Nu 3 Exam 2 Chp 37

Front 1

Heart failure, sometimes referred to as ______ _______, is a general term for the inability of the heart to work effectively as a pump.

Back 1

pump failure

Front 2

Most heart failure begins with failure of the ________ _______ and progresses to failure of _________ _______.

Back 2

1) left ventricle
2) both ventricles

Front 3

Typical causes of left-sided heart (________) failure include hypertensive, _________ ______, and valvular disease involving the __________ or _________ valve.

Back 3

1) ventricular
2) coronary artery
3) mitral
4) aortic

Front 4

Left-sided heart failure was formerly referred to as ________ _________ __________ (___); however, not all cases of LVF involve fluid accumulation.

Back 4

Congestive Heart Failure (CHF)

Front 5

Systolic heart failure (_______ ________ _______) results when the heart cannot contract forcefully enough during systole to _________ _______ _______ of blood into the circulation. Preload increases with decreased contractility, and afterload increases as a result of increased peripheral resistance.

Back 5

1) systolic ventricular dysfunction
2) eject adequate amounts

Front 6

The _______ _______ (the percentage of blood ejected from the heart during systole) drops from a normal 50% to 70% to below 40% with _______ _______.

Back 6

1) ejection fraction
2) ventricular dilation

Front 7

So what that ejection fraction drops to below 40%?

Back 7

As ejection fraction decreases, tissue perfusion diminishes and blood accumulates in the pulmonary vessels.

Front 8

In contrast, _______ _______ ________ (heart failure with preserved left ventricular function) occurs when the left ventricle _________ _______ adequately during diastole.

Back 8

1) diastolic heart failure
2) cannot relax

Front 9

Inadequate relaxation or "______" prevents the ventricle from filling with sufficient blood to ensure an ________ ______ ____.

Back 9

1) stiffening
2) adequate cardiac output

Front 10

_____-_____ ______ (_______) failure may be caused by left ventricular failure, right ventricular MI, or ________ ________.

Back 10

1) Right-sided heart (ventricular)
2) pulmonary hypertension

Front 11

In Right-sided HF, the right ventricle cannot _______ ______. Increased volume and pressure develop in the _________ ________, and ________ ________ results.

Back 11

1) empty completely
2) venous system
3) peripheral edema

Front 12

_____ - _____ ______ failure can occur when cardiac output remains _______ or ______ _______, unlike left- and right- sided heart failure, which are typically ______ - _______ states.

Back 12

1) High-output heart failure
2) normal
3) above normal
4) low-output

Front 13

High-output failure is caused by increased ______ _______ or _________ conditions, such as septicemia (_____), _______, and ________. This type of heart failure is not as common as other types.

Back 13

1) metabolic needs
2) hyperkinetic
3) fever
4) anemia
5) hyperthyroidism

Front 14

In HF, stimulation of _______ _______ _______ (i.e., increasing catecholamines) as a result of tissue ______ represents the most immediate compensatory mechanism.

Back 14

1) sympathetic nervous system
2) hypoxia

Front 15

Stimulation of the adrenergic receptors causes an increase in heart rate ( ____ _____) and blood pressure from ____________ ( _______ ________ ).

Back 15

1) beta adrenergic
2) vasoconstiction
3) alpha adrenergic

Front 16

Because cardiac output (CO) is the product of heart rate (HR) and stroke volume (SV), an increase in HR results in an immediate increase in ______ _______.

Back 16

cardiac output

Front 17

______ _______ is also improved by sympathetic stimulation. Sympathetic stimulation increases venous return to the heart, which further stretches the myocardial fibers causing dilation.

Back 17

Stroke Volume

Front 18

According to ______ _____, increased myocardial stretch results in more forceful contraction. More forceful contraction results in SV and CO. After a critical point is reached within the cardiac muscle, further volume and stretch reduce the force of contraction and cardiac output.

Back 18

Starling's law

Front 19

Sympathetic stimulation also results in _______ _______.

Back 19

arterial vasoconstriction

Front 20

Constriction of the arteries increases ________, the resistance against which the heart must pump. As it increases, the left ventricle requires more energy to eject its contents and SV may ________.

Back 20

1) afterload
2) decline

Front 21

Reduced blood flow to the kidneys, a common occurrence in low-output states, results in activation of the _____ - ______ system.

Back 21

renin-angiotensin system (RAS)

Front 22

Vasoconstriction becomes more pronounced in response to __________, and ________ secretion causes sodium and water retention. _______ and ________ increase.

Back 22

1) angiotensin II
2) aldosterone
3) preload
4) afterload

Front 23

Angiotensin II contributes to ________ ________ resulting in progressive myocyte ( _______ ) contractile dysfunction over time.

Back 23

1) ventricular remodeling
2) myocardial cell

Front 24

In those who have had an MI, heart muscle cell injury causes an ________ ______.

Back 24

immune response

Front 25

Pro-inflammatory cytokines, such as ________ _______ _______ and interleukins ( ___ and ____ ), are released, especially with left-sided HF. These substances contribute to ventricular remodeling.

Back 25

1) tumor necrosis factor (TNF)
2) IL-1 and IL-6

Front 26

________ ________ are neurohormones that work to promote vasodilation and diuresis through sodium loss in the ______ ______.

Back 26

1) Natriuretic peptides
2) renal tubules

Front 27

The _____ _____ ______ is produced and released by the ventricles when the patient has fluid overload as a result of HF.

Back 27

B-type natriuretic peptide (BNP)

Front 28

____ increases with age and has greater concentration in women. People who are ______ have lower levels of it compared with those who are not.

Back 28

1) BNP
2) obese

Front 29

Low cardiac output (CO) causes decreased ________ _______. As a result, the posterior pituitary gland secretes _______ (antidiuretic hormone [ADH]).

Back 29

1) cerebral perfusion
2) vasopressin

Front 30

_________ hormone causes vasoconstriction and fluid retention, which worsen HF.

Back 30

antidiuretic hormone or vasopressin

Front 31

________ is secreted by endothelial cells when they are stretched.

Back 31

Endothelin

Front 32

As the myocardial fibers are stretched in patients with HF, _______ (a potent vasoconstrictor) is released, which increases peripheral resistance and hypertension. HF worsens as a result of these actions.

Back 32

Endothelin

Front 33

________ _______ (enlargement of the myocardium), with or without _______ _______, is another compensatory mechanism.

Back 33

1) myocardial hypertrophy
2) chamber dilation

Front 34

The walls of the heart thicken to provide more ______ _____, which results in more forceful contractions, further increasing ________ _______.

Back 34

1) muscle mass
2) cardiac output

Front 35

Cardiac muscle, however, may hypertrophy more rapidly than _______ _______ can provide adequate blood supply to the muscle. Often hypertrophied heart is slightly _______ deprived.

Back 35

1) collateral circulation
2) oxygen

Front 36

As HF becomes very severe, patient may begin expectorating _____, _____ ______ - a sign of life-threatening pulmonary edema.

Back 36

frothy, pink sputum

Front 37

As ______ ______ develops, the patient often stops previously tolerated levels of activity because of ________ of _______.

Back 37

1) exertional dyspnea
2) shortness of breath

Front 38

Dyspnea at rest in recumbent (lying flat) position is know as _________.

Back 38

orthopnea

Front 39

Patients who describe sudden awakening with a feeling of breathlessness 2 to 5 hours after falling asleep have ______ ________ _________.

Back 39

paroxysmal nocturnal dyspnea

Front 40

In advanced right-sided HF, ________ and an increased ______ _______ may develop from the pronounced liver congestion.

Back 40

1) ascites
2) abdominal girth

Front 41

Define formula for measuring proportional pulse pressure?

Back 41

Systolic BP - Diastolic BP and all that over Systolic BP

- if result is less than 25% it means severely compromised cardiac output

Front 42

The pulse may be tachycardic, or it may alternate in strength - what is it called?

Back 42

pulsus alternans

Front 43

A third heart sound, (S3) _______, an early diastolic filling sound indicating an increase in left ventricular pressure, may be heard on auscultation.

Back 43

gallop

Front 44

S4 is not necessarily a sign of heart failure, but is a reflection of _________ ________ _________.

Back 44

decreased ventricular compliance.

Front 45

What is an unreliable sign of HF?

Back 45

Edema

Front 46

What is a more reliable sign of HF than edema?

Back 46

accurate daily weights to document fluid retention or loss

Front 47

What serum electrolytes you should check for HF?

Back 47

- sodium
- potassium
- magnesium
- calcium
- chloride

Front 48

Any impairment of renal function resulting from inadequate perfussion causes elevated blood _______ _______ and serum _______ and decreased ________ _________ levels.

Back 48

1) urea nitrogen
2) creatinine
3) creatinine clearance

Front 49

In HF urinalysis may reveal proteinuria and high _______ _______.

Back 49

specific gravity

Front 50

________ and _______ tests should be performed to identify HF resulting from anemia.

Back 50

1) Hemoglobin
2) hematocrit

Front 51

__-_______ _______ ______ is used for diagnosing HF (in particular, diastolic HF) in patients with acute dyspnea.

Back 51

B-type natriuretic peptide (BNP)

Front 52

__________ is an early indicator of decreased compliance of the heart and occurs before the BNP rises.

Back 52

Microalbuminuria

Front 53

______ ______ ______ values often reveal hypoxia (low oxygen level) because oxygen does not diffuse easily through fluid-filled alveoli.

Back 53

Arterial Blood Gas (ABG)

Front 54

Respiratory alkalosis may occur due to ________?

Back 54

hyperventilation

Front 55

Respiratory acidosis may occur due to ________?

Back 55

carbon dioxide retention

Front 56

What is the best tool for diagnosing heart failure?

Back 56

EKG

Front 57

Which test may reveal enlargement of the heart?

Back 57

Chest x-ray

Front 58

_______ ______ (thallium imaging or technetium pyrophosphate scanning) can also indicate the presence and cause of HF.

Back 58

Radionuclide studies

Front 59

_________ ________ scans provide information about left ventricular ejection fraction and velocity, which are typically low in patients with HF.

Back 59

Multigated angiographic (MUGA)

Front 60

________ ________ ______ allow the assessment of cardiac function and volume status in acutely ill patients.

Back 60

Pulmonary artery catheters

Front 61

What's ACE?

Back 61

angiotensin-converting enzyme

Front 62

What's ARB?

Back 62

angiotensin receptor blocker

Front 63

ACE inhibitors and ARBs are started ________ and _______. The first dose may be associated with a rapid drop in BP. Patients at risk for hypotension usually have an initial systolic BP less than ______, are ______ than 75 years, have a serum _____ level less than 137 mEq/L, or are volume depleted. Monitor BP for several hours after the initial dose and each time the dose is increased.

Back 63

1) slowly and cautiously
2) 100 mm Hg
3) sodium

Front 64

The clinical manifestations of ______ _______ are often vague and nonspecific and include _______, ______, and changes in _______ ______, especially in older adults.

Back 64

1) digitalis toxicity
2) anorexia
3) fatigue
4) mental status

Front 65

Digitalis toxicity may cause nearly any dysrhythmia, but _____ are most commonly noted.

Back 65

premature ventricular complexes