Heart Failure/cad

Front 1

heart failure

Back 1

a clinical syndrome in which the heart, via an abnormality of cardiac function (detectable or not), fails to pump blood at rate to meet needs of the metabolizing tissues and/or pumps only from an abnormally elevated diastolic filling pressure

Front 2

compensatory mechanisms during heart failure

Back 2

SNS stimulation to release norepineprhine and epinephrine, to increase HR; boost the SV by increasing the amt of circulating volume by neurohormone activation; renin secretion

Front 3

endothelin

Back 3

a hormone released in response to angiotensin II, vasopressin, etc; causes vasoconstriction

Front 4

"clinical syndrome" associated with HF

Back 4

elevated ventricular/atrial pressures; sodium and water retention; decreased cardiac output; circulatory and pulmonary congestion

Front 5

when does the decompensated phase of HF begin?

Back 5

over time the heart becomes stiff and noncompliant, and eventually, hypertrophy occurs, leading to endothelial dysfunction and ventricular remodeling

Front 6

what is decompensated HF?

Back 6

a loss of balance between the mechanisms of HF and the body's attempt to overcome the failing process; the end result is the client begins to demonstrate the S/S of HF

Front 7

two types of HF

Back 7

systolic and diastolic

Front 8

systolic heart failure

Back 8

poor contractility of the myocardium resulting in decreased CO and resulting in the SVR; this causes an increase in afterload

Front 9

diastolic heart failure

Back 9

stiff myocardium, which impairs the ability of the left ventricle to fill up with blood; this causes an increase in pressure in the left atrium and pulmonary vascular causing the pulmonary signs of heart failure

Front 10

heart failure is cause by what?

Back 10

disorders of the heart muscle resulting in decreased contractile properties of the heart; CHD leading to MI, HTN, valvular heart disease, congenital heart disease, cardiomyopathies, dysrhythmias

Front 11

Left-Sided Heart Failure (forward failure)

Back 11

congestion occurs mainly in the lungs from blood backing up into the pulmonary veins and capillaries; orthopnea and/or dyspnea develops in the recumbent position and is relieved with the elevation of the head with pillows; the change in the number of pillows is important; orthopnea occurs rapidly, often within a minute or two of recumbency and develops when the client is awake; paroxysmal nocturnal dyspnea usually occurs (may take longer to relieve than orthopnea); cough may be dry, unproductive or red tinged; fatigue, insomnia, restlessness, tachycardia (S3 ventricular gallop); confusion, memory impairment in elder

Front 12

Right-Sided Heart Failure (backward flow)

Back 12

congestion in systemic veins and capillaries; edema of the ankles, unexplained weight gain, liver congestion, JVD, anorexia/nausea, nocturia, weakness

Front 13

cardiovascular findings in both left and right-sided HF

Back 13

cardiomegaly; ventricular gallop; rapid HR; dvlpmt of pulsus alternans (alternation in strength of beat)

Front 14

most common cause of right-sided failure is?

Back 14

left-sided failure

Front 15

meds for HF

Back 15

diuretics; positive inotropic agents; vasodilators; ACE inhibitors; beta blockers; ARBs (angiotensin II receptor blockers); aldosterone antagonists; human BNP

Front 16

monitor for increase in what blood serum level during therapy for HF?

Back 16

potassium

Front 17

acute pulmonary edema

Back 17

excess fluid in the lung, either in the interstitial spaces or in the alveoli; may be caused by heart disease, MI, left-sided HF, circulatory overload, drug hypersensitivity, lung injuries, infection and/or fever

Front 18

clinical manifestations of acute pulmonary edema

Back 18

coughing and restlessness and tachycardia; extreme dyspnea and orthopnea; cough (white or pink tinged); anxiety, JVD

Front 19

placing client in upright position prevents what?

Back 19

venous return (for HF, etc)

Front 20

cardiomyopathy

Back 20

disease of the heart muscle; primary (cause unknown) and secondary (cause known)

Front 21

three groups of cardiomyopathy and describe

Back 21

1.DILATED- most common; both right and left ventricle dilate, causing a decrease in the heart's ability to pump blood efficiently to the body (alcohol abuse, chemo, chemical agents, third trimester pregnancy)
2. HYPERTROPHIC- primarily due to abnormal thickening of the ventricular septum of the heart (genetically transmitted)
3. RESTRICTIVE- rare in the US

Front 22

clinical manifestations of cardiomyopathy

Back 22

exertion dyspnea, chest pain, signs of HF, pulmonary edema, dysrhythmias, pericardial effusions, cardiac murmur, syncope

Front 23

CAD is caused by

Back 23

atherosclerosis

Front 24

#1 cause of death in America?

