Reflective accounts

Chronic heart failure: part 1

A CPD article improved Lorna Young’s knowledge of the pathopysiology, signs and symptoms of chronic heart failure

A CPD article improved Lorna Young’s knowledge of the pathopysiology, signs and symptoms of chronic heart failure


Picture: SPL

What was the nature of the CPD activity, practice-related feedback and/or event and/or experience in your practice?

The article outlined the physiology of the heart, the pathophysiology, signs and symptoms of chronic heart failure, and how the condition is diagnosed.

What did you learn from the CPD activity, feedback and/or event and/or experience in your practice?

Reading the article improved my knowledge of the physiology of the heart. It outlined the renin-angiotensin-aldosterone system, and I learned how this controls blood pressure and the balance of electrolytes and plasma volume.

The article discussed two forms of chronic heart failure: left ventricular systolic dysfunction with reduced ejection fraction and heart failure with preserved ejection fraction. It defined ejection fraction as a measurement of the percentage of blood forced out of the left ventricle on each contraction. Ejection fraction has an important role in the diagnosis of heart failure, and lower ejection fraction is associated with a lower survival rate.

I learned that the signs and symptoms of chronic heart failure are generally the result of reduced cardiac output and the accumulation of excess fluid, for example breathlessness, orthopnoea, paroxysmal nocturnal dyspnoea and peripheral oedema. The article stated orthopnoea can be monitored by the number of pillows the patient uses when lying in bed; the use of more pillows indicates more severe orthopnoea.

Patients with chronic heart failure may also experience mental health symptoms, such as low mood, anxiety and depression. This is an area that nurses should assess and monitor as part of a holistic approach to patient care.

After reading the article, I am aware of the requirement for a B-type natriuretic peptide (BNP) blood test to rule out chronic heart failure as a cause of a patient’s breathlessness, or to identify whether further investigation is required.

How did you change or improve your practice?

The article provided information about chronic heart failure that is relevant to my role in an acute medical assessment unit. I have gained knowledge of the signs and symptoms that a patient with suspected chronic heart failure might present with, and how the condition is diagnosed.

I will use this knowledge in my practice to improve patient care. For example, I understand why a BNP blood test may be required for patients experiencing breathlessness, and I will be able to explain to them why such diagnostic tests are being undertaken. By providing such information, I will ensure patients are better informed before they consent to the blood test being undertaken.

I am also aware that patients with chronic heart failure may be experiencing mental health symptoms. I intend to provide appropriate support for these patients, or refer them to specialist services where necessary.

How is this relevant to the Code? Select one or more themes: Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust

The Code theme of practising effectively states that nurses must assess need and deliver treatment based on the best evidence. The article provided evidence-based information about the assessment, diagnosis and symptoms of chronic heart failure. This will enable me to maintain my knowledge and skills, and to provide safe and effective patient care.

Lorna Young is a staff nurse at West Suffolk Hospital, Bury St Edmunds


This reflective account is based on NS875 Brake R, Jones ID (2017) Chronic heart failure part 1: pathophysiology, signs and symptoms. Nursing Standard. 31, 19, 54-60

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