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Acute Test #2 > Heart Failure > Flashcards

Heart Failure Flashcards

(61 cards)

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1
Q

where can you best auscultate murmurs

A

mid clavicular line 5th ICS at apex

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2
Q

cardiac output

A
  • CO = stroke volume x HR

- 4-6L/min

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3
Q

heart failure

A
  • inadequate cardiac output
  • myocardium unable to pump enough blood to meet O2 requirements
  • impaired cardiac pumping/filling
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4
Q

mortality rate of HF

A
  • 33% in first year of dx
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5
Q

preload

A
  • volume of blood in ventricles at end of diastole (filling)
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6
Q

afterload

A
  • resistance left ventricle must overcome to circulate blood

- increased after load = increased cardiac workload

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7
Q

what causes increased preload

A
  • hypervolemia
  • regurgitation of cardiac valve
  • HF
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8
Q

what causes increased after load

A
  • HTN

- vasoconstriction

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9
Q

causes of HF (8)

A
  • HTN
  • congenital heart defects
  • structural defects
  • arrhythmia, previous MI, anemia, pulmonary disease, liver failure, renal failure, hypervolemia
  • ineffective endocarditis, cardiomyopathies
  • stress
  • obesity
  • smoking
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10
Q

what is backflow

A
  • 100cc comes in RA then RV
  • compromised heart only giving half a squeeze pumping out 70cc
  • have 30cc remaining in RV
  • but another 100cc is coming into RA then RV
  • heart will try to grow and stretch to increase space for fluid resulting in backflow and symptoms
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11
Q

how can previous MI lead to HF

A
  • necrotic/scar tissue = improper electrical current and contraction
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12
Q

4 compensatory mechanisms

A

1) frank starlings law (dilation)
2) ventricular hypertrophy
3) sympathetic nervous system activation
4) neurohormonal response

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13
Q

frank starlings law

A
  • ventricles stretch to accommodate contraction issues

- after time elasticity is lost = improper recoil and boggy heart

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14
Q

ventricular hypertrophy

A
  • increasing size/strength of heart muscle to increase force of contraction
  • over time muscle gets too big = smaller ventricle space = decreased CO
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15
Q

sympathetic nervous system

A
  • decreased CO = tells heart to pump harder and faster
  • fight or flight response (E and NE) = increasing HR = increased O2 demands
  • lead to ventricular hypertrophy
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16
Q

neurohormonal response

A
  • decreased CO = decreased O2 to kidney = renin-angiotensin-aldosterone system
  • activation of angiotensin II = vasoconstriction increasing BP
  • aldosterone = retain Na = retain H2O = increased volume
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17
Q

decompensated HF

A
  • when compensatory mechanisms are no longer working/useful
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18
Q

ventricular remodelling

A
  • when heart starts to reshape to accommodate extra fluid and ineffective pumping
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19
Q

right sided HF

A
  • blood starts backing up out of RA into vena cavas

- systemic S&S

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20
Q

right sided HF symptoms

A
  • dependent edema
  • bilateral pitting edema
  • ascites (edema around abdomen)
  • weight gain
  • distended jugular vein
  • fatigue
  • enlarged liver & spleen
  • anorexia/GI complaints
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21
Q

symptoms of ascites

A
  • N&V
  • GI distress
  • decrease appetite
  • all from pressure on abdomen
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22
Q

other term for rt sided HF

A

cor pulmonale

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23
Q

jugular venous pressure (JVP)

A
  • to assess rt sided HF
  • pt at 45 degrees
  • looking for pulsation in internal jugular and measure up
  • <2 is ok
  • > 3 = rt sided HF
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24
Q

