Congestive Heart Failure – Causes of Pulmonary Edema (Nursing)

00:00 Hi, this is Prof. Laws with an update on the nomenclature for congestive heart failure or as it's now called, heart failure.

00:09 So you'll see the term congestive heart failure in the literature, but there's movement towards just calling it heart failure or HF.

00:17 In addition, systolic and diastolic heart failure are heart failure with reduced ejection fraction.

00:24 You'll see that written as HF that little “r” and “EF” for reduced ejection fraction.

00:31 Heart failure with preserved ejection fraction will be named HF.

00:36 That's small “p” for preserved and the letters “EF”, respectively. So let's break down congestive heart failure.

00:43 We've already said that the heart's not able to or it's not strong enough to efficiently pump an adequate amount of volume of blood to the rest of the body.

00:52 Then fluid begins to back up within the circulation.

00:56 After the fluid builds up in the lungs, and it begins to fill the alveoli with fluid.

01:01 pSo now instead of alveoli, you got a little water balloons in your lungs, okay.

01:06 Now I know that's a concept you've probably heard before, I want to invite a friend help us understand this even more.

01:13 This is a friend from my childhood.

01:15 I love this game, oh wagga wagga wagga wagga wagga wagga wagga wagga, maybe you recognize it, yeah I know.

01:21 You've probably played in some really cool retro places but I'm gonna use this little guy to walk us through the flow of blood so you're rock solid on what happens in congestive heart failure.

01:32 Okay, so this is gonna involve your pencil or your finger because I want you to trace the blood with our little friend there, our tour guide through the system.

01:42 Now in a normal pump, I'm talking about a heart and a system that's working efficiently, right? There's no problems, the heart hasn't had a heart attack because you know in a heart attack, you end up myocardial infarction, you end up with dead tissue and a dead tissue is stiff tissue.

02:00 So stiff tissue doesn't expand and contract efficiently, that's another cause of CHF - a heart that's taken a hit.

02:07 We're not looking at a heart like that, we're gonna look at a normal, healthy functioning heart.

02:14 Okay, so a normal pump - that's what we're looking at.

02:17 So unoxygenated blood, put your finger right on my little friend there, the little Pac-Man-like guy.

02:23 Put your finger right there.

02:25 No I'm serious.

02:27 Don't just listen to my voice, get your body involved, that's a great way to remember information in your brain.

02:33 Okay, so this is unoxygenated blood returning to the heart on the right side.

02:39 Now our little friend there is coming up from the bottom, right? It's coming up from my legs but you have your finger there.

02:44 If you trace it in, remember you also have unoxygenated blood coming down from your head too so you see you got those two vessels, so trace those two vessels - the superior and the inferior coming back to the right atrium.

02:58 Alright, now the unoxygenated blood enters the heart at the right atrium.

03:03 So make sure you got that clear in your mind, it's coming from my lower extremities and down from my head, now I'm in the right atrium.

03:12 Now after that, do you remember the name of the valve that it goes through? Okay, cool if you're not really solid on heart anatomy, you will be by the time we're done with this video series.

03:22 So the unoxygenated blood came in my right atrium, now we're down in the right ventricle.

03:29 The valve that it passes through is the tricuspid valve.

03:33 Now tri- sounds like right to me so that's how I always remember that the tricuspid valve is on the right side of the heart So right atrium, unoxygenated blood through the tricuspid valve into the right ventricle.

03:49 So you got your finger there, you see that's where we are.

03:51 Now for the right ventricle, the blood travels with the pulmonary artery into the lungs.

03:57 Ooh, okay so look at that, we kinda stretched it out for you so you can see it.

04:02 You know you're, this isn't exactly what it would look like compacted in your body but it's a great way for you to grasp the concepts.

04:09 Right atrioum - tricuspid valve - right ventricle, to both the lungs, the right and left lungs.

04:17 So right ventricle pushes unoxygenated blood through the pulmonary artery.

04:23 Remember it's called the pulmonary artery because it's taking blood away from the heart.

04:27 That's why its name is artery, going to the lungs to get oxygenated.

04:32 So strong functioning heart: unoxygenated blood - right atrium through the tricuspid valve - right ventricle then it goes to both the right and the left lungs.

04:45 Now the blood picks up oxygen in the lungs, yeah that's a good thing and it comes back to the heart on both sides.

04:52 So you're coming back from both the right and the left lung to the left atrium.

04:57 Okay, so in the left atrium, it's going to pass through the mitral valve into the left ventricle.

05:04 Okay, right atrium - tricuspid - right ventricle - both the lungs, right to get oxygenated, comes back to the left atrium, goes through the mitral valve into that left ventricle.

