Heart Failure

Question 1

What does CHF stand for?

Answer 1

Congestive Heart Failure

Question 2

What is CHF?

Answer 2

When the heart is unable to pump sufficient blood to meet the metabolic needs of the body

Question 3

Where does the blood back up into during CHF?

Answer 3

Pulmonary circuit
Systemic circuit
or both

Question 4

Why does CHF usually occur?

Answer 4

Secondary to another condition

Question 5

Is CHF chronic?

Answer 5

YES, but you live with it and it does not go away!

Question 6

Left Sided Heart Failure: CAUSES

Answer 6

• LV is commonly damaged during an MI
• Chronic hypertension long term effects of having to pump against the increased after load

Question 7

The right side of the heart ________ during left sided failure.

Answer 7

continues to pump normally

Question 8

Left sided heart failure: The left side of the heart is _______ from the pulmonary vessels.

Answer 8

Unable to pump the blood

Question 9

As a result of the left side failing, what happens?

Answer 9

The blood backs up behind the LV and the pressure in the left atrium and pulmonary veins INCREASE

Question 10

As the pulmonary veins become engorged with blood…..

Answer 10

Serum is forced out of the pulmonary capillaries and into the alveoli

Question 11

It is a respiratory problem but has a ______!

Answer 11

Cardiac

Question 12

with Congested heart failure the lungs feel like they are ______ !!

Answer 12

DROWNING

Question 13

Pt will present with ____ during left sided congestive heart failure

Answer 13

SOB
Hypertensive!!
Restlessness
Agitation
Confusion
Tachypnea
Crackles and possibly wheezes
Frothy, pink sputum

Question 14

If they are shortness of breath what should you never do?

Answer 14

NEVER LAY THEM DOWN SUPINE! because the fluids will overtake their lungs!!

Question 15

Increases fluid in the vessels leaks into the interstitial spaces causing narrowing of the bronchioles causing what sound?

Answer 15

Wheezing!

Question 16

Air passing through the fluid filled alveoli causes what sound in the lungs?

Answer 16

Crackles!!

Question 17

How do you manage CHF?

Answer 17

Improving oxygenation
Decreasing workload
Reducing the preload so that the LV is less overburdened.
Take VITALS- spo2, etco2, o2, IV, 12 lead ECG
Position up right

Question 18

What are the effects of nitro?

Answer 18

• vasodilation
• reduces the cardiac workload and improved cardiac output

Question 19

Wheezes: you should AVOID…. what type of medications?

Answer 19

Bronchodilators (VENTOILIN) should be avoided as they increase tachycardia!!!

Question 20

What does CPAP do to the lungs?

Answer 20

• Keep the alveoli open due to the fluid
• works to hold the alveoli open through the resp. cycle so that o2 and co2 can diffuse exchange normally

Question 21

Can the mask be removed for medication adminstration?

Answer 21

YES!!

Question 22

CHF always presents with LOW blood pressure, true or false?

Answer 22

FALSE CHF n e v e r presents with low blood pressure

Question 23

What kind of patient do we have to use CPAP on?

Answer 23

Conscious, alert and following commands!!
Severe resp. distress
Acute pulmomary edema or COPD
tachypnea
normotensive
Spo2 <90%

Question 24

What is paroxysmal nocturnal dyspnea?

Answer 24

• severe attacks of SOB and coughing that typically happen at night
• usually wakes up the person from sleep
• often occurs with LHF where the cause is chronic overload as opposed to an MI
• 1-2 weeks of SOB at night

Question 25

What is right sided heart failure?

Answer 25

the right side is working harder to pump blood into the enlarged pulmonary arteries

Question 26

Pulmonary hypertension is…

Answer 26

chronic increased resistance of blood through the lungs- backing blood into the RV= increased workload = failure

Question 27

Pulmonary embolism is….

Answer 27

forward blood flow through the pulmonary system is blocked by a clot = increased workload on RV = failure

Question 28

If pulmonary edema is present=

Answer 28

secondary to LHF

Question 29

If no pulmonary edema is present=

Answer 29

lung or right sided heart problems

Question 30

When the right side of the heart fails… pressure ____ behind the RV and ______ pressure in the systemic veins causing them to become __________ !!!!

Answer 30

backs up
increases
ENGORGED

Question 31

What is JVD?

Answer 31

Jugular vein distention

Question 32

What is one obvious sign of CHF in the body?

Answer 32

PITTING EDEMA in the legs

Question 33

How do we manage RHF?

Answer 33

make the pt comfortable
monitor

Question 34

If pt presents w RHF AND LHF what do we do???

Answer 34

Treat the left side congestive heart failure FIRST

Question 35

When does cardiogenic shock occur?

Answer 35

when the heart is so severely damaged that it can no longer pump sufficient blood to maintain tissue perfusion

Question 36

When ____ % of the LV myocardium is involved, LHF usually develops

Answer 36

25%

Question 37

When ___% or more of the LV myocardium involved, it is infarcted

Answer 37

40%

Question 38

Cardiogenic shock can happen after what?

Answer 38

after resuscitation ROSC

Question 39

Signs and symptoms of cardiogenic shock:

Answer 39

confusion/comatose
restless and anxious if awake
pale, cold skin
poor sp02 readings due to peripheral shunting
rapid, shallow respirations often crackles
rapid thready pulse

Question 40

What is relative hypotension?

Answer 40

fluid loss within the body
- dehydration, cannot see the source of fluid loss

Question 41

What is absolute hypotension?

Answer 41

TRAUMAAAA- you can see the fluid loss/blood

Question 42

What is the management of CHF?

Answer 42

improve oxygenation and perfusion
100% supplemental O2
place the pt supine unless pulmonary edema is present
cardiac monitor and 12 lead
transport quickly