37 Circulatory failure as a result of acute heart failure reduces cardiac output and perfusion pressure, resulting in inadequate tissue perfusion. Heart failure (HF) can be chronic or acute, left-sided, right-sided or bilateral and due to either systolic or diastolic dysfunction. The diagnosis of HF is made when the patient complains of a number of signs and symptoms, with evidence of a cardiac abnormality found on blood tests and/or cardiac imaging (Table 37.1). HF is seen as a syndrome rather than a diagnosis, so the cause of the failure needs to be determined.1 Problems leading to HF are outlined (Box 37.1). Many people experience chronic heart failure, with occasional acute decompensation requiring hospital admission. Whatever the cause of HF, nurses should be able to recognise the signs of acute heart failure, instigate appropriate monitoring, escalating care to enable prompt diagnosis and treatment. Predominantly a problem of left ventricular systolic dysfunction (LVSD), it is caused by the inability of the LV myocardium to contract effectively, reducing the amount of blood (or SV) ejected. In health about 60% of the blood (ejection fraction) in the ventricle is ejected, but in HF the ejection fraction can fall to 20% or less. Failure of the LV in systole is caused by a number of problems, such as myocardial infarction or cardiomyopathy.
Acute circulatory failure 5: heart failure
Heart failure: how does it happen?
Systolic dysfunction
Diastolic dysfunction
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