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119 Cards in this Set

  • Front
  • Back
What is heart failure?
physiological state in which heart is unable to pump enough blood to meet metabolic demands of body
supply and demand are unequal
Is HF a disease or syndrome?
What causes readmittance with CHF?
According to Frank Starling Mechanism, what determines the force of the heartbeat?
length of the fibers
According to Frank Starling Mechanism, the more you stretch, the...?
greater the force
According to Frank Starling Mechanism, the more fluid in the left ventricle...?
the greater the force of the contraction
According to Frank Starling Mechanism, chronic distension over time can lead to?
hypertrophied left ventricle
According to Frank Starling Mechanism, this overdistension of the heart leads to?
less forceful contraction
Why is overdistension bad on the heart?
it has less elastic recoil, which decreases SV
What is formula for CO
What happens to HR if SV goes down?
it increases
What happens to HR with HF if left alone?
it will increase
Why does HR not increase on hospitalized patients with HF
we treat them with beta blockers and Digoxin
What is contractility
how well heart contracts
What are the 4 components that determine heart performance
heart rate
what is preload?
fluid that's coming in
the amount of blood in the ventricles at the end of diastole
How do we manipulate preload?
we increase with Fluids and decrease with Lasix
What does Lasix do to preload?
decreases it
When do we give Lasix in terms of preload
if it's too high
What do fluids do to preload
increases it
When do we give fluids in terms of preload
if it's too low
What is afterload
the pressure against which the left ventricle ejects blood
What do we do to increase afterload
What do we do to decrease afterload
Blood pressure medications
What causes increased afterload?
hypertension from the increased pressure
What would you do with preload if your systolic BP was 60?
give fluids to increase it
All cardiac drugs affect one of these 4 components
heart rate
What drug is used to treat pulmonary hypertension?
What are some causes of HF
abnormal loading conditions, abnormal muscle function, or diseases/conditions that limit Ventricular filling
How do you decrease afterload?
vasodilators, Lasix
What are things that affect preload and/or afterload
anything that increases pressure or volume of the load of the ventricles
valvular abnormalities
fluid overload
pulmonary hypertension
What are things that cause abnormal muscle function and affect contractility
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)
what is ventricular aneurysm
outpouch area of the ventricle that is not as strong and won't contract the same
What may cause limited ventricular filling
constrictive pericarditis
cardiac tamponade
What is constrictive pericarditis
fluid in the pericardial sac that makes you unable to take in enough stroke volume because of the pressure on the heart
What is cardiac tamponade
blood in the pericardial sac that pushes on the heart and decreases the amount of stroke volume
What are conditions that may precipitate/cause heart failure
conditions that increase O2 demand
Thiamine deficiency
Chronic pulmonary or liver disease
What are conditions that increase O2 demand
thyroid disorders
Why does Thiamine deficiency precipitate HF
reduces contractility
Who is likely to get thiamine deficiency that leads to HF
What is patho of HF
demand>supply, compensatory mechanisms activated
tries to improve CO, but causes abnormal cardiac growth and remodeling
Never remodel to...
make smaller! Always make bigger!
What are some compensatory mechanisms for HF
Ventricular dilation
Increased sympathetic nervous system stimulation
Neurohormonal activation
What is ventricular dilation used for as compensation
dilates ventricles to increase preload in order to increase cardiac ouput
Why can ventricular dilation worsen HF
the heart becomes overstretched, less effective, and actually requires more oxygen, which leads to hypoxia
What occurs in compensation with increase of the sympathetic nervous system?
constriction in order to increase afterload
Tachycardia and increased myocardial contractility
Why can Sympathetic stimulation worsen HF
increases myocardial workload and increases O2 demands
What occurs in compensation with neurohormonal activation?
increases in norepinephrine and cytokines and stimulation of renin-angiotension
What does increase in norepi cause?
vasoconstriction and tachycardia
What is an important cytokine to recognize in HF
what is BNP
brain natriuretic peptide
When is BNP released?
as the ventricles stretch, fill, and distend, they release BNP
Increase BNP is a sign of?
worsening CHF
What levels do you monitor in CHF patients
what does stimulation of the renin angiotensin system do?
increase fluid retention and blood pressure
Where is BNP found
When are cytokines triggered?
big evens like inflammation
What is remodeling of the heart?
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
