 Hello and welcome to nursing school explained. Today's topic is heart failure. So let's take a look at the basic physiology first. So I've drawn out a little diagram of the heart and lungs here. So we have the right atrium, right ventricle, left atrium, left ventricle, lungs in blue. Then we have the superior and inferior vena cava bringing the blood back to the heart. We have the pulmonary vasculature going to the lungs and then the aorta leaving the heart. And I'm a big fan of knowing the physiology of how the system is supposed to function. That way if something goes wrong you can really refer back to and say well I know it's supposed to function this way. Now if this is going on what kind of signs and symptoms am I going to see in this patient. So first of all the normal blood flow through the heart. Remember the blood comes back into the right atrium from the peripheral vasculature, flows through the right ventricle, goes out to the lungs, returns back in the left atrium, goes to the left ventricle and goes back out into the body. Now when the heart fails, so the heart is not able to pump efficiently then we have right or left sided heart failure. So either one of these two sides can fail. Now the most common heart failure is left sided heart failure and the most common cause for that is hypertension. So basically when there is an increased blood volume in the patient system the heart has to pump extra hard to pump all that fluid around. So if the blood pressure is elevated it takes some extra force of that left ventricle to create the cardiac output and after a while that heart muscle will wear out and it will lead to heart failure. So now if we think about it if that left ventricle is not working the blood is going to back up to where it came from which means the lungs and so the patient's complaints will be mostly shortness of breath or I also wrote down orthopnea and orthopnea basically means shortness of breath with activity, they might have some chest pain, they might feel fatigued, they might have some nocturia, they will definitely have some weight gain because they're retaining all that fluid, they might have paroxysmal nocturnal dyspnea, PND and I wrote in parentheses here pillows. So that means when the patient is sleeping at night typically we sleep flat but because there's so much workload now on the heart when the patient is flat because all the fluids are at the same plane that in order for the patient to get some relief they need to elevate the head of the bed and usually they prop themselves with extra pillows because they can breathe easier when they sleep up, when they sleep sitting upright and the term for that is paroxysmal nocturnal dyspnea and when the patient tells you I'm using three pillows at night to sleep that's usually a warning sign that there's something going on with heart failure where that fluid is backing up into the lungs and the patient might have left side heart failure and then also pink frothy sputum is another thing that we need to watch out for and that's more in the later stages so if there's so much congestion now in the lungs because the heart is not pumping the fluid through the body efficiently and it backs up into the lungs it can cause pulmonary edema and then the lungs get congested and the way that the body tries to get rid of that extra fluid from the lungs is by sputum production and there will be a little bit of bleeding in there which is why that sputum will be pink and frothy. Now for right-sided heart failure is usually most commonly caused by left-sided heart failure so if there's something going on with this ventricle the fluid backs up into the lungs eventually it'll get so bad that the lungs get so congested and then fluid is backing up all the way to the right ventricle excuse me it will have all the signs and symptoms of right-sided heart failure now another cause of right-sided heart failure is some pulmonary pathology so that can be pulmonary hypertension asbestosis any of the things that stem directly from the lungs that could cause some lung congestion and then the lungs are not really profusing and that fluid is backing up into the right side of the heart so symptoms of right-sided heart failure basically the fluid will back up and it'll get back into the systemic circulation so symptoms will be peripheral edema very typical patient while complaining of lower big complaining of lower extremity edema a sidey so now if that right side of the heart is not working and the blood is backing up into the peripheral circulation there could be fluid sitting being pushed out by the principle of basically osmosis and the oncotic pressure so that there's extra fluid collecting in the abdomen and now they'll have asides they can also have hepatosplenomegaly because again if the fluid is being backed up the organs that sit in that superior infirmenia kebab that come up the organs are the the liver and the spleen so if the fluid is backing up it might back it up into the liver and spleen making that enlarged and hepatosplenomegaly basically just means enlarged liver and spleen and then the patient can also have JVD jugular venous distention because again if that right side of the heart is not pumping efficiently fluid is going to back up and you will see that in their jugular veins