heart failure

Question 1

types of HF

Answer 1

left sided/right sided
systolic or diastolic
acute or chronic

Question 2

most common type of HF

Answer 2

left sided

Question 3

what happens in left sided HF

Answer 3

blood backs up in lungs
- systolic, diastolic, or mixed s/d failure
- pulmonary edema

Question 4

systolic HF occurs bc of…

Answer 4

inability of the heart to pump d/t…
- decreased contractility
- increased after load (HTN)
- cardiomyopathy

Question 5

what does systolic HF result in

Answer 5

less than 45% EF
can get as low as 5-10% (not good life expectancy)

Question 6

diastolic HF occurs because of…

Answer 6

inability of ventricles to relax and fill with blood

Question 7

most common cause of diastolic HF

Answer 7

HTN -> left ventricular hypertrophy

Question 8

what is mixed systolic and diastolic HF

Answer 8

extremely low EF with high pulmonary pressures
- biventricular failure
- typically d/t dilated cardiomyopathy

Question 9

what is increased in pulmonary edema

Answer 9

-pulmonary/cap. hydrostatic pressure
- lymphatic flow
- fluid in alveoli

Question 10

right sided HF results in

Answer 10

blood backing up into veins

Question 11

right sided hf etiology

Answer 11

left hf
rv infarction
cor pulmonale

Question 12

types of right sided HF

Answer 12

acute- decompensated
chronic- biventricular

Question 13

stage 1 NYHA HF

Answer 13

no limitations, no S&S with nl activity

Question 14

stage 2 NYHA HF

Answer 14

slight limitations, S&S with nl activity

Question 15

stage 3 NYHA HF

Answer 15

marked limitations, comfortable at rest

Question 16

stage 4 NYHA HF

Answer 16

cannot carry on activity, S&S at rest, hospitalized

Question 17

3 compensatory mechanisms in HF

Answer 17

RAAS
SNS
natriuretic peptides

Question 18

what triggers RAAS compensatory mechanism in HF and what does it result in

Answer 18

• low CO and decreased renal perfusion
• vasoconstriction, fluid retention, increased BP

Question 19

SNS compensatory mechanism trigger

Answer 19

low SV and CO

Question 20

SNS compensation results in…

Answer 20

vasoconstriction
+inotropy
+ chronotropy
increased preload/afterload
dilation-> hypertrophy

Question 21

renal effects of ANP and BNP

Answer 21

diuresis and natriuresis
(more pee and sodium in pee)

Question 22

CV effects of ANP and BNP

Answer 22

vasodilation

Question 23

hormonal effects of ANP and BNP

Answer 23

inhibit RAAS
prevents ADH release

Question 24

S&S of leftsided HF

Answer 24

• crackles, dyspnea, orthopnea, cough
• S3, S4, pulses alternans, tachycardia
• AMS, confusion, kidney issues

Question 25

S&S of rightsided HF

Answer 25

- edema - JVD, hepatomegaly (RUQ pain) - wt gain (3lbs in 2 days = ADHF)

Question 26

S&S of chronic HF

Answer 26

FACES fatigue activity limitation congestion/cough edema SOB

Question 27

S&S of ADHF

Answer 27

SCARS skin pale clammy and cyanotic crackles AMS respirations tachy and labored sputum pink and frothy

Question 28

3 ways to diagnose HF

Answer 28

echo (to get EF) EKG MUGA scan

Question 29

BNP labs indicating severity of HF

Answer 29

>100= HF >300= mild HF >600= moderate HF >900= severe HF

Question 30

tx / interventions for acute HF

Answer 30

oxygen fluid restriction telemetry daily weights

Question 31

best way to track fluid balance day by day

Answer 31

daily weights

Question 32

first line meds for drug therapy

Answer 32

RAAS inhibitors (ACE-I and ARBs)

Question 33

other drug tx for HF

Answer 33

diuretics BB vasodilators inotropes antidysrhythmics morphine for vasodilation

Question 34

ideal med for BP and pain

Answer 34

morphine

Question 35

what does AICD stand for

Answer 35

automatic implantable cardioverter defibrillator

Question 36

teaching for AICD

Answer 36

- cannot raise arm over shoulder lvl - avoid magnets - dont carry cell in pocket - keep devise info card on person

Question 37

VAD stands for

Answer 37

ventricular assisted advice