05:17 Now the left ventricle's job is to send blood out to up and down, right? UP to my brain, DOWN to the rest of my body carrying oxygen.

05:27 Alright, so we've got that just a quick review of heart anatomy.

05:32 Now pause the video, and see if you can trace up blood naming the valves, naming whether it's oxygenated or not.

05:39 Trace it all the way from the brain and the body, all the way through the left ventricle back out to the body.

05:53 Okay, welcome back.

05:54 I hope you took advantage of doing that a couple times because don't make the mistake that a lot of us make.

05:59 We think, yeah yeah yeah that makes sense now why she's saying it.

06:02 Yeah, of course it does because it's like we're singing karaoke, right? I'm the words on the screen and you're going along with me and it makes sense but that doesn't mean you've encoded it in your brain yet.

06:13 So you're capable of it, more than capable of understanding the stuff but it takes time and repetition.

06:20 So make sure you've paused it, you've done it multiple times, you have it rock solid without even having to look at it.

06:27 You can picture it in your own mind, then you know you're ready to move forward.

06:32 Alright, now let's talk about congestive heart failure, this is when it is not a healthy, strong functioning normal pump.

06:42 This heart is having problems that's why we call it congestive heart failure.

06:47 This means the heart is failing and congestive, it's like if your nose is all stuffed up, that's one of the problems.

06:53 That's the same thing with congestive heart failure - things are backing up, things are swollen, the heart is failing.

07:01 So you've got a normal heart and a congestive heart failure heart right there.

07:05 See you've got that thickening of that ventricular chamber, that wall.

07:09 Now see if you can recall why did that happen? What is one chronic problem that could be a big factor in causing a thick left ventricular wall? Cool! Did you remember that it's hypertension? Right, if that left ventricles have to work really hard because all the vessels in my body are clamped down, that means the afterload or the workload of the heart has pushed the blood out through those vessels then that's a higher afterload, it gets thicker which is helpful initially but remember, then it's too much of a good thing and the heart becomes stiff and not able to really fully empty.

07:52 So in CHF, that's why the heart can't keep up.

07:56 It can't pop strong enough to keep that good balance so fluid begins to back up.

08:01 Now, you already know the answer to my next question, you really do.

08:06 If you walked with me through the other stuff, if you've pause the video and you've practiced, you've got this.

08:11 So here's where your extra effort is really going to pay off.

08:15 Okay, so let's rewind, we're going to talk about what happens in congestive heart failure.

08:21 So normally, when we look at this slide, remember where the blood is gone.

08:25 I know, let's go through it just one more time.

08:28 Remember blood comes from here and here into my right atrium.

08:31 then it goes to the valve, the tricuspid valve then it's in the, right - right ventricle then it goes to, yep - the lungs, dump off that CO2, pick up the oxygen, come back to the left atrium.

08:46 Okay, now we're all together.

08:48 You see our guide, it's right there in the left atrium.

08:52 Then the blood that's now been oxygenated, right? It's coming back to the pulmonary vein because veins ring blood back to the heart.

09:00 Now it should move through the mitral valve into the left ventricle.

09:05 The problem is, in a normal heart, it would pump it out through the rest of the body, everything would be wonderful.

09:12 No, that's not what happens sadly in congestive heart failure.

09:16 This heart has a ventricle that's not strong enough to efficiently pump out blood out to the rest of the body.

09:23 Okay, now we have a real problem.

09:25 That's critically important that that left ventricle be strong enough to push blood out to the rest of the body.

09:32 Congestive heart failure - it's not.

09:35 so what happens? What happens when a ventricle can't pump blood out efficiently? Well, blood backs up where? Well, the next likely spot is gonna be the left atrium, right? It's gonna go backwards.

09:51 It's supposed to be going this way but now it's gonna back up so it's gonna go into the left atrium and it's gonna back up into both of the lungs.

10:01 Aaah, since that left ventricle is not strong enough to keep blood moving the direction it's supposed to go, it's gonna start backing up.

10:11 Now when it starts backing up, you're gonna have extra fluid hanging around and seeping out of the blood tissue, right? Into the tissues.

10:19 So we've got extra fluid volume seeping out of the blood supply into the tissues.

10:25 When we're talking about the lungs, those are the alveoli.

10:28 So those little alveoli, they're supposed to be these open little balls that exchange CO2 for O2 now become water balloons.

10:38 Alright, so that is one of the primary causes of pulmonary edema.

10:43 Now before you go on, I want you to just pause the video go back and review that and see if, pretend you're trying to teach someone else why congestive heart failure causes pulmonary edema.

10:55 Just do it one more time and I promise you'll have it down solid.