Heart Failure

Front 1

What is a major sign of Ventricular dysfunction-

Back 1

exertion dyspnea

Front 2

HF can develop after these conditions

Back 2

a. long-standing hypertension, coronary artery disease (CAD), and myocardial infarction

Front 3

What are the symptoms of the pump of the heart not being effective

Back 3

edema, orthopnea, exertional dyspnea

Front 4

orthopnea

Back 4

shortness of breath while lying flas

Front 5

HF symptoms when not perfusing

Back 5

i. restlessness, confusion, and decreased attention span LOC
ii. Cyanosis(saturation) and ↓CR(perfusion) from a lack of oxygen
iii. Fatigue or weakness
iv. Rapid or irregular heart beat

Front 6

HF pulmonary congestion causes what symptoms

Back 6

1. cough
2. wt gain
3. DJV
4. increased urination
5. anorexia, indegestion

Front 7

what position is recommended for pt w/ HF

DON'T PUT BED BELOW

why

Back 7

90 degrees
NOT BELOW 30 DEGREES
fluid would rush back into lungs

Front 8

talk about diabetes and HF

Back 8

all diabetics are at risk of HF regardless if they have HTN or MI

* constant inflammatory response causes hypertrophy

Front 9

risk factors for HF

Back 9

>65
HTN
smoking
diabetes
obesity
high serum cholesterol

Front 10

1. normal ejection fraction
2. HF ejection fraction
3. EF % that is life threatening arrhythmia

Back 10

1. normal: 60-80%
2. HF: <40%
3. life threatening arrhythmia: <35%

Front 11

G. Systolic HF causes:

Back 11

a. Impaired contractile function (e.g., MI)
b. Increased afterload (e.g., hypertension)
c. Cardiomyopathy (increased preload, contraction)
d. Mechanical abnormalities (e.g., valve disease)

Front 12

what is diastolic HF

Back 12

inability of the heart to relax and refill

Front 13

what is the ejection fraction in diastolic HF

Back 13

normal

Front 14

what's going on w/ lungs and heart in diastolic HF

Back 14

pulmonary congestion
pulmonary HTN
ventricular hypertrophy

Front 15

b. Diastolic failure is characterized by

Back 15

high filling pressures due to stiff or noncompliant ventricles and results in venous engorgement in both pulmonary and systemic vascular systems.

Front 16

a. NYHA: I-IV- classified according
B. ACC/AHA Stage- classified according

Back 16

a. NYHA: I-IV- classified according to pt funtioning
b. ACC/AHA Stage- classified according to stage of disease

Front 17

which stage has conditions or behaviors associated w/ HF (atherosclerosis, CAD, diabetes, family hx cardiomyopathy, hx alcohol, rheumatic fever, cardiotoxic meds

Back 17

Stage A: ACC/AHA

Front 18

Which stage has structural chg but no s/s

Back 18

Stage B: ACC/AHA
class 1 of NYHA

Front 19

Which stage has structural chg and sysmptoms

Back 19

stage C AHA/ACC
class II or III NYHA

Front 20

what is a huge clinical sign of HF

Back 20

s3
gallop

Front 21

when the heart is struggling, what are the compensatory mechanisms

Back 21

SNS stimulation
Activation of RAAS system
myocardial hypertrophy
activation of peptides and hormones

Front 22

What effects does an increase of SNS have on cardio

Back 22

increases HR
increases conductivity
peripheral constriction

Front 23

Pulsus alternans- what is this? When is it seen

Back 23

alternates in strength- bound and then goes regular

SNS stimulation in HF

Front 24

What are you going to see w/ pt w/ HF and SNS stimulation

Back 24

2. Tachycardia-how do you know it’s tachy?
3. Pulsus alternans- alternates in strength- bound and then goes regular how do you know?
4. PAC premature atrial contractions or AF atrial fibrillation
5. S3 gallop first sign of HF

Front 25

activation of RAAS causes

Back 25

Na/H2o retention
cardiac remodeling- hypertrophy, fibrosis

Front 26

monitoring and assessment of HF includes:

