Heart Failure Flashcards by Erin Nolan

T or F: Heart failure is an event.

FALSE

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heart failure

inability of the myocardium to pump enough blood to meet the needs of the body

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Heart failure involves impaired
a) pumping
b) filling
c) both

c) both

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Common causes of HF (many)

CAD/MI

hypertension

valvular disease - rheumatic fever

R sided pulmonary hypertension

infiltrative disorders

pericardial disease (restrictive)

inflammatory (myocarditis)

cardiomyopathy

dysrhythmias

medication non-compliance

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Top 3 causes of HF

1) CAD/MI

2) hypertension

3) valvular disease

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Effects of valves not closing all the way

NOT going to have a CLOSED SYSTEM (isovolumetric)

leakage

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Effects of valve stenosis

have to pump harder

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Impacts on the cardio system

affects preload, filling, afterload

decreased filling time

decreased time in diastole

increased HR

increased BP

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Pathophysiology - 3 major systems

1) SNS
-bad

2) RAAS
-bad

3) Natriuretic Peptide system
-good

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SNS chemicals

catecholamines

E and NE

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SNS effects

VASOCONSTRICTION
-increased HR
-decreased filling time
-increased BP
-increased afterload
-increased oxygen needs and demand on heart

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Receptors that activate the CNS

baroreceptors

sense low BP

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Med that targets SNS

beta-blockers

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RAAS chemicals

angiotensin II

aldosterone

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RAAS effects

VASOCONSTRICTION
-increased BP
-increased afterload

Na+/water retention
-increased BP

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Meds that target RAAS

ACE inhibitors

ARBs

diuretics

Mineralocorticoid Receptor Antagonist

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What secretes ADH?

posterior pituitary

stimulates by low perfusion

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What does ADH do?

acts on DISTAL tubules to increased reabsorption of water

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Frank Starling Mechanism

heart’s SV increases in response to an increase in the volume of blood in the ventricles at the end of diastole

eventually overstretch will result in ineffective contaction

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Chemicals of the Natriuretic Peptide System

ANP

BNP

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ANP released from the…

atria

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BNP released from the…

ventricles

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In heart failure, levels of ANP and BNP are:
a) elevated
b) lowered

a) elevated

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What increases levels of ANP and BNP?

STRETCH

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Effects of ANP and BNP

diuretic natriuretic hypotensive inhibits RAAS and SNS

Main compensation mechanisms (4)

1) SNS 2) neural-hormone/RAAS 3) dilation of ventricle -Frank-Starling 4) ventricular hypertrophy

Acute HF

sudden onset NO compensatory mechanisms over days or hours e.g. MI

Chronic HF

ongoing process months to years progressive worsening of ventricular function chronic neuro-hormonal activation that results in ventricular remodelling

Left-sided HF

left ventricular dysfunction disturbance of the contractile function of the left ventricle, resulting in a low cardiac output state

Right-sided HF

ineffective right ventricular contractile function backwards flow

Most common HF: a) left b) right

a) left

What is right-sided HF most often a result of?

left-sided HF

Systolic HF

PUMPING problem decreased contractility

Diastolic HF

FILLING problem

Ejection fraction is determined by: a) % of blood being pumped out b) volume of blood being pumped out

a) % of blood being pumped out EF can look normal because it's not showing volume

EF may be normal in: a) systolic HF b) diastolic HF

b) diastolic HF less volume, but normal %

How is EF calculated?

echo (cardiac ultrasound) left ventricle

Clinical heart failure syndromes (3)

1) HFrEF 2) HFpEF 3) HFpEF

Complications of HF (many)

pleural effusions dysrhythmias left ventricle thrombus hepatomegaly renal failure (pre-renal)

Diagnosis of HF

history and physical exam chest x-ray ECG BNP levels echo may do imaging, catheterization, stress testing etc.

Big consideration with assessment

what has CHANGED

Signs of worsening HF (many)

hypotension worsening renal function altered mentation dyspnea at REST** worsening congestion weight gain* electrolyte disturbance defib - repeating firings afib

Conditions associated with worsening HF (many)

pneumonia PE diabetic ketoacidosis ACS

Abnormal heart sounds associated with HF

murmur S3 and S4 -resistance to filling

Grade I HF

normal EF: > 50%

Grade II HF

mild EF: 41 - 49%

Grade III HF

moderate EF: 30 - 41%

Grade IV HF

severe EF: < 30%

Lab work (many)

BNP CBC -anemia -polycythemia -leukocytosis Electrolytes Renal function Liver function -enzymes will be elevated Troponin, CK Glucose Thyroid Blood gases

Consideration for hypertension management

don't want it to be too high OR too low need to fine tune meds

Considerations for nutrition

decreased appetite and nausea small, frequent meals sodium and fluid restriction

Sodium restriction values

<2 to 3 g/day Severe: 1.5 g/day

Fluid restriction values

1.5 - 2L/day

Concerning weight gain

2 - 3 lbs in a day 5 lbs in a week

Considerations for activity

cluster care allows adequate rest restrict during periods of exacerbation according to tolerance

Principles of pharmacologic therapy

start low, go slow 1 med at a time reassess patient-specific parameters*

Medication therapy main goals (2)

1) HR < 70 bpm 2) restore normal sinus rhythm

Med that you may start first

ACE inhibitor or ARB

Meds for REDUCED EF HF

ACE inhibitor/ARB Beta-blocker MRA

Meds for PRESERVED EF HF

Beta-blocker/Ca+ channel blocker Nitrates Diuretics

"New" meds

Neprilysin inhibitor ARB + neprilysin

Which drug is neprilysin contraindicated with?

ACE inhibotor

What does Ivabradine (Lancora) act on?

If channel in the SA node does NOT lower BP in conjunction with other meds

SGLT2 Inhibitor MOA

reduces reabsorption of glucose from tubular lumen more glucose excreted pulls water with it (diuretic)

Digoxin MOA

acts by INHIBITING the Na-K-ATPase pump decreases HR increases contractility

Consideration for Digoxin

last resort bad side effects like bradycardia usually only used for patients with high HRs

Venous Thromboembolism Prophylaxis med

heparin

Criteria for taking heparin

afib EF: <35%

Side effects of metal valves

blood clots have to be on anticoagulants for life

Side effects of tissue valves

no blood clots but don't last as long

Most patients will have a change in symptoms at least __ to ___ days before ER visit

2 to 3 days

What medication is typically given at the hospital for HF exacerbations?

diuretics

Most common symptoms during palliation (3)

1) dyspnea 2) pain 3) fatigue