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119 Cards in this Set
- Front
- Back
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What is heart failure?
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physiological state in which heart is unable to pump enough blood to meet metabolic demands of body
supply and demand are unequal |
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Is HF a disease or syndrome?
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syndrome!
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What causes readmittance with CHF?
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symptoms
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According to Frank Starling Mechanism, what determines the force of the heartbeat?
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length of the fibers
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According to Frank Starling Mechanism, the more you stretch, the...?
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greater the force
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According to Frank Starling Mechanism, the more fluid in the left ventricle...?
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the greater the force of the contraction
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According to Frank Starling Mechanism, chronic distension over time can lead to?
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hypertrophied left ventricle
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According to Frank Starling Mechanism, this overdistension of the heart leads to?
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less forceful contraction
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Why is overdistension bad on the heart?
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it has less elastic recoil, which decreases SV
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What is formula for CO
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HR X SV= CO
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What happens to HR if SV goes down?
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it increases
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What happens to HR with HF if left alone?
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it will increase
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Why does HR not increase on hospitalized patients with HF
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we treat them with beta blockers and Digoxin
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What is contractility
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how well heart contracts
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What are the 4 components that determine heart performance
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contractility
preload afterload heart rate |
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what is preload?
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fluid that's coming in
the amount of blood in the ventricles at the end of diastole |
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How do we manipulate preload?
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we increase with Fluids and decrease with Lasix
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What does Lasix do to preload?
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decreases it
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When do we give Lasix in terms of preload
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if it's too high
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What do fluids do to preload
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increases it
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When do we give fluids in terms of preload
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if it's too low
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What is afterload
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the pressure against which the left ventricle ejects blood
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What do we do to increase afterload
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fluid
vasoconstrictors |
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What do we do to decrease afterload
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vasodilators
Lasix Blood pressure medications |
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What causes increased afterload?
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hypertension from the increased pressure
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What would you do with preload if your systolic BP was 60?
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give fluids to increase it
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All cardiac drugs affect one of these 4 components
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preload
contractility afterload heart rate |
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What drug is used to treat pulmonary hypertension?
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viagra
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What are some causes of HF
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CAD
abnormal loading conditions, abnormal muscle function, or diseases/conditions that limit Ventricular filling |
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How do you decrease afterload?
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vasodilators, Lasix
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What are things that affect preload and/or afterload
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anything that increases pressure or volume of the load of the ventricles
valvular abnormalities fluid overload hypertension pulmonary hypertension |
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What are things that cause abnormal muscle function and affect contractility
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MI
Myocarditis (viral, fungal, toxic, any kind) Cardiomyopathy (tons of causes, virus, alcohol, genes, etc.) Ventricular aneurysm (outpouch area that is not as strong and won't contract the same) |
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what is ventricular aneurysm
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outpouch area of the ventricle that is not as strong and won't contract the same
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What may cause limited ventricular filling
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constrictive pericarditis
cardiac tamponade |
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What is constrictive pericarditis
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fluid in the pericardial sac that makes you unable to take in enough stroke volume because of the pressure on the heart
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What is cardiac tamponade
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blood in the pericardial sac that pushes on the heart and decreases the amount of stroke volume
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What are conditions that may precipitate/cause heart failure
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conditions that increase O2 demand
Thiamine deficiency Chronic pulmonary or liver disease |
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What are conditions that increase O2 demand
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stress
infection anemia thyroid disorders pregnancy paget's |
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Why does Thiamine deficiency precipitate HF
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reduces contractility
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Who is likely to get thiamine deficiency that leads to HF
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alcoholics
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What is patho of HF
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demand>supply, compensatory mechanisms activated
tries to improve CO, but causes abnormal cardiac growth and remodeling |
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Never remodel to...
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make smaller! Always make bigger!
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What are some compensatory mechanisms for HF
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Ventricular dilation
Increased sympathetic nervous system stimulation Neurohormonal activation |
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What is ventricular dilation used for as compensation
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dilates ventricles to increase preload in order to increase cardiac ouput
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Why can ventricular dilation worsen HF
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the heart becomes overstretched, less effective, and actually requires more oxygen, which leads to hypoxia
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What occurs in compensation with increase of the sympathetic nervous system?
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constriction in order to increase afterload
Tachycardia and increased myocardial contractility |
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Why can Sympathetic stimulation worsen HF
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increases myocardial workload and increases O2 demands
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What occurs in compensation with neurohormonal activation?
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increases in norepinephrine and cytokines and stimulation of renin-angiotension
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What does increase in norepi cause?
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vasoconstriction and tachycardia
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What is an important cytokine to recognize in HF
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BNP
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what is BNP
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brain natriuretic peptide
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When is BNP released?
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as the ventricles stretch, fill, and distend, they release BNP
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Increase BNP is a sign of?
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worsening CHF
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What levels do you monitor in CHF patients
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BNP
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what does stimulation of the renin angiotensin system do?
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increase fluid retention and blood pressure
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Where is BNP found
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ventricles
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When are cytokines triggered?
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big evens like inflammation
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What is remodeling of the heart?
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overtime, changes from compensation cause cahnges in structure, function, and gene expression of the myocardial cells
These cells die and are replaced with mutant cardia cells that are bigger and die quickly Causes weak, hypertrophied heart |
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Can you undo a remodeled house?
