Heart Failure II - Diagnosis & Treatment Flashcards
Increased inotropy usually leads to decreased __________.
lusitropy
What are the three main clinical symptoms of congestive heart failure?
Fatigue (due to decreased cardiac output), edema (due to increased pressure from the right side of the heart that backs up in the venous return system), and breathlessness (due to back up in the lungs)
Orthopnea is ____________.
the immediate shortness of breath when lying flat
Describe the pathophysiology of orthopnea and paroxysmal noctural dyspnea.
Both relate to lying down and having fluid accumulate in the lungs; orthopnea results from pooled venous blood immediately flowing to the lungs, while PND results from sodium returning from the interstitial space (where it had accumulated from gravity) flowing back to the intravascular area
Edema due to HF can lead to ____________.
hepatic congestion, gall bladder swelling, and ascites
List some of the factors that can precipitate a worsening of CHF symptoms.
(1) increased circulating volume (such as from increased sodium intake or renal failure); (2) increased afterload (such as from aortic stenosis, uncontrolled hypertension, or pulmonary embolism); (3) decreased inotropy (such as from a ß-blocker or MI); (4) arrhymthia; or (5) increased metabolic demands
Describe the four stages of the New York Heart Association’s CHF scale.
I = asymptomatic; II = symptomatic with moderate exertion; III = symptomatic with minimal exertion; and IV = symptomatic at rest
Describe the American Heart Association’s stages of heart failure.
A = at risk of heart failure, but no symptoms present; B = structural evidence of disease, but no other symptoms; C = structural heart disease with prior or current symptoms; D = refractory heart failure requiring specialized interventions
Symptoms are ___________, while signs are _____________.
what patients reports; what is found on physical exam
Rales are _________.
the velcro sound that results from pulmonary edema–wet alveolae from the edema
The extremities of those with HF will often be ___________.
cool and edematous
Signs of HF include __________.
cool extremities, rales, jugular distention, tachycardia, tachypnea, hypoxia, gallops, and low pulse pressure
JVP helps to differentiate ____________.
hypotension from right-sided heart failure and hypotension from sepsis
The JVP has the ACXVY waves. What is the A? X? V?
A is during ventricular diastole–it is a peak in pressure that results from the right atrium contracting; X is during ventricular systole–it is a dip in pressure that results from the atrium filling up; and V is a minor peak in pressure that results from the tricuspid valve pressing backward into the right atrium.
S3 is thought to result from ____________; it has the characteristic ________ sound.
rapid expansion of the ventricle walls during diastole; “Ken-tuck-ey”
