systemic congestion, and chamber dilation. Abnormal cell growth manifested by myocardial hypertrophy and adverse remodeling is also triggered by angiotensin II(Osborn, 2014 p1029).” Patient’s chest radiography showed cardiomegaly as a result of abnormal cell growth due to increased workload of the heart.
In addition to decreased renal perfusion, decrease in cardiac output can affect other organs as well. Decrease cardiac output leads to ischemia because the oxygen demand from the organs is still there, however there is inadequate blood pumped by the heart to meet these demands. As a result, less oxygen is carried by red blood cells is getting to the organs.
Systolic dysfunction, also known as left ventricular systolic dysfunction(LVSD), results in volume overload and decreased contractility. It is diagnosed when the left ventricular ejection fraction (LVEF) is less than 40%. Normal LVEF is 55%-70%. Patient’s ejection fraction is 25-30% with cardiomyopathy. LVEF is the proportion of blood ejected during each ventricular contraction compared to the total ventricular filling volume. Cardiac remodeling occurs when prolonged activation of the sympathetic nervous system and renin-angiotensin-aldosterone leads to damaged and maladaptation of the myocardium. Myocytes will “revert to a fetal-type expression and ultimately changes the myocyte geometry from elliptical to spherical (Osborn, 2014 p1027).” The change in shape at the cellular level will manifest to changes in the size, shape, and function of the heart. There are three types of heart failure depending on the anatomy of the ventricles; right, left, or biventricular heart failure.
Right-sided heart failure is characterized as impairment to the pumping ability of the right side of the heart. The cause of right-sided defectiveness is left-sided dysfunction, isolated right ventricular myocardial infarction, and a process where blood cannot flow into the pulmonary vasculature in the lungs. The backup of blood leads to congestion and elevated pressure in the systemic veins and capillaries. Manifestation of right-sided heart failure includes elevated neck veins, abdominal ascites, edema, poor appetite, nausea and vomiting, and lower extremity swelling of the ankles and calves. Pt reports poor appetite, N/V, and has +2 pitting edema in LLE.
Left-sided heart failure is characterized as impairment to the pumping ability of the left side of the heart. Blood that is backed up in the pulmonary circulation increases pressure in the pulmonary veins and capillaries. Signs and symptoms that will occur as a result include poor concentration/mentation, pulmonary congestion, cough, paroxysmal nocturnal dyspnea, orthopnea, crackles, and activity intolerance.