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NO! There is no going back
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What is the main goal when it comes to heart remodeling?
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prevention
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When will you see JVD
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lots of fluid overload!
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What is sputum like with HF?
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hopefully just white and frothy
Pink and frothy means pulmonary edema |
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What does pink and frothy sputum mean
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pulmonary edema
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What will they do with patients with pulmonary hypertension
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very strict fluid
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what might they give to a patient with pulmonary edema
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very HIGH lasix doses
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What must happen before you get pulmonary edema
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extremely high pressure
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What occurs in Left sided heart failure
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increased LV pressure goes to pulmonary circulation which increases pulmonary capillary pressure. Oncotic pressure causes fluid to move into alveoli
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What will you heart in lungs if patient has Left sided HF
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crackles
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Who should you restrict fluids
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pulmonary edema
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What happens if you cause fluid to pool in lungs from too much fluid?
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sit up high and fast, give O2 and then anticipate giving Lasix
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What can cause fluid overload very quickly?
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blood transfusions
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What are signs and symptoms of Left sided HF
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SOB, dyspnea on exertion, PND, orthopnea, crackles, sputum, tachypnea, wheezing, S3 sound
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What does S3 sound like?
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Kentucky
from stretching from all the fluid |
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What do you watch closely with left sided HF
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respirations
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What do you do if patient with blood transfusion gets fluid overload?
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slow it down and give Lasix (sit up fast)
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How long should you take to give blood?
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the FULL four hours
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What should you usually do if you're giving blood with person with CHF
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stop maintenance fluid
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A person with Left sided HF will usually sleep...
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with LOTS of pillows
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What is best way for patients at home to monitor fluid status
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daily weight
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When should a person with HF call, depending on their daily weight
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a gain of 2 pounds in one day or 5 pounds in one week!
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What should you do while giving blood to HF patient?
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ask if doctor wants Lasix, watch closely, listen to lungs, do vitals, do pulse ox!
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How should patient be weight?
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daily on SAME scale every morning
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How much Lasix might you anticipate giving to a Left sided HF patient with fluid overload?
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40-80/ day
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Where should you usually check for crackles in the morning in patients with left sided HF?
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posterior bottom of lungs
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What is right sided heart failure?
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increased pressure and volume in R ventricle that goes upward to vena cava and down portal system, causing venous congestion to teh liver
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Signs and symptoms of R sided HF
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ascites
increased liver labs chronic abdominal pain pedal edema JVD |
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What does patient usually have with HF
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both sided HF
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Look at feet to see...
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how big their heart is
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What do you use ECHO for?
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measure EF
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What is normal EF
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50-70%
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What does decrease in EF show?
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worsening of HF
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What is EF?
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cc's of blood ejected each pump of the heart/ Stroke Volume
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What are ways to diagnose HF
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ECHO (ejection fraction)
EKG CXR ABGs liver enzymes BUN, Cr BNP |
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When will you especially see elevated liver enzymes with HF
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right sided
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What is ejection fraction used for
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to help plan care for ambulation and activity and to make reasonable goals
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Why would you have elevated BUN and Cr with HF
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poor SV and poor CO leads to poorly perfused kidney and you can get end stage renal disease which makes it even harder to rid fluid
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What do you want to see in a patient with HF
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high pulse ox
clear lung sounds respirations WNL |
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What is a guide to tell how pad a patient with HF is so we can alter care?
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New York Heart Association Classification
Class I through IV |
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What is Class I HF
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no limitations
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What is Class IV HF
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complete rest
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What are some ways to improve pump performance in HF
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oxygen therapy
Digoxin Inotropes |
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When is Digoxin used in HF
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if persons still symptomatic despire use of ACE Inhibitors and Beta blockers
It is a third line medication |
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What is an inotrope given for HF
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Dopamine/ dobutamine
IV ONLY!! portacath |
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How do you give Dopamine?
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IV only!
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what can you give IV to promote diuresis?
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Matracor/Nesiritide
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What do you give BEFORE giving Dig?
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ACE inhibitors and Beta blockers
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What do ACE inhibitors do?
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blocks production of Angiotensin II (which is a vasocontrictor) and increases renal blood flow, lessens neurohormonal effects on HF and lessens remodeling and increases survival
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All persons with HF should be on..?
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ACE inhibitors
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What is a standard of care for HF
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ACE inhibitors
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What are some beta blockers
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atenolol, lopressor
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What do beta blockers do
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inhibit the effects of the sympathetic nervous system and decrease mortality
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What should you ask before holding a med?
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how LOW can a patient go
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Some other treatments for HF
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Ventricular assist devices
intra-aortic balloon pumps heart transplant |
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What is VAD?
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go into the heart to take over the L ventricle's workload
have external battery! always know where spare battery is |
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What should you always know with VAD?
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where spare battery is located
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What is intra aortic balloon pump?
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bridge to transplant or if had failed cardiac surgery
goes through the vein to increase blood to coronary arteries |
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When can you NOT do heart transplant?
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if they have pulmonary hypertension, its not enough; need lung transplant too
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What do people with pulmonary hypertension need?
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heart AND lung transplant
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How do you know if Lasix has been effective in HF treatment?
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if lungs are clear!
Know INTENDED effect and WHY you gave it in the first place! |
