--- title: "An ASC PreOp Nurse’s Guide to Ejection Fraction and CHF – Part 3: Understanding Congestive Heart Failure" description: A detailed overview of Congestive Heart Failure that aims to solidify a better understanding for ASC nurses. image: https://blog.onemnethealth.com/hubfs/iStock-947331372.jpg --- [![One Mnet Health Logo (Full Color)](https://blog.onemnethealth.com/hs-fs/hubfs/fullcolor.black-3.png?width=1840&height=663&name=fullcolor.black-3.png "One Mnet Health Logo (Full Color)")](https://www.onemedicalpassport.com/facility/) - [Home](https://onemnethealth.com) - [Solutions](https://onemnethealth.com/solutions/) - [ONEflow](https://onemnethealth.com/oneflow/) - [Medical Passport](https://onemnethealth.com/medical-passport/) - [Engage](https://onemnethealth.com/engage/) - [Payments (1st & 3rd Party)](https://onemnethealth.com/payments/) - [Success Stories](https://onemnethealth.com/success-stories/) - [News & Events](https://onemnethealth.com/news/) - [About](https://onemnethealth.com/about/) - [Careers](https://onemnethealth.com/careers/) - [FAQs](https://onemnethealth.com/faq/) - [Request A Demo](https://onemnethealth.com/contact/) ### Want to stay in the know on the latest ASC tips and topics? ### Recent Posts ### Looking for Something? [![New call-to-action](https://no-cache.hubspot.com/cta/default/5271895/62be96b8-3ca5-489a-a11a-7a6a83415a69.png)](https://cta-redirect.hubspot.com/cta/redirect/5271895/62be96b8-3ca5-489a-a11a-7a6a83415a69) [![New call-to-action](https://no-cache.hubspot.com/cta/default/5271895/e0bd18b7-18eb-4856-a7d9-660285ff88f2.png)](https://cta-redirect.hubspot.com/cta/redirect/5271895/e0bd18b7-18eb-4856-a7d9-660285ff88f2) ### Categories - [ASC (79)](https://blog.onemnethealth.com/tag/asc) - [ambulatory surgery center (74)](https://blog.onemnethealth.com/tag/ambulatory-surgery-center) - [video (34)](https://blog.onemnethealth.com/tag/video) - [nurse guide (29)](https://blog.onemnethealth.com/tag/nurse-guide) - [patient satisfaction (26)](https://blog.onemnethealth.com/tag/patient-satisfaction) - [patient communication (25)](https://blog.onemnethealth.com/tag/patient-communication) - [surgical facility (24)](https://blog.onemnethealth.com/tag/surgical-facility) - [business and finance (22)](https://blog.onemnethealth.com/tag/business-and-finance) - [technology (22)](https://blog.onemnethealth.com/tag/technology) - [patient engagement (17)](https://blog.onemnethealth.com/tag/patient-engagement) - [ambulatory software (16)](https://blog.onemnethealth.com/tag/ambulatory-software) - [pre-admissions (14)](https://blog.onemnethealth.com/tag/pre-admissions) - [Case Study (13)](https://blog.onemnethealth.com/tag/case-study) - [covid19 (12)](https://blog.onemnethealth.com/tag/covid19) - [ambulatory surgery center software (10)](https://blog.onemnethealth.com/tag/ambulatory-surgery-center-software) - [outpatient surgery (10)](https://blog.onemnethealth.com/tag/outpatient-surgery) - [complex cases (7)](https://blog.onemnethealth.com/tag/complex-cases) - [culture of safety (7)](https://blog.onemnethealth.com/tag/culture-of-safety) - [employee satisfaction (7)](https://blog.onemnethealth.com/tag/employee-satisfaction) - [outpatient surgery software (7)](https://blog.onemnethealth.com/tag/outpatient-surgery-software) - [administrator (6)](https://blog.onemnethealth.com/tag/administrator) - [cardiac (6)](https://blog.onemnethealth.com/tag/cardiac) - [or volume (6)](https://blog.onemnethealth.com/tag/or-volume) - [patient tracking (6)](https://blog.onemnethealth.com/tag/patient-tracking) - [postop (6)](https://blog.onemnethealth.com/tag/postop) - [solutions (6)](https://blog.onemnethealth.com/tag/solutions) - [document management (5)](https://blog.onemnethealth.com/tag/document-management) - [implementation (5)](https://blog.onemnethealth.com/tag/implementation) - [surgery