left sided HF

A
  • blood backs up into Lt and Rt pulmonary veins

- respiratory symptoms

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25
left sided HF symptoms (11)
- pulmonary congestion - tripod - confusion/altered LOC (less blood/O2 to brain) - exertion dyspnea - cyanosis - tachycardia (brain telling heart not enough blood so pump faster/harder) - orthopnea - paroxysmal nocturnal dyspnea - chest discomfort (less blood to coronary arteries) - nocturia - increased pulmonary capillary wedge pressure
26
cardinal sign of left sided HF
- orthopnea | - difficulty breathing why lying down
27
symptoms of pulmonary congestion
- bilateral crackles - bilateral wheezes - cough - blood-tinged sputum - tachypnea
28
ejection fraction
- % of blood pumped out of LV during contraction - amount of blood pumped out/amount of blood in chamber - decreased EF = decreased CO
29
ejection fraction numbers
- 50-70% = normal (anything less = compromised LV) - 41-49% = borderline - <40% = reduced
30
diagnostic tests for HF
- S&S + pt hx - CXR (to see boggy heart) - Echo - EF - BNP - ABGs (blood saturation with O2) - liver and kidney function tests
31
echocardiogram
- measures myocardial thickness - view BF to determine backflow - view valves to see if they are shutting properly
32
valves and ventricular remodelling
- valves can't grow and stretch so when heart does they pull apart and then cant close properly
33
BNP
- b type peptide - hormone released when heart is working really hard - quick to check if Lt HF or lung issue
34
BNP values
- <100ng/L = HF improbable - 100-500ng/L = HF probable - >500ng/L = HF very probable
35
liver function test
- Rt sided because of backflow - de O2 blood sitting in liver = atrophy and necrotic tissue - prevents liver from excreting toxins - albumin made in liver for oncotic pressure, low albumin = fluid seeping out into interstitial spaces
36
kidney function test
- Lt sided because of lack of forward flow - kidneys don't do well without blood/O2 - worried about kidney failure - BUN, creatinine
37
complications of HF
- pleural effusion - dysrhythmias - LV thrombus - hepatomegaly - renal failure (decreased BF)
38
pleural effusion complication
- fluis in visceral pleura - blood backs up and moves into lower pressure system - fluid surrounding lungs preventing full expansion - increased pressure in lungs
39
dysrhythmia complication
- heart stretches = altered electrical conduction | - a fib is common
40
LV thrombus
- clot in LV - from stagnant blood - can pump out and get stuck = stroke, PE, MI
41
hepatomegaly
- Rt HF - non-efficient drainage of BF - accumulation of de O2 blood - atrophy, necrosis of liver
42
pharmacological management of HF (10)
- ACE inhibitors - ARBs - angiotensin-receptor neprilysin inhibitors - beta blockers - diuretics - opioid - vasodilators - inotropes - antidysrhythmic agents - anticoagulants
43
ACE inhibitors
- lower BP | - capoten, vasotec, altace, zestril
44
ARBs
- lower BP, dont effect HR | - atacand, cozaar, diovan
45
angiotensin receptor neprilysin inhibitors
- lower BP, dont affect HR | - sacubitil/valsartan
46
beta blockers
- decrease BP, HR, CO | - metoprolol, coreg
47
diuretics
- to decrease BV - aldosterone antagonist (K sparing) - aldactone - loop diuretic (K wasting) - furosemide - thiazide (K wasting) - hydrochlorothiazide
48
opioids
- vasodilation - helps with oxygenation - morphine
49
vasodilators
- decrease vascular resistance | - nitrates, nitroprusside
50
inotropes
- increase contractility of the heart without increasing O2 demands - cardiac glycoside - digoxin - beta adrenergic agonist - dopamine - phosphodiesterase inhibitors - milrione
51
goals for treating HF (8)
- improve myocardial function - reduce circulating BV - reduce venous return - reduce afterload - reduce myocardium demands - improve cardiac function - improve gas exchange and oxygenation - decrease anxiety
52
digoxin
- cardiac glycoside that increases contractility - apical pulse for 60 secs as it decreases HR - 1.8-2.3 therapeutic range - risk of toxicity increases with hypokalemia - digoxin binds to K+ so if there is none then digoxin is free floating
53
digoxin toxicity symptoms
- see yellow - flu like symptoms - decreased HR - blurred vision
54
nursing management of HF
- hemodynamic monitoring - daily weights - ins/outs - diet (Na restrictive, H2O follows Na) - lab values - respiratory, cardio, integument, abdominal, neurological assessments
55
daily weights
- morning before breakfast | - >2kg over 2-5 days means peripheral edema and they are retaining too much fluid
56
chronic HF
- chronic progressive state - medically managed at home - Telehealth home monitor - at home monitoring
57
biventricular pacing
- boggy heart and electric conduction affected | - pacemaker implanted to send current to make heart contract
58
implantable cardio-defibrillators
implanted defibrillator
59
intra-aortic balloon pump (IABP)
- balloon inserted in aorta - balloon inflates when heart is at rest to increase pressure and fill ventricle more - push blood into coronary arteries - balloon deflates on contraction - can increase CO by 40%
60
ventricular assistive device (VADs)
- LVAD inserted in LV - external pump takes blood from LV and forces it into aorta - bypasses LV
61
artificial heart
- cut off ventricles and put in 2 artificial pumps that take over for ventricles

Acute Test #2 (4 decks)

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