Back 26

1. lung ausculations wheeze, crackles that don't go away w/coughing- inspiration and expiration, r/t engourged blood vessels
2. neck veins, abd girth, hepatomegalay,
3. I&O, daily wt

Front 27

labs to check w/ HF

Back 27

1. BNP/serum creatinine, creatine clearance
2. urine analysis for proteinuria microalbuminuia early indicator of decreased compliance of the heart
3. electrolytes

Front 28

When are these activated? TNF, IL-1 and IL-6, BNP, ADH, Endothelin

Back 28

Compensatory mechanisms w/ heart failure

Front 29

1. What is endothelin
2. what stimulates its release
3. what does it cause in the body

Back 29

ii. Endothelin a potent vasoconstrictor is stimulated by ADH, catecholamines, and angiotensin II, causing:
1. Arterial vasoconstriction
2. Increase in cardiac contractility
3. Hypertrophy

Front 30

What are antagonist to Endothelin and Aldosterone

Back 30

ANP and BNP

Front 31

What is Paroxysmal nocturnal dyspnea:

Back 31

after falling asleep edema rushes to lungs pt wakes with breathlessness.

Front 32

what s/s will a patient w/ HF display

Back 32

a. Dyspnea:
b. Excertional dyspnea:
c. Orthopnea:
d. Paroxysmal nocturnal dyspnea:
e. Ventricular dysrhythmias- the collateral circulation does not keep with the growth of cardiac tissue.

Front 33

what type of V/Q mismatch occurs with heart failure

Why is this more dangerous than respiratory V/Q mismatch

Back 33

dead space, problem w/perfusion

heart cannot give any more output

Front 34

M. Clinical manifestations of left sided heart failure:

Back 34

a. Orthopnea-POSITIONAL DIFF BREATHING
b. Dyspnea, tachypnea
c. Paroxsymal nocturnal dyspnea-
d. Cyanosis
e. Cool extremities/weak pulses-
f. Cough with frothy, blood-tinged sputum-
g. Breath sounds: Crackles, wheezes
h. Tachycardia
i. Hypotension or hypertension

Front 35

clinical manifestations of Rt sided heart failure

Back 35

i. Jugular venous distention
ii. Hepatomegaly, splenomegaly
iii. Vascular congestion of GI tract
iv. Peripheral edema

Front 36

b. COR PULMONALE:

Back 36

right sided heart failure

Front 37

Pitting edema: how assess

Back 37

apply pressure 3 sec, over 2 mm= pitting

Front 38

w/ HF, what does sudden wt gain indicate

Back 38

treatment is not working

condition exacerbated

Front 39

What is unacceptable wt gain

Back 39

> 3 lbs over 2 days
3-5 lbs over wk

Front 40

What ongoing assessments are important w/ HF

Back 40

i. History and physical examination
ii. Chest x-ray useful for spotting Lt ventricular failure
iii. ECG does not indicate extent or presence of HF- ONLY TELLS ABOUT CONDUCTION
iv. Lab studies (e.g., cardiac enzymes, (TRIPONIN- released by muscle when there has been heart damage)B-type Natriuretic peptide {BNP})
v. MUGA- TELLS HOW BAC HF IS: GIVES: EF and velocity
vi. Echocardiogram best assessment tool
vii. Hemodynamic assessment PAP/PAW

Front 41

Goals of HF treatment:

Back 41

a. Improving gas exchange
b. Improving cardiac output
c. Decreasing fatigue and weakness
d. Preventing or Managing Pulmonary Edema

Front 42

What steps are taken to Improve gas exchange:

Back 42

a. High Fowler’s position first step if pt has difficulty breathing, put arms on pillow.
b. Supplemental oxygen keep sats at 90%
c. Continuous ECG monitoring vitals q hr

Front 43

Na restriction to

Back 43

2.5 grams/day

Front 44

Type drug: Catopril

Back 44

ACEi

Front 45

ACEi:
1. SE

Back 45

1. 1st dose orthostatic hypotension
2. cough
3. hyperkalemia- due to decrease of aldosterone
4. renal failure
5. angio edema
6. fetal injury

Front 46

ACEi
pt teaching
Labs to monitor

Back 46

sit up slowly, dangle feet

monitor: K, kidney function- creatine clearance