Chapter 25: Managing Heart Disease Complications

Heart failure is defined as a clinical syndrome resulting from structural or functional cardiac disorders that impair the ventricle's ability to fill with or eject blood, and it is categorized into Heart Failure with reduced Ejection Fraction (HFrEF or systolic failure), Heart Failure with preserved Ejection Fraction (HFpEF or diastolic failure), and the emerging classification of Heart Failure with midrange Ejection Fraction (HFmrEF). The text details the complex pathophysiology involving neurohormonal compensatory mechanisms, such as the stimulation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS), which release epinephrine, norepinephrine, angiotensin II, and aldosterone to increase blood pressure and fluid retention, ultimately leading to ventricular remodeling and worsening cardiac function. Clinical manifestations are distinguished between left-sided heart failure, which causes pulmonary congestion, dyspnea, orthopnea, and paroxysmal nocturnal dyspnea, and right-sided heart failure, which results in systemic congestion, jugular venous distention, hepatomegaly, ascites, and dependent edema. Diagnostic assessment relies on echocardiograms to measure ejection fraction and laboratory tests such as B-type natriuretic peptide (BNP) levels to confirm the diagnosis and assess severity. Medical management is extensively covered, emphasizing pharmacologic therapies including diuretics (loop, thiazide, and aldosterone antagonists) for fluid overload, angiotensin system blockers (ACE inhibitors, ARBs, and ARNIs) to reduce afterload and preload, and beta-blockers to block sympathetic effects and reduce cardiac workload. The chapter also outlines the use of digitalis to improve contractility, ivabradine for heart rate control, and intravenous inotropes like dobutamine and milrinone for severe ventricular dysfunction. Non-pharmacologic and surgical interventions discussed include nutritional therapy with sodium restriction, cardiac resynchronization therapy (CRT) with biventricular pacing, implantable cardioverter defibrillators (ICDs), ultrafiltration, and cardiac transplantation for end-stage disease. The nursing process highlights the importance of patient education regarding self-care, medication adherence, daily weight monitoring, and recognizing signs of exacerbation. Finally, the text addresses critical complications such as acute decompensated heart failure leading to pulmonary edema, cardiogenic shock, thromboembolism, pericardial effusion resulting in cardiac tamponade, and the emergency management of cardiac arrest using Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) protocols including high-quality CPR and defibrillation.