C155_Pathopharm.docx - Running head FOUNDATION Foundation...

Running head: PATHOPHARMOCOLOGICAL FOUNDATION 1
Pathopharmacological Foundation for Advanced Nursing Practice
C 155
Western Governors University
April, 2018

Pathopharmacological Foundation 2
Pathopharmacological Foundation for Advanced Nursing Practice
Investigation of Disease Process
Congestive heart failure is a condition where the heart is unable to effectively pump to
provide sufficient blood flow throughout the circulatory system. There are multiple causes and
risk factors associated with the development of heart failure. More than 5 million Americans are
living with a diagnosis of Heart failure and this number continues to rise with increasing age
(Kemp & Conte, 2012). It is reported that there is 500,000 new diagnosis of heart failure each
year, and is responsible for 1 out of 3 deaths (Kemp & Conte, 2012). Heart failure is a leading
cause of hospitalization, 30 day re-hospitalization, resulting in 10-38 billion dollars in healthcare
costs yearly (Kemp & Conte, 2012).
Pathophysiology
The heart is a muscle that is responsible to pump blood that is full of oxygen, nutrients,
hormones and cells throughout the circulatory system. This ensures organs are receiving what
they need to function properly. Many environmental, social, and genetic factors that contribute
to heart disease include age, obesity, smoking, substance abuse, diabetes, kidney failure,
hypertension, myocardial infarction, coronary artery disease, congenital abnormalities, and
infections. Heart failure is a progressive disease that initiates in the setting of heart disease,
resulting in an injury or strain to the myocardial muscle. Heart failure can occur from prolonged
myocardial strain or an event resulting in injury, thus decreasing the hearts ability to pump
effectively and maintain cardiac output (McCance & Huether, 2014). Cardiac output is defined
as the amount of blood pumped through the systemic and pulmonary systems (McCance &
Huether, 2014). Cardiac output is affected by preload, afterload, contractility, and heart rate.

Pathopharmacological Foundation 3
Decreased cardiac output creates a domino effect the heart is unable to generate the pressure
required to pump oxygen rich blood throughout the system to all vital organs, increasing the
heart rate to compensate. When the pump isn’t working this directly affects preload and
afterload. Increased afterload, leaves blood in the ventricles which will lead to ventricular
remodeling (McCance & Huether, 2014). As the heart compensates the myocardial muscle
continues to stretch and begins to hypertrophy continuing to change the contractility of the heart.
Venous and pulmonary congestion will occur as the as the heart is weaker and unable to manage
preload (McCance & Huether, 2014).
As the heart begins to fail, the human body works to preserve tissue perfusion by
compensating. Compensation is seen through the Frank – Starling mechanism, and
neurohormonal activation (Kemp & Conte, 2012). When there is a decrease in cardiac output
and a decrease in blood pressure the body engages the sympathetic nervous system to restore
balance through the release of catecholamine.