Overview
Heart failure (HF) occurs when the heart cannot pump or fill effectively enough to meet the body’s needs without abnormally elevated filling pressures.
Congestive Heart Failure (CHF) refers to heart failure associated with fluid congestion.
Heart failure can affect both circulation and fluid balance, potentially causing shortness of breath, swelling, and reduced exercise tolerance.
Common Causes & Risk Factors
- Hypertension: Long-term high blood pressure increases the heart’s workload.
- Coronary Artery Disease: Reduced blood supply can damage or weaken the heart muscle.
- Previous Heart Attack: Damaged heart muscle may pump less effectively.
- Heart Valve Disease: Abnormal valves can increase pressure or volume strain.
- Cardiomyopathy: Disease of the heart muscle that affects its structure or function.
- Arrhythmias: Abnormal rhythms can impair effective pumping.
Key Mechanisms
- Reduced Cardiac Output: The heart may deliver insufficient blood to body tissues.
- Fluid Retention: Reduced kidney perfusion and compensatory hormonal responses can promote sodium and water retention.
- Pulmonary Congestion: Elevated pressures in the pulmonary circulation can cause fluid to accumulate in lung tissue.
- Peripheral Congestion: Increased venous pressure can cause fluid to collect in the legs, ankles, or other tissues.
Common Signs & Symptoms
| Finding | Description | Why It Happens |
|---|---|---|
| Dyspnea | Shortness of breath | Pulmonary congestion or reduced ability to meet oxygen demands |
| Orthopnea | Difficulty breathing while lying flat | Lying down increases venous return, potentially worsening lung congestion |
| Paroxysmal Nocturnal Dyspnea (PND) | Sudden episodes of severe breathlessness that awaken a person from sleep | Redistribution of fluid and changes in cardiac filling pressures during sleep |
| Peripheral Edema | Swelling, particularly in the feet, ankles, and legs | Increased venous pressure and fluid retention |
| Nocturia | Increased urination during the night | Fluid from dependent tissues may return to circulation when lying down, increasing nighttime urine production |
| Fatigue / Weakness | Reduced energy and exercise tolerance | Reduced cardiac reserve, impaired perfusion, and other factors |
| Rapid Weight Gain | Sudden increase in body weight | Fluid accumulation rather than an immediate increase in body fat |
Important distinction: Orthopnea is breathlessness while lying flat. PND is sudden breathlessness that awakens someone after they have been asleep. They are related but different symptoms.
CNA Considerations
- Observe and report new or worsening breathing difficulty.
- Assist with upright positioning when appropriate and consistent with the care plan.
- Record daily weights consistently when ordered.
- Observe and report new or worsening edema.
- Follow prescribed fluid-intake and output monitoring.
- Observe activity tolerance, fatigue, and changes from baseline.
- Follow prescribed mobility, diet, and fluid restrictions.
- Report worsening symptoms promptly.
Emergency signs: Severe breathing difficulty, new chest pain, fainting, or sudden unresponsiveness require immediate emergency response.
Clinical Connections
- Cardiovascular System
- Respiratory System
- Cardiac Output
- Fluid Balance
- Vital Signs
- Recognizing Patient Distress
- Cardiac Arrest & CPR Response
Questions
- How can heart failure cause fluid retention?
- Why does lying flat worsen breathing for some residents with heart failure?
- What distinguishes orthopnea from paroxysmal nocturnal dyspnea?
- Why can heart failure cause peripheral edema and nocturia?
- Why is sudden weight gain important in heart failure?
- What changes should a CNA report promptly?
Sources
- American Heart Association — Heart Failure Signs and Symptoms
- American Heart Association — Managing Heart Failure Symptoms
Flashcards
What is heart failure?01-foundations / diseases-conditions
Impaired pumping or filling of the heart that can cause inadequate circulation or congestion.
What is orthopnea?01-foundations / diseases-conditions
Difficulty breathing while lying flat.
What is paroxysmal nocturnal dyspnea (PND)?02-mechanisms / diseases-conditions
Sudden breathlessness that awakens a person from sleep.
Why does heart failure cause peripheral edema?02-mechanisms / diseases-conditions
Increased venous pressure and fluid retention cause swelling.
Why can heart failure cause nocturia?02-mechanisms / diseases-conditions
Fluid shifts into circulation when lying down, increasing nighttime urine production.
Why is rapid weight gain concerning in heart failure?02-mechanisms / diseases-conditions
It may indicate worsening fluid retention.
What should a CNA monitor in a resident with heart failure?03-application / diseases-conditions
Breathing, edema, weight, intake and output when ordered, and activity tolerance.