Can you undo a remodeled house?
NO! There is no going back
What is the main goal when it comes to heart remodeling?
When will you see JVD
lots of fluid overload!
What is sputum like with HF?
hopefully just white and frothy
Pink and frothy means pulmonary edema
What does pink and frothy sputum mean
pulmonary edema
What will they do with patients with pulmonary hypertension
very strict fluid
what might they give to a patient with pulmonary edema
very HIGH lasix doses
What must happen before you get pulmonary edema
extremely high pressure
What occurs in Left sided heart failure
increased LV pressure goes to pulmonary circulation which increases pulmonary capillary pressure. Oncotic pressure causes fluid to move into alveoli
What will you heart in lungs if patient has Left sided HF
Who should you restrict fluids
pulmonary edema
What happens if you cause fluid to pool in lungs from too much fluid?
sit up high and fast, give O2 and then anticipate giving Lasix
What can cause fluid overload very quickly?
blood transfusions
What are signs and symptoms of Left sided HF
SOB, dyspnea on exertion, PND, orthopnea, crackles, sputum, tachypnea, wheezing, S3 sound
What does S3 sound like?
from stretching from all the fluid
What do you watch closely with left sided HF
What do you do if patient with blood transfusion gets fluid overload?
slow it down and give Lasix (sit up fast)
How long should you take to give blood?
the FULL four hours
What should you usually do if you're giving blood with person with CHF
stop maintenance fluid
A person with Left sided HF will usually sleep...
with LOTS of pillows
What is best way for patients at home to monitor fluid status
daily weight
When should a person with HF call, depending on their daily weight
a gain of 2 pounds in one day or 5 pounds in one week!
What should you do while giving blood to HF patient?
ask if doctor wants Lasix, watch closely, listen to lungs, do vitals, do pulse ox!
How should patient be weight?
daily on SAME scale every morning
How much Lasix might you anticipate giving to a Left sided HF patient with fluid overload?
40-80/ day
Where should you usually check for crackles in the morning in patients with left sided HF?
posterior bottom of lungs
What is right sided heart failure?
increased pressure and volume in R ventricle that goes upward to vena cava and down portal system, causing venous congestion to teh liver
Signs and symptoms of R sided HF
increased liver labs
chronic abdominal pain
pedal edema
What does patient usually have with HF
both sided HF
Look at feet to see...
how big their heart is
What do you use ECHO for?
measure EF
What is normal EF
What does decrease in EF show?
worsening of HF
What is EF?
cc's of blood ejected each pump of the heart/ Stroke Volume
What are ways to diagnose HF
ECHO (ejection fraction)
liver enzymes
When will you especially see elevated liver enzymes with HF
right sided
What is ejection fraction used for
to help plan care for ambulation and activity and to make reasonable goals
Why would you have elevated BUN and Cr with HF
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
What do you want to see in a patient with HF
high pulse ox
clear lung sounds
respirations WNL
What is a guide to tell how pad a patient with HF is so we can alter care?
New York Heart Association Classification
Class I through IV
What is Class I HF
no limitations
What is Class IV HF
complete rest
What are some ways to improve pump performance in HF
oxygen therapy
When is Digoxin used in HF
if persons still symptomatic despire use of ACE Inhibitors and Beta blockers

It is a third line medication
What is an inotrope given for HF
Dopamine/ dobutamine
How do you give Dopamine?
IV only!
what can you give IV to promote diuresis?
What do you give BEFORE giving Dig?
ACE inhibitors and Beta blockers
What do ACE inhibitors do?
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
All persons with HF should be on..?
ACE inhibitors
What is a standard of care for HF
ACE inhibitors
What are some beta blockers
atenolol, lopressor
What do beta blockers do
inhibit the effects of the sympathetic nervous system and decrease mortality
What should you ask before holding a med?
how LOW can a patient go
Some other treatments for HF
Ventricular assist devices
intra-aortic balloon pumps
heart transplant
What is VAD?
go into the heart to take over the L ventricle's workload

have external battery! always know where spare battery is
What should you always know with VAD?
where spare battery is located
What is intra aortic balloon pump?
bridge to transplant or if had failed cardiac surgery
goes through the vein to increase blood to coronary arteries
When can you NOT do heart transplant?
if they have pulmonary hypertension, its not enough; need lung transplant too
What do people with pulmonary hypertension need?
heart AND lung transplant
How do you know if Lasix has been effective in HF treatment?
if lungs are clear!

Know INTENDED effect and WHY you gave it in the first place!