According to a study by the American Heart Association, 1 in 4 patients diagnosed with heart failure will have hospital readmission within 30 days, and approximately half will have a readmission within six months. (American Heart Association [AHA], 2021). These readmissions cause substantial financial impacts on already stressed healthcare systems. Left-sided heart failure can be systolic or diastolic in nature- occurring when the heart cannot effectively operate as a pump, failing the body’s demands.

Systolic heart failure is characterized by the left ventricle not having a firm “squeeze,” leading to less blood circulating around the body. As the squeeze begins to fail, so does the ejection fraction (EF) of the heart. Systolic heart failure is categorized by the ejection fracture becoming less than 40%.

Diastolic heart failure occurs when left ventricular diastolic heart function is impaired. During diastole, the heart is in a period of relaxation and refills with blood. When diastolic heart failure occurs, there is impairment to the cardiac muscle during the relaxation (refilling) period of the left ventricle, causing it not to fill adequately. This leads to decreased cardiac output. As the cardiac output decreases, the heart attempts to compensate for this failure by increasing the left arterial pressure. This results in pulmonary congestion.

This patient has systolic heart failure. The case study states that during the echocardiogram, the patient had an ejection fracture of 25% with decreased motion in the anterior wall of the heart. As stated above, an EF of less than 40% is consistent with systolic heart failure.

Left-sided heart failure can be recognized by the “lung” effects accompanying systolic or diastolic heart failure.

Dyspnea on exertion- shortness of breath on exertion is a classic sign of heart failure. As the heart fails to pump fluid around the body, it begins to accumulate in the lungs, causing increased work of breathing during physical activities.

Pitting edema- increased fluid retention into the extremities, or extreme cases, anasarca occurs when the shift of extra fluid moves into the extracellular spaces. “Edema does not become clinically apparent until the interstitial volume has increased by 2.5 to 3 liters because the tissues constituting the interstitial can easily accommodate several liters of fluid. Therefore, a patient’s weight may increase by nearly 10% before pitting edema is evident.” (Thibodeau & Drazner, 2018). Assessing heart failure patients’ daily weight is a simple, non-invasive intervention to assess fluid accumulation before distress occurs.

Jugular vein distention- JVD is an easily identifiable physical finding of decompensated CHF. Building pressure causes the jugular vein to be visible due to increased pressure in the right atrium and superior vena cava.

Orthopnea-increased shortness of breath while in the supine or semi-fowlers position. Patients experiencing heart failure laying in dependent positions have increased shortness of breath at rest as the body cannot compensate for the redistribution of blood volume from the lower extremities into the lungs.

Third heart sounds are clinically significant in the diagnosis and assessment of heart failure as they indicate severe mitral valve regurgitation. Third heart sounds are mainly created by diastolic distension of the left ventricle accompanying rapid ventricular filling leading to the slowing of atrioventricular blood flow. Ejection fraction is the measurement of how effectively the heart is functioning as a pump. A typical range of EF is between 55-70%. An EF of less than 40% is systolic heart failure. This patient has an EF of 25%- meaning a dangerously impaired heart muscle.