scheduling (5)](https://blog.onemnethealth.com/tag/surgery-scheduling) - [ASC Everyday Heroes (4)](https://blog.onemnethealth.com/tag/asc-everyday-heroes) - [hiring (4)](https://blog.onemnethealth.com/tag/hiring) - [patient survey (4)](https://blog.onemnethealth.com/tag/patient-survey) - [preop (4)](https://blog.onemnethealth.com/tag/preop) - [scheduling (4)](https://blog.onemnethealth.com/tag/scheduling) - [security (4)](https://blog.onemnethealth.com/tag/security) - [surgery center (4)](https://blog.onemnethealth.com/tag/surgery-center) - [total joint (4)](https://blog.onemnethealth.com/tag/total-joint) - [women in healthcare (4)](https://blog.onemnethealth.com/tag/women-in-healthcare) - [ASC booking (3)](https://blog.onemnethealth.com/tag/asc-booking) - [CMS (3)](https://blog.onemnethealth.com/tag/cms) - [CMS requirements (3)](https://blog.onemnethealth.com/tag/cms-requirements) - [Derek's Corner (3)](https://blog.onemnethealth.com/tag/dereks-corner) - [best practices (3)](https://blog.onemnethealth.com/tag/best-practices) - [data integration (3)](https://blog.onemnethealth.com/tag/data-integration) - [everyday heroes (3)](https://blog.onemnethealth.com/tag/everyday-heroes) - [job security (3)](https://blog.onemnethealth.com/tag/job-security) - [outpatient surgery center (3)](https://blog.onemnethealth.com/tag/outpatient-surgery-center) - [patient registration (3)](https://blog.onemnethealth.com/tag/patient-registration) - [payment plan (3)](https://blog.onemnethealth.com/tag/payment-plan) - [preop nurse (3)](https://blog.onemnethealth.com/tag/preop-nurse) - [revenue (3)](https://blog.onemnethealth.com/tag/revenue) - [risk management (3)](https://blog.onemnethealth.com/tag/risk-management) - [senior patients (3)](https://blog.onemnethealth.com/tag/senior-patients) - [specialty procedures (3)](https://blog.onemnethealth.com/tag/specialty-procedures) - [texting (3)](https://blog.onemnethealth.com/tag/texting) - [vendor management (3)](https://blog.onemnethealth.com/tag/vendor-management) - [ASC quality reporting (2)](https://blog.onemnethealth.com/tag/asc-quality-reporting) - [Accreditation (2)](https://blog.onemnethealth.com/tag/accreditation) - [GI (2)](https://blog.onemnethealth.com/tag/gi) - [ambulatory surgery center surveys (2)](https://blog.onemnethealth.com/tag/ambulatory-surgery-center-surveys) - [burnout (2)](https://blog.onemnethealth.com/tag/burnout) - [cancellations (2)](https://blog.onemnethealth.com/tag/cancellations) - [clinical (2)](https://blog.onemnethealth.com/tag/clinical) - [cost (2)](https://blog.onemnethealth.com/tag/cost) - [digital chart storage (2)](https://blog.onemnethealth.com/tag/digital-chart-storage) - [disinfect (2)](https://blog.onemnethealth.com/tag/disinfect) - [healthcare consumerism (2)](https://blog.onemnethealth.com/tag/healthcare-consumerism) - [infection control (2)](https://blog.onemnethealth.com/tag/infection-control) - [new hire (2)](https://blog.onemnethealth.com/tag/new-hire) - [patient charts (2)](https://blog.onemnethealth.com/tag/patient-charts) - [patient risk (2)](https://blog.onemnethealth.com/tag/patient-risk) - [payments (2)](https://blog.onemnethealth.com/tag/payments) - [sleep study (2)](https://blog.onemnethealth.com/tag/sleep-study) - [time management (2)](https://blog.onemnethealth.com/tag/time-management) - [2021 (1)](https://blog.onemnethealth.com/tag/2021) - [4 tips (1)](https://blog.onemnethealth.com/tag/4-tips) - [Accredited (1)](https://blog.onemnethealth.com/tag/accredited) - [Billing (1)](https://blog.onemnethealth.com/tag/billing) - [ERAS (1)](https://blog.onemnethealth.com/tag/eras) - [One Mnet Health (1)](https://blog.onemnethealth.com/tag/one-mnet-health) - [SaaS (1)](https://blog.onemnethealth.com/tag/saas) - [capnography (1)](https://blog.onemnethealth.com/tag/capnography) - [certfication (1)](https://blog.onemnethealth.com/tag/certfication) - [colonoscopy (1)](https://blog.onemnethealth.com/tag/colonoscopy) - [conscious sedation (1)](https://blog.onemnethealth.com/tag/conscious-sedation) - [corona virus (1)](https://blog.onemnethealth.com/tag/corona-virus) - [customer spotlight (1)](https://blog.onemnethealth.com/tag/customer-spotlight) - [diagnosis (1)](https://blog.onemnethealth.com/tag/diagnosis) - [elderly patients (1)](https://blog.onemnethealth.com/tag/elderly-patients) - [endo (1)](https://blog.onemnethealth.com/tag/endo) - [hygiene (1)](https://blog.onemnethealth.com/tag/hygiene) - [intubation (1)](https://blog.onemnethealth.com/tag/intubation) - [laryngoscopy (1)](https://blog.onemnethealth.com/tag/laryngoscopy) - [marketing (1)](https://blog.onemnethealth.com/tag/marketing) - [obesity (1)](https://blog.onemnethealth.com/tag/obesity) - [outsourcing (1)](https://blog.onemnethealth.com/tag/outsourcing) - [patient (1)](https://blog.onemnethealth.com/tag/patient) - [patient finance (1)](https://blog.onemnethealth.com/tag/patient-finance) - [patient satifaction (1)](https://blog.onemnethealth.com/tag/patient-satifaction) - [payment (1)](https://blog.onemnethealth.com/tag/payment) - [personalized care (1)](https://blog.onemnethealth.com/tag/personalized-care) - [physician offices (1)](https://blog.onemnethealth.com/tag/physician-offices) - [pricing (1)](https://blog.onemnethealth.com/tag/pricing) - [recovery (1)](https://blog.onemnethealth.com/tag/recovery) - [screening (1)](https://blog.onemnethealth.com/tag/screening) - [sleep apnea (1)](https://blog.onemnethealth.com/tag/sleep-apnea) - [staff burden (1)](https://blog.onemnethealth.com/tag/staff-burden) - [staffing shortage (1)](https://blog.onemnethealth.com/tag/staffing-shortage) - [top 12 (1)](https://blog.onemnethealth.com/tag/top-12) - [vendor communication (1)](https://blog.onemnethealth.com/tag/vendor-communication) - [vendors (1)](https://blog.onemnethealth.com/tag/vendors) See all 07.08.2019[Stephen Punzak MD](https://blog.onemnethealth.com/author/stephen-punzak-md) # An ASC PreOp Nurse’s Guide to Ejection Fraction and CHF – Part 3: Understanding Congestive Heart Failure In Part 1 of this 4-part series, I talked about what Ejection Fraction (EF) is. In Part 2, I talked about the classifications of normal and abnormal EF. In this 3rd blog article in the series, I’ll talk about Congestive Heart Failure - commonly known as just CHF. As an ambulatory surgery center nurse involved in the preop evaluation of patients, you’ve undoubtedly seen patients whose medical history mentions CHF. Understanding the severity of the CHF, and what additional testing (if any) should be done, is super important for the safe care of a patient with a history of CHF. The first thing to know is that there are two main flavors of CHF: systolic (caused by decreased contractility of the left ventricle, i.e., a decreased EF) and diastolic (a stiff left ventricle with reduced compliance that doesn’t relax normally during diastole, the filling phase of the cardiac cycle). Patients can have both types. Patients with CHF are at constant risk of pulmonary edema (water in the lungs). That’s because the right ventricle keeps pumping blood to the left ventricle, but if the left ventricle can’t pump well enough to keep up or is too stiff (non-compliant and can’t stretch to fill fully), blood builds up on that side of the heart. Like a traffic jam building up behind a wreck, the problem moves backwards from the source. In this case, the left atria (the heart chamber before the left ventricle) swells first, then the pulmonary veins, and finally the increased volume and pressure from the buildup of blood causes fluid in the pulmonary capillaries deep in the lungs to leak into the lung tissue causing fluid