ADH 3; CHF + Shock Flashcards
(38 cards)
What is CHF?
Congestive Heart Failure
PUMPING/FILLING problem
usually due to impaired myocardial contraction
positive feedback! hence “congestion”
ACUTE (acute excess demands)
Fluid overload
A-fib
Injury
MI
Hyperthyroidism*
Infection/Fever*
*from book
CHRONIC (chronic excessive workload)
Hypertension CAD Valve problems COPD Obesity, sedentary lifestyle Thyroid Inflammation/Infection Substance abuse
Cardiac Output is…regulated by…
Cardiac Reserve is…affected by…
*NOT
- AMOUNT of blood pumped in 1 min (HR x stroke volume)
- regulated by O2 demands - as O2 use increases, CO increases (perfusion) think of running & flushing
- Ability of heart to increase CO to meet demands
- Ventricle damage (pumping)
Contractility is…
Ejection Fraction is…
*NOT
- ability of cardiac muscle to shorten during systole
- necessary to eject blood during systole
-(approx 60)% of blood in ventricles that is ejected during systole
HR
Rapid HR
*NOT
Ventricular contractions per minutes; affects CO
Rapid HR - shorten ventricular filling (diastole) reducing stroke volume & CO
SLOW HR - reduces CO because of less cardiac cycles
What are the 5 TYPES of Heart Failure
Systolic Diastolic LF side RT side HIGH output
Systolic
PUMPING problem (afterload)
Ventricle not pumping
DEC ejection fraction
Ex. Hypertension increases afterload/resistance
Diastolic
FILLING problem (preload)
Ventricle not relaxing/STIFF
NORM ejection fraction
LF side
Left Ventricle (backing up into LUNGS)
RT side
Right ventricle (backing up to REST of BODY)
HIGH output
OK but not meeting demands of body
S/S of RT sided HF; backup to rest of body - 4
CAUSE is…
- Edema
- JVD
- GI congestion = anorexia, ascited, WT gain
- Liver/Spleen enlargement (RUQ pain)
pulmonary issue; restricted blood flow to lungs
(pulmonary edema)
S/S of LF sided HF; backup to lungs - 4
pulmonary congestion (backward effects)
decreased cardiac output (forward effects)
CAUSES - 2
- SOB (orthopnea/dyspnea)
- Cough/Crackles
- S3 gallop (over already filled ventricles)
- Nocturia
Hypertension, CAD
HIGH output; PTs in hypermetabolic states 4
require…
- Hyperthyroidism
- Infection
- Anemia
- Pregnancy
require INC CO
Flash Pulmonary Edema is…
HALLMARK SIGN?
Treatment?
Acute emergency condition
pink frothy speutum
- O2, intubation,
- diuretics,
- morphine (to relaxt PT + vasodilation + DEC preload)
NY Heart Association Classification: Class 1 Class 2 Class 3 Class 4
Class 1: no limitation, asymptomatic during ADLs
Class 2: slight limitation, mild symptoms during ADLS
Class 3: moderate limitations, symptoms w/minimal activity
Class 4: severe limitations,symptoms present at rest; end stage CHF, shock
Compensatory Mechanisms: SNS RAAS Ventricular Hypertophy BNP
SNS - inc HR, vasoconstricts, INC BR
RAAS - retains, vasoconstricts, DEC UR,
Ventricular Hypertophy - thickening of muscle
BNP - release to decrease SNS
Diagnostic Studies: CXR EKG Echocardiogram Liver & Renal function test
CXR - lungs & heart size & congestion
EKG - monitor for changes/arrhythmias
Echo - moving heart pictures (beating of your heart baby)
LFT/Urinalalysis- BUN, Creatinine (assess liver function affected by heart failure)
Diagnostic Studies: BNP ABGs CBC K levels
BNP - enzyme released during HF (need additional tests to confirm)
ABGs - gas exchanged in lungs & tissues
CBC - Hgb, Hct
K levels - (3.5 - 5)
BNP: B-type Natriuretic Peptide
LEVELS
< 100 no failure 100-300 some failure > 300 mild failure > 600 moderate failure > 900 severe failure
Treatment
UNLOAD!
U - Upright position N - Nitrates L - Lasix O - Oxygen A - ACE/ARBS (inhibit RAAS) D - Digoxin
Non-Pharmacological MGMT
Oxygen Smoking cessation Exercise - NOT for Class 5 WT loss ETOH limitation Na restricted diet Fluid restriction - strict I/O; 1500ml/day
Device therapy
Pacemakers
Internal Cardiac Defibrillator
Ventricular Assist Device
