects the normal mechanism of the gaseous exchange (West, 2012). All these reasons lead to dyspnoea disorder. The atrial fibrillation reported in Mrs. Brown is caused by faster beating of the heart in order to compensate the pumping power that is lost (Katz Konstam, 2012). The increased rate of pulses in the patient is due to this reason. The increased in blood pressure disrupts the normal flow of the blood and causes elevated high pressure clinically reported in the patient of concern. As the heart is unable to pump out the requi red blood, the blood returns back to venous system taken via lungs. The blood accumulating inside the alveoli of the lungs produces crackles sound with auscultation (Boucher et al., 2013). Mrs. Brown showed a fall SpO2 level with 85%, whereas the normal saturation level of oxygen remains between 95-99% (Radak et al., 2013). As in case of the heart failure, the adequate blood is not pumped out affecting the lungs; low oxygen is transported by the blood in the body, which is determined by the oxygen saturation level. All these are the clinical symptoms with respect to exacerbation of left-sided heart failure (Corsonello et al., 2013). The nursing strategies are formulated diagnose acute left-sided heart failure. Among the various interventions, the two most potential nursing strategies for controlling the cardiac output are discussed here in treating Mrs. Brown. i) Controlling the Cardiac output: Regular readings of the heart rate with apical pulses and showing any kind of irregularity in heart rate should be noted (Fung, 2013). The rationality of this strategy is that in order to compensate the reduced contraction of the ventricle, the heart rate increases termed as tachycardia. The palpation of peripheral pulse can be helpful to determine the decreased cardiac output. Regular monitoring of the blood pressure is vital that occurs with increased vascular resistance (Mancia et al., 2013). Whenever body cannot overcome, hypotension occurs. Apart from all these, change in skin colour and cyanosis inspection should be done. Reduced peripheral perfusion causes a pale appearance due to abnormal cardiac output. Appearance of cyanosis can reflect heart failure. ii) Supplying ventilation and oxygenation: Proper auscultation of the sound produced during breathing and recording any kind of crackles is required to record any kind of pulmonary congestion and accumulated secretions (Boucher et al., 2013). In order to lower the oxygen demand and improvise the inflated lung the patient should be given complete bed rest and lifting the bed on the head side at 30degree angle with proper support. Oxygenation prescribed by the doctor in charge can be reduces the hypoxemia (Radak et al., 2013). Mrs. Brown was given IV furosemide and sublingual glyceryl trinitrate. Furosemide is a loop diuretic that restricts the water reabsorption in nephrone. This drug inhibits the action of co-transporter of sodium, potassium and chloride in the Henles loop. Furosemide also reduces the venous pressure by reducing the intravascular volume, the pulmonary veins pressure and pressure created in filling the chambers of the heart (Costanzon Jessup, 2012). The capacity of the venous system increases and the circulation becomes normal. The other drug named glyceryl trinitrate reduces the resistance of the pulmonary vascular system and dilates the venous and arterial system (Lozo et al., 2014). This vasodilator causes activation of the guanylate cyclase that activates the protein kinase pathway phosphorylating the cells of smooth muscle giving rise to dephosphorylation of the myosin chain. In the later stage, the release of the calcium ions cause vasodilation and relaxes the smooth muscle cells. The side effects of furosemide are impairment in hearing, itching, pain progression from upper stomach to back, feeling of nausea with vomiting and urine becomes darker (Costanzon Jessup, 2012). The side effects of glyceryl trinitrate are feeling dizzy, vomiting, decreased blood pressure, headache, and appearance of sore and itching (Lozo et al., 2014). Therefore, while giving these medicines to Mrs. Brown; utmost monitoring should be done to restrict any of these side effects. As one of the drugs was given intravenously, proper care should be taken to avoid kind of inflammation at the applied site (Goldschneider et al., 2014). 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