Imagine you’re at clinical and your patient comes into the hospital with no energy and is having trouble breathing. You might initially think, “QUICK! Somebody get this guy an inhaler!!” Because we always freak out about everything as students, right? Okay…maybe that was just me. I’m dramatic.
So because you caught on before I did, you would probably have asked some follow up questions by now, like what’s his health background? What was he doing before the shortness of breath occurred? Has this happened before? You also probably already listened to his lungs, so what do those sound like?
So now you’re probably saying to yourself, “Hmm, well this could be a lot of different things” and patting yourself on the back for your excellent critical thinking and assessment skills (well deserved, by the way).
And you would be RIGHT! This could be a whole bunch of different things. But let’s go with left-sided heart failure for now, simply because I already outlined this blog post!
The left ventricle cannot pump out enough blood your body needs.
-Heart tissue death causing the muscle to fail (heart attack)
-There’s not enough blood in the left ventricle to pump out (mitral stenosis or atrial fibrillation)
-The ventricle can’t push out the blood it does have (hypertension, aortic stenosis, mitral insufficiency)
In Systolic HF, the heart cannot contract enough to keep up with the amount of blood your body needs.
Ideally, there’s 70mL of blood that fill your left ventricle between each heartbeat. And in a perfect world, that full 70mL of blood should be pumped out by your left ventricle during each heartbeat.
But in systolic HF, for example, there may be 70mL of blood entering your left ventricle, but only 30mL is being pumped out. That leaves 40mL of blood left sitting in your left ventricle.
But now, because the rest of your heart is working so nicely, another 70mL of blood just filled your left ventricle again, adding to the 40mL that was still sitting in there. That’s a total of 110mL of blood that has filled your left ventricle!
That’s a big problem for your heart, because it can’t hold that much blood all at once. So now your heart muscle stretches (increased preload) and blood backs up into your lungs.
In Diastolic HF, your heart muscle cannot relax enough to fill completely.
Remember, your heart is a muscle. And what happens when you go to the gym and do bicep curls with a lot of resistance? Your muscles get bigger!
The same thing is happening to your heart. Your heart muscle is getting bigger and can’t fill all the way.
Your heart muscle also gets stiff. Have you ever tried to blow up a super old balloon? You know, the one that’s been in your cupboard for three years? They are really hard to inflate because the elastic has broken down.
This happens with your heart too. When you heart muscles tissue dies, it leaves scar tissue. And scar tissue cannot stretch as much, so your heart muscle stiffens up.
Both of these factors prevent your heart from fully relaxing and letting in enough blood into the ventricle.
Because the blood cannot more forward into the circulatory system, it backs up into the lungs. Remember the shortness of breath our patient had? BINGO!
And imagine how you would feel if you weren’t getting blood to your brain, fingers and toes? A little weak, I’d say! Remember the fatigue your patient had? DOUBLE BINGO!
More symptoms you might see are:
-Pulmonary congestion, crackles in the lungs
-Weak pulses in the periphery
-Confusion, mental status changes
-Decreased urine output
All of these symptoms make sense when we think about what is actually happening in the heart.
We would expect wet lungs because the blood is backing up into the pulmonary circulation. We would expect weak pulses, fatigue, mental status changes, and decreased urine output because there is not enough blood going to the brain, extremities and kidneys for them to function properly.
Phew..are you still with me? That was a loaded blog! Unfortunately, cardiac is one of the hardest nursing topics to master. But fortunately, once you’ve mastered it, you’ve mastered the hardest nursing topic. It’s all uphill from here, right?
Tell me about your biggest dramatic, freak-out at clinical.
Eckman, M., & Share, D. (2013). Pathophysiology made incredibly easy. Ambler, PA: Lippincott Williams & Wilkins.
Ignatavicius, D. D, & Workman, M. L. (2013). Medical-surgical nursing: Patient-centered collaborative care. (5th ed.). (Vols. 1-2). St. Louis, MO: Elsevier Saunders.