in the lungs- aka pulmonary edema. As mentioned in Part 2 of this series, the heart and body initially try to compensate for a reduced EF, but all of these compensatory mechanisms come at a steep price. For example, an increase in heart rate to maintain cardiac output places a greater strain on the heart, particularly in a patient with coronary artery disease and areas of cardiac ischemia (inadequate blood flow). Systemic vascular resistance increases (arteries constrict) to maintain blood pressure, but this makes it even harder for the weakened heart to pump against this increased resistance. Increases in renin, angiotensin and aldosterone cause the body to hold on to more fluid thus increasing intravascular volume, but this can result in dire consequences of CHF such as pulmonary edema (water in the lungs). Treatment of CHF largely revolves around blunting the compensatory mechanisms that can be so harmful in the long run. Thus, beta blockers are prescribed to blunt the effects of catecholamines (epinephrine and norepinephrine) that cause increased heart rate and increased systemic vascular resistance. ACE inhibitors are given to reduce the renin-angiotensin involvement, and diuretics such as Lasix are used to reverse increases in intravascular fluid volume. Check out our [other blogs](https://blog.onemnethealth.com/) if you missed them, and be sure to comment down below to let us know your thoughts on our CHF blog series. --- About the Author: Stephen Punzak, MD is a practicing Anesthesiologist as well as the CEO of [One Medical Passport](http://1mp.com/). He founded One Medical Passport because he has always had a vision of how healthcare could run more efficiently using technology.  He frequently writes on medical topics, workflow efficient measures and ASC industry trends.  Topics: [ambulatory surgery center](https://blog.onemnethealth.com/tag/ambulatory-surgery-center), [cardiac](https://blog.onemnethealth.com/tag/cardiac) ![Stephen Punzak MD](https://blog.onemnethealth.com/hs-fs/hubfs/fullcolor.black-1.png?width=200&height=72&name=fullcolor.black-1.png) ### Written by [Stephen Punzak MD](https://blog.onemnethealth.com/author/stephen-punzak-md) Dr. Stephen Punzak, M.D., Founded One Medical Passport in 2000 and serves as its Chief Executive Officer. For the past 17 years Dr. Punzak has worked as an anesthesiologist for large tertiary hospitals and ambulatory surgery centers. ## Related Blogs ### [A PreOp Nurse’s Guide to Ejection Fraction and CHF- Part 1](https://blog.onemnethealth.com/a-preop-nurses-guide-to-ejection-fraction-and-chf-part-1) ### [A PreOp Nurse’s Guide to Ejection Fraction and CHF- Part 2](https://blog.onemnethealth.com/a-preop-nurses-guide-to-ejection-fraction-and-chf-part-2) ### [An Ambulatory Surgery Center PreOp Nurse’s Guide To Cardiac Testing – Part 3 Nuclear Medicine Stress Test](https://blog.onemnethealth.com/an-ambulatory-surgery-center-preop-nurses-guide-to-cardiac-testing-part-3-nuclear-medicine-stress-test) #### COMPANY - [One Mnet Health](https://onemnethealth.com/) #### CONTACT SALES - *![phone](https://www.svgrepo.com/show/524807/phone.svg)* ##### PHONE [888.807.7709](tel:8888077709) #### CONTACT SUPPORT - ##### FACILITIES [Click here to contact the Passport Care Team for facility support.](https://www.onemedicalpassport.com/facility/) Phone: [800.540.7527, ext. 2](tel:8005407527) - ##### PATIENTS [Start your Patient Registration (Medical Passport) here](https://www.onemedicalpassport.com/?help) ![one medical](https://blog.onemnethealth.com/hubfs/OneMedicalPassport_June2019/Images/one-medical-logo-dark.svg) - - - © 2023 One Mnet Health. All rights reserved. ONE MEDICAL PASSPORT®, MEDICAL PASSPORT®, and PASSPORT ENGAGE® are trademarks of One Mnet Health. [Privacy Policy & Terms of Service](https://onemnethealth.com/privacy-policy/)