Heart failure Flashcards
(39 cards)
What is heart failure?
Heart failure (HF) is a syndrome of ventricular dysfunction where the heart can’t pump blood effectively for the body’s needs.
How does heart failure happen anatomically?
Heart failure can manifest separately as left or right-side ventricular failure or both.
What is systolic heart failure?
Systolic heart failure is characterized by weakened contraction/pumping force of the heart with LVEF < 40%.
What is diastolic heart failure?
Diastolic heart failure occurs when the heart fills with blood poorly, with LVEF between 40–50%.
What is the normal level of LVEF?
The normal level of LVEF is 55-70%, measured with heart ultrasound (echo).
Anatomy and physiology
https://youtu.be/yGcVrEai2dM?feature=shared
What are the causes of heart failure?
(in ~90% of cases): Coronary artery disease (CAD), Hypertension, Valvular heart disease.
Cardiomyopathy, Acute coronary syndrome, chronic lack of oxygen, Right-sided HF often caused by left-sided HF or severe lung diseases (e.g., COPD)
Divided into acute and chronic heart failure, chronic can be stable but there may be acute phases
What are the symptoms of heart failure?
Can manifest quickly or slowly, Dyspnea (especially with exertion), Breathlessnes, Fatigue, tachycardia, Dry cough (often night), Peripheral edema (ankles), Weight gain, pleural effusion, ascites, Worsens with exercise initially/ first appear in exercise.
How is heart failure detected clinically and physically?
Interview: Symptoms, medical history
Clinical examination: Signs of fluid overload, heart sounds, breathing
Vital signs: HR, BP, rhythm, oxygenation
Gets more common with aging (stiffness of the heart, fibrosis)
What are the tests and diagnosis that can be made to determine heart failure?
Chest X-ray, 12-lead ECG, stress ECG
Echocardiography (LVEF measurement) * (ejection fraction EF measured, normal 50- 70%)
Lab tests: BNP/pro-BNP (amino acids called natriuretic propeptid released when heart muscle is strained), thyroid tests
Coronary angiography
MRI (possibly)
What are the symptoms of exacerbated heart failure?
Acute shortness of breath, Pulmonary congestion (pulmonary edema), Rapid weight gain, Fatigue, confusion, cold extremities
How can exacerbated heart failure and its symptoms be treated?
IV diuretics, oxygen, morphine, GTN, IV beta-blockers, Simdax infusion in severe cases, Treat underlying cause
What is the aim for treating heart failure?
AIM is to restore quality of life and functional ability, prevent hospital admissions, reduce mortality
What are the non-pharmacological treatments of her failure?
Diet: Sodium & fluid restriction, Lifestyle: exercise, weight loss, smoking cessation, Vaccinations (influenza, pneumococcal)
What are the pharmacological treatments of heart failure?
Diuretics (adjustable dose)
ACE inhibitors / ARBs (lower BP by dilating arteries, improve pumping ability,enforce diuretics effect, supress stress hormone effect, dry cough common side-effect)
Beta-blockers used together with ACE inhibitors, aldosterone antagonists
angiotensin II receptor blockers used if ACE inhibitors not suitable
Digoxin (narrow therapeutic range)
Aldosteron antagonists conteract aldesteron effect in body which holds back salt and water in our body and loose potassium
Nitrates, antithrombotics
In acute phase may need CCU/ICU treatment (pulmonary oedema, cardiogenic shock)
Device therapy e.g. pacing, mechanical pump, heart transplant
What are the short and long term treatments of heart failure?
Short-term: Symptom relief (diuretics, oxygen)
Long-term: Lifestyle, medications, device therapy (pacing, mechanical pumps, transplant)
What is congestive heart failure (CHF)?
CHF is a clinical syndrome where the heart is unable to pump efficiently, causing fluid accumulation in lungs, abdomen, and extremities. It includes both systolic and diastolic dysfunction and can be left-, right-, or biventricular.
What are the risk factors, causes of congestive heart failure?
CAD, hypertension, valvular disease, Myocardial infarction, Lung disease (for right-sided CHF), Arrhythmias (e.g., atrial fibrillation)
What are the symptoms of congestive heart failure?
Dyspnea, edema, orthopnea, fatigue, Nocturnal cough, weight gain
What are the general measures taken to treat CHF?
Diet modification: Fluid/sodium restriction, Treat underlying cause or factors, Education, monitoring, health maintenance (Vaccines, wellness checks), Adequate rest, oxygen, Mild exercise, Alcohol/ smoking cessation.
What are the medication for CHF?
Diuretics, ACE inhibitors, Angiotensin receptor blockers (ARBs), beta-blockers, cardiac glycosides, aldosterone antagonists, digoxin
Surgical: Valve repair/ replacement surgery, Revascularization, Angioplasty, CABG (bypass)
Device therapy:
Cardiac resynchronization (CRT) - Biventricular pacing. Ventricular Assisted Devices (VAD) - Often used as a bridge while waiting for definitive therapy, Implantable cardioverter defibrillator (ICD) - to reduce incidence of cardiac death seen, Pacemaker, ICD (defibrillator), LVAD (mechanical support), heart transplant
What are the NYHA heart failure classifications?
Functional classification based on symptom severity:
Class I: Cardiac disease but no symptoms and no limitation of physical activity
Class II: Mild symptoms and slight limitation of physical activity, comfortable at rest.
Class III: Significant limitation in activity due to symptoms. Marked limitations of physical activity. Comfortable only at rest.
Class IV: Severe limitations. Symptoms even while at rest. Unable to carry on any physical activity
What are nursing observations and assessments for heart failure?
Daily weight monitoring
Peripheral edema (check for pitting-oedema)
Shortness of breath, dry cough
Fatigue.
Confusion (especially elderly) cognitive problems
Monitor vital signs (rhythm, P, BP), arrhythmias
Patient-reported symptoms
