of this paper is to review left sided heart failure. This will include
statistics, predisposing factors, signs and symptoms, diagnostic studies,
medical and surgical treatments including nursing care.
Description of Left Sided Heart Failure.
Left sided heart
failure is a condition that does not allow the heart to fill or pump
effectively, therefore, the heart can not provide or meet the needs of the
body. There are two types of left sided heart failure, systolic and diastolic.
These conditions lead to a decrease in cardiac output and pulmonary congestion.
During systolic heart failure, the heart is unable to contact forcefully and cannot
eject enough blood into the circulation system. As a result, there is a
decrease in tissue perfusion and a buildup of blood in the pulmonary vessels.
During diastolic heart failure the left ventricle is unable to relax and
becomes stiff. The stiffening of the left ventricle prevents it from filling,
leading to a decrease in cardiac output.
Left sided Heart
failure is the most predominant diagnosis in the United States and it is also
the leading cause of death amongst all ethnicities. Over six hundred thousand Americans die from
heart failure each year, with left sided heart failure being the most common
type of heart disease. According to the Washington state department of health,
heart failure is the second leading cause of death in the state. Worldwide, there is a forty percent mortality
rate for patients that have been hospitalized with left sided heart failure in
the last five years.
Regardless of advances in medicine,
treating heart failure has been challenging for
physicians and medical teams (Inamdar., 2016).
sided Heart failure and its risk factors affect most of the population. The most common risk factors that can be
treated or controlled are having high blood pressure, a high cholesterol count,
having a sedentary lifestyle, being overweight and following an unhealthy diet
with most of the dietary intake being fats. Smoking, using drugs and consuming alcohol
daily are also risk factors that can be controlled. Factors that can’t be
controlled or treated include age, gender, race, and history of diabetes,
anemia, valvular and coronary disease. African American males and people 65 and
older have the highest incidence of heart failure (Dunley, Weston, Jacobsen,
and Rogers 2009).
to heart failure being a slow, debilitating disease many Americans ignore the
common signs and symptoms. A person in
the initial stages of left sided heart failure will lack signs and symptoms due
to the bodies compensation mechanism. The bodies compensation mechanism includes
stimulation of the sympathetic nervous system, the activation of Renin-Angiotensin
system, and myocardial hypertrophy. Due to a decrease in cardiac output a
person in an advance stage of left sided heart failure will experience,
fatigue, excessive amounts of urine output during the day with a decrease at
night, confusion, restlessness, dizziness, a high heart rate, palpitations,
pallid skin color, weak peripheral pulses, cool extremities and chest pain. Signs
and symptoms that indicate pulmonary congestion are a hacking cough that’s
usually more severe at bed time, shortness of breath, frothy pink sputum, a low
respiration rate, and crackles in the lungs on auscultation. Psychosocially, a
patient is prone to Anxiety and depression due to the slow progression of the
If a patient
presents with signs and symptoms of left sided heart failure, a physician and
medical team will start by completing a full assessment including medical
history, vital signs, a head to toe assessment, laboratory studies, diagnostic
tests and if needed hemodynamic monitoring. Electrolytes, hemoglobin and
hematocrit, B-type natriuretic peptide, urine analysis, and arterial blood
gasses are common laboratory tests drawn if heart failure is suspected.
An imbalance of
Electrolytes such as potassium, sodium, calcium, and magnesium can indicate complications
due to left sided heart failure or medications that are used to treat the
condition. To rule out anemia as a cause
of heart failure a Hematocrit and hemoglobin can be drawn. A B-Type natriuretic
peptide will be elevated due to myocardial injury; however, it is not specific
to left sided heart failure. Regardless of specificity it is a lab that is used
periodically in conjunction with treatment as it will decrease if treatment is
working, A normal range for BNP is 0-100 pg/ml. A urine analysis will show microalbuminuria if
there is renal function decline due to the decrease in cardiac output and
tissue perfusion. Microalbuminuria will usually be present before the elevation
of BNP. Arterial blood gasses are important laboratory studies that can show
hypoxemia, respiratory and metabolic acidosis or alkalosis. During left sided
heart failure arterial blood gases will usually show hypoxemia as the heart is failing
to supply the body with sufficient oxygenated blood.
are helpful when diagnosing left sided heart failure. X-Ray, CT, and MRI are some of the imaging studies
used. On an X-Ray the heart will appear
enlarged or there might be fluid present in the lungs. Liquid contrast might be used before a CT or
MRI, as the contrast will help healthcare providers see images better. After a patient receives contrast for a CT or MRI
it is important for nursing staff to encourage fluids to help the kidneys flush
the contrast out. An echocardiogram is a
type of ultrasound where soundwaves are used to show the function and structure
of the heart. This test is considered the
best diagnostic study when diagnosing left sided heart failure.
is a more invasive way to assess cardiac function. This type of monitoring allows for direct assessment
of cardiac output and volume status by monitoring blood pressure and oxygen in the
veins, arteries and heart.