Back 24

CAD

Front 25

stable angina

Back 25

triggered by a predictable situation (walking, emotions, etc); relieved with nitroglycerins, rest, or both

Front 26

unstable angina

Back 26

unpredictable exertion or emotion which may occur at night; attacks increase over time (number, duration, etc); treated as a medical emergency

Front 27

variant angina

Back 27

longer duration; occurs while at rest, usually b/t 12 am and 8 am; result of coronary artery spasm

Front 28

nocturnal angina

Back 28

possibly associated with REM during dreaming

Front 29

angina decubitis

Back 29

occurs during reclining and improved when standing or sitting

Front 30

intractable angina

Back 30

chronic and unresponsive to intervention

Front 31

postinfarction angina

Back 31

post MI

Front 32

client education when taking nitroglycerin (for chronic stable angina or unstable angina)

Back 32

discontinue activity or remove self from stressful event; if pain does not subside, sit down and take nitroglycerin; wait 5 minutes before another dose; call 911 if pain does not subside after 3 doses or if pain persists after 15-20 min

Front 33

side effects of nitroglycerin

Back 33

tachycardia; syncope; hypotension; headache

Front 34

MONA

Back 34

Morphine; Oxygen; Nitrates; Aspirin

Front 35

the leading cause of death in women

Back 35

CAD

Front 36

hallmark finding for systolic failure

Back 36

decrease in the left ventricular ejection fraction

Front 37

ventricular dilation as a compensatory mechanism for diastolic/systolic failure

Back 37

occurs when the pressure in the left ventricle is elevated; initially is an adaptive mechanism; eventually becomes inadequate and CO decreases

Front 38

hypertrophy of heart muscle

Back 38

is a response to chronic dilation of heart muscle; has poor contractility and higher oxygen needs; has poor coronary artery circulation; is prone to ventricular dysrhythmias

Front 39

ANP and BNP

Back 39

released in response to increases in atrial volume and ventricular pressure; promote venous and arterial vasodilation, reducing preload and afterload; endothelin and aldosterone antagonists; inhibit the development of cardiac hypertrophy

Front 40

chronic heart failure manifestations

Back 40

fatigue; dyspnea; orthopnea; paroxysmal nocturnal dyspnea; persistent, dry cough, unrelieved w/ position change or over-the-counter suppressants; dependent edema; nocturia; dusky, cool skin; shiny and swollen lower extremities; restlessness, confusion, decreased memory; chest pain (angina); anorexia; nausea

Front 41

complications of chronic HF

Back 41

pleural effusion; atrial fibrillation (loss of atrial contraction, which can reduce CO by 10-20%); hepatomegaly (esp. with RV failure); dysrhythmias; renal insufficiency or failure

Front 42

how to improve gas exchange and oxygenation

Back 42

supplemental oxygen; morphine sulfate; noninvasive ventilatory support (BiPAP)

Front 43

weight gain of how much in over how much time should be reported to a HCP in patients with chronic HF?

Back 43

3 lb over 2 days or 3-5 lb over a week

Front 44

ANP triggered by increase in what?

Back 44

volume

Front 45

BNP triggered by increase in what?

Back 45

pressure

Front 46

nitric oxide does what?

Back 46

relaxes arterial smooth muscle

Front 47

cor pulmonale

Back 47

right ventricular dilation and hypertrophy caused by pulmonary disease; can also cause right-sided failure or RV infarction

Front 48

ADHF usually manifests itself as....?

Back 48

pulmonary edema (gets more severe as time goes on, and the increased intravascular pressure pushes fluid into interstitial space; eventually, alveoli and airways become flooded w/ fluid)

Front 49

most common cause of pulmonary edema

Back 49

acute LV failure secondary to CAD

Front 50

C-reactive protein (CRP)

Back 50

nonspecific marker of inflammation; is increased in many patients with CAD

Front 51

stages of development of atherosclerosis

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1. fatty streak
2. fibrous plaque
3. complicated lesion (most dangerous)

Front 52

collateral circulation

Back 52

new vessels that develop as a result of an obstruction of blood flow

Front 53

homocysteine

Back 53

sulfur-containing amino acid, produced by the breakdown of essential amino acid methionine, found in dietary protein; high levels POSSIBLY contribute to atherosclerosis

Front 54

the major route of elimination of cholesterol

Back 54

via conversion to bile acids in the liver

Front 55

primary reason for chronic stable angina

Back 55

narrowing of coronary arteries

Front 56

acute coronary syndrome (ACS)

Back 56

when ischemia is prolonged and not easily reversible; associated with deterioration of a once stable atherosclerotic plaque --- it has ruptured

Front 57

manifestations of ACS

Back 57

unstable angina and MI

Front 58

unstable angina

Back 58

new chest pain; occurs at rest, or has worsening pattern; EMERGENCY

Front 59

cardiogenic shock

Back 59

occurs when inadequate oxygen and nutrients are supplied to the tissues because of severe LV failure; less common result of MI

Front 60

sudden cardiac death (SCD)

Back 60

usually NOT in people who have had an acute MI; but due to ventricular dysrhythmias