Medical-surgical Nursing Demystified

(^32) Medical-Surgical Nursing Demystified
When disease affects primarily the left side of the heart, the blood will back up
into the lungs. When disease affects primarily the right side of the heart, the sys-
temic circulation may be overloaded. When the heart failure becomes significant,
the whole circulatory system may be compromised.
HALLMARK SIGNS AND SYMPTOMS

• Extra heart sounds (normal heart sounds were described in the beginning):
  
  
  • S3: Soft sound caused by vibration of the ventricular wall caused by rapid
    filling. Heard after S2 heart sound. Heard over the apex of the left ventri-
    cle, fourth intercostal space along the mid-clavicular line. Best heard when
    patient lies on left side. Usually indicates heart failure.
  
  
  • S4: Vibration of valves and the ventricular walls during the second phase
    of ventricular filling when the atria contract. Heard before S1, in the same
    location as S3, usually due to a “stiff heart.”
  
  
  • Murmur: Sounds of turbulence caused by blood flow. Heard anywhere
    around the heart.
  
  
  
  


• Congestive heart failure


• Fatigue


• Syncope


• Chest pain

PROGNOSIS

Medications can help the heart to pump more efficiently. Some medications are

used for disease management; others are used for symptom control. Monitoring

dietary intake of sodium and fluids can also help with symptom control.

Heart failure is the main complication of heart disease, produced by an abnor-

mality of pumping function. The heart is unable to carry blood effectively to meet

metabolic needs. The resulting problems include acute left ventricular dysfunction

usually due to arrhythmias and myocardial infarction, and chronic failure due to

fluid overload, usually in valvular heart disease.

Heart failure is a compromise of any of the following:

• Contractility of the muscle


• Heart rate


• Ventricular preload


• Ventricular afterload