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Flashcards in Heart Failure Deck (30):
1

Heart Failure/CHF

Cardiovascular condition in which the heart is unable to pump an adequate amount of blood to meet the metabolic needs of the body

2

heart failure is a complication of 

an MI

3

common causes of HF


•MI, arrhythmias, CAD, RHD, cardiomyopathy, anemia, endocarditis, pulmonary emboli, hypertensive crisis, congenital defects, Diabetes, smoking, substance abuse, family history.
 

4

types of HF

Left sided 

right sided

high output 

5

left sided heart failure

can be acute or chronic

Subtypes:  Systolic ventricular dysfunction

           and Diastolic heart failure.

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systolic ventricular dysfunction


•Results when heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation.

•Ejection fraction drops to below 40 % with ventricular dilation.  Tissue perfusion decreases and fluid accumulates in the pulmonary vessels.
•Called forward failure.  Cardiac output is decreased and fluid backs up into pulmonary system.
 

7

what is another name for systolic ventricular dysfunction 

foward failure 

8

diastolic Heart Failure 


•Left ventricle cannot relax adequately during diastole.  Prevents ventricle from filling with sufficient blood to maintain adequate cardiac output.
•Ventricle becomes less compliant over time because more pressure is needed to move the same amount of blood as compared to a healthy heart.
 

9

diastolic heart failure backs up in 

lungs 

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right sided heart failure


•May be caused by left ventricular failure, right ventricular MI, pulmonary hypertension
The right ventricle cannot empty completely so increased volume and pressure develop in the venous system.  Peripheral edema results

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right sided failure you get more 

peripheral edema

12

high output heart failure 


•Cardiac output can remain normal or above normal
•Caused by increased metabolic demands or hyperkinetic conditions like septicemia and hyperthyroidism
•Not as common
 

13

long term use of NSAIDS

cause fluid and sodium retention

which can cause HF

14

pioglitazone (actos) 

used for diabetics causes fluid and sodium retention leading to HF

15

left sided HF symptoms

*RESPIRATORY SYMPTOMS*


•Fatique, weakness, oliguria during the day, nocturia at night, angina, confusion, restlessness, dizziness, tachycardia, palpitations, pallor, weak peripheral pulses, cool extremities,
•Decreased PaO2, Hacking cough worse at night, dyspnea, breathlessness, crackles or wheezes in the lungs, frothy pink tinged sputum, tachypnea, murmurs
 

16

Right sided HF symptoms

*THINK VEINS*
•Jugular neck vein distention
•Enlarged liver and spleen
•Dependent edema in legs and sacrum
•Distended abdomen, anorexia & nausea
•Swollen hands & fingers
•Polyuria at night
•Weight gain
•Increased BP (excess volume) or decreased BP from failure.
 

17

diagnostic assessments for HF

BNP (Best TEST)


•B-Type natriuretic peptide ( BNP ) is used for diagnosing Heart Failure
•Electrolyte imbalances may result from HF
•BUN & creatinine to check effect of HF on kidneys
•Urinalysis shows proteinuria
•Hgb & Hct to identify HF caused by anemia
•Microalbuminuria is an early indicator of decreased compliance of heart
 

18

B-Type natriuretic peptide (BNP)

secreted from the ventricles or lower chambers of the heart in response to changes in pressure that occur when heart failure develops and worsens.

trying to compensate for failure.  tries to regulates BP and fluid balance.

19

more diagnostic tests for HF


•Arterial blood gases often show hypoxia.  Respiratory alkalosis may occur because of hyperventilation.  Respiratory acidosis may occur because of carbon dioxide retention
•Chest Xrays help diagnose LVF
•Echocardiogram considered best tool for diagnosing HF.  Also determines ejection fraction.
•Radionuclide imaging helps dx HF


•Electrocardiogram can show ventricular hypertrophy, arrhythmias, and any degree of myocardial ischemia or injury
•Pulmonary artery catheters allow assessment of cardiac function and volume in acutely ill patients.
 

20

medical treatment for HF


•Medications
•Continuous positive airway pressure (CPAP)- improves sleep apnea in HF and improves cardiac output
•Cardiac resynchronization therapy (CRT)- is biventricular pacing that stimