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kol- Med Surg 320 Spring > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

How is CAD different then HF?

A

HF= Pump Failure = ventricles aren’t able to pump EFFECTIVELY/enough blood/O2 to meet demands of body

CAD=the build up of atherosclerosis in the arteries that are feeding blood and oxygen to the heart

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2
Q

HF characteristics

A
  • Inability of the heart to work effectively
  • Usually a chronic health problem
  • Life threatening
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3
Q

5 contributing factors to HF

A

1.High Blood Pressure
2.Heart Problems
-Valve Defects, Rhythm Disorders, Heart Muscle Defects, CAD
3.Lifestyle
-Failure to take preventative medications, Diet (excessive salt/fluid), Alcohol/drug misuse
4.Other Medical Conditions
-Anemia, Kidney disease, obesity, Diabetes, Thyroid Disorder
5.Lung problems
-Poor blood supply to lungs, lung disease, asthma, bronchitis, obstructed airways, high BP in
lungs

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4
Q

preload vs afterload

A

PRELOAD= volume of blood in ventricles at end of diastole (diastolic pressure), determines how much heart will stretch

AFTERLOAD = resistance left ventricle must overcome to circulate blood = systemic vascular resistance

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5
Q

Preload is increased in

A
  • Hypervolemia, regurgitation of cardiac valves, heart failure
  • Hypertension can also cause high preload!
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6
Q

Afterload is increased in ___ & _____

Increased afterload leads to

A

-Hypertension, vasoconstriction –> leads to left ventricle hypertrophy/failure

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7
Q

another name for left sided HF

A

Congestive HF

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8
Q

Typical causes of Left sided HF

A
  • *HTN
  • CAD (and Myocardial Infarction) - blockage of main artery to left ventricle
  • Valvular Disease
  • Cardiomyopathies
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9
Q

2 types of left sided HF

A

systolic and diastolic

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10
Q

diastolic vs systolic left sided HF

A

Systolic
-Left ventricle pump failure, failing to contract enough

Diastolic
-Left Ventricle doesn’t relax during diastole

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11
Q

EF in L sided HF: diastolic vs systolic

A

Systolic = EF <40%
Diastolic = EF preserved but misleading
—>Does not hold as much blood but percentage of EF is same b/c there was never that much blood in the their to begin with

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12
Q

most common cause of systolic L sided HF

A

HTN

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13
Q

most common cause of diastolic left sided HF?

A

Aging

Being a woman

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14
Q

Left sided HF: diastolic vs systolic ventricles?

A

diastolic- -Stiff ventricle (rigid and thick)

systolic - -Ventricular Dilation (flabby and thin)

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15
Q

systolic left sided HF

A
  • Left ventricle pump failure, failing to contract enough
  • EF < 40%
  • Ejection fraction= % of blood pushed out of Left Ventricle during contraction, normal is 50-70%
  • Ventricular Dilation (flabby and thin)
  • Most common cause is HTN
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16
Q

Diastolic left sided HF

A
  • Left Ventricle doesn’t relax during diastole
  • Preserved EF (but can be misleading)
  • Stiff ventricle (rigid and thick)
  • Does not hold as much blood but percentage of EF is same b/c there was never that much blood in the their to begin with
  • *Most common cause is Aging
  • Females more likely to have
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17
Q

normal EF

A

50-70%

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18
Q

What happens when blood doesn’t have good forward flow

AND

What happens when blood backs up

A

moving into L atria and back into lungs + decrease O2 to body

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19
Q

Clinical manifestations of left sided HF

A
  • Weakness - lack of O2
  • Fatigue - lack of O2
  • Dizziness- lack of O2
  • Acute Confusion - lack of O2
  • Oliguria –> kidney not getting enough blood flow/O2
  • Pulmonary congestion - blood back up/ poor gas exchange
  • Breathlessness - blood back up + lack of O2
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20
Q

causes of right sided HF

A
  • # 1 =Left ventricular failure –> high pressure area builds up in lungs due to back flow> Right ventricle has to push really hard to get blood through to the lungs > Right side hypertrophies
  • Right ventricular Myocardial Infarction
  • Pulmonary HTN (Cor Pulmonale) - Right side has a hard time pushing blood forward, isolated right sided heart failure

(-PE and Cor pulmonale = isolated right sided heart failure)

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21
Q

what is right sided HF?

A
  • Right ventricle cannot empty completely

- ->Increased pressure in venous system —>Peripheral edema, fluid back into spleen/liver

22
Q

clinical manifestations of right sided HF

A

(fluid backing up into the system)

  • Jugular vein distention
  • Increased abdominal girth (ascites, hepatomegaly)
  • Dependent edema
  • Hepatomegaly –>Hepatojugular reflux - press on liver and see immediate jugular vein distention
  • Ascites –> Measure abdominal girth
  • *Weight most reliable indicator of fluid gain loss
23
Q

considerations for taking Daily weights

when to call provider?

A

Same time everyday

1-2 lbs/ day or 3 lbs/ week = call provider

24
Q

labs for HF

A
  • hyponatremia
  • HgB and Hematocrit
  • -BNP brain natriuretic peptide
  • Urinanlysis
  • ABG
25
Q

BNP < 100 =

A

normal!

BNP > 100 = risk for HF

26
Q

What is BNP

A

brain natriuretic peptide –> released from overstretched heart muscle , good for diagnosing acute heart failure

27
Q

Which test will check for EF?

A

echocardiogram

28
Q

normal vs left sided diastolic vs left sided systolic HF EF

A

55-70%= normal

<40% = Left Systolic failure
Normal EF = Left Diastolic

29
Q

another name for an invasive pulmonary catheter to monitor HF?

A

Swann Catheter

30
Q

Oxygenation management (3)

A
  • Positions in high Fowlers if patient dyspneic
  • Apply Oxygen
  • Maintain oxygen sat. above 90%
31
Q

Benefits of Bipap? (2)

A
  • Reduces Preload b/c increases pressure in thoracic cavity and reduces fluid coming into heart
  • Opens Alveoli due to increased pressure
32
Q

how often to auscultate breath sounds when concerned about oxygenation with HF?

A

every 4-8 hours

33
Q

3 things to make the heart pump better

A

Preload reduction
Afterload reduction
Contractility enhancement

34
Q

ACE, ARB

A

reduce afterload

35
Q

Diuretics

A

reduce preload, improve contractility

36
Q

Morphine

A

reduced pre/after load/anxiety

37
Q

Beta Blockers

A

not used acutely, long term management

38
Q

Digoxin and Nitrates

A

reduce after/preload

39
Q

fluid and sodium restrictions for HF

A
  • Fluid Restrictions - <2L /day

- Sodium Restrictions - 2-3 g/day

40
Q

pulmonary edema onset

A

rapid!

41
Q

s/s of pulmonary edema

A
  • Dyspnea & Persistent Cough
  • Coarse Crackles in bases of lungs
  • Pink frothy sputum
  • (Other: Cyanosis, Tachycardia, Anxiety)
  • High Fowler’s
42
Q

vital sign that will help guide therapy for pulmonary edema

A

BP

43
Q

Non surgical options for managing HF

A
  • CPAP = Continuous Positive Airway Pressure - reduces preload, opens alveoli
  • Ultrafiltration- removal of fluids - reduces preload
  • Cardiac Resynchronization Therapy/ Biventricular Pacing : for pump failure
  • Implantable Cardiac Defibrillator - EV <30% = candidate for it
  • Gene Therapy
44
Q

Bi ventricular pacing indicated in HF patients with:

A
  • LEF < 35%
    • NYHA functional class III or IV
    • Medication optimized
45
Q

Surgical managements for HF

A
  • VADS
  • Heart reduction
  • Endoventricular circular patch cardioplasty
  • Acorn cardiac support
46
Q

Vads are what kind of therapy

A

-external power source, goes through hole in abdomen
Bridge Therapy: temporary until heart transplant
or
Destination Therapy: final therapy - no transplant

47
Q

indications of worsening HF

A
  • Rapid weight gain
  • Decrease in activity or exercise tolerance
  • Cough/ Congestion
  • Excessive awakening at night for urination
  • Dyspnea
  • Increased edema in feet/ankles/ascites
48
Q

most important diagnostic indicators for HF

A

ECHO + BNP

49
Q

NYHA Class 1

A

Class I - No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc.

50
Q

NYHA Class 2

A

Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.

51
Q

NYHA Class 3

A

Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20—100 m).Comfortable only at rest.

52
Q

NYHA Class 4

A

Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.

kol- Med Surg 320 Spring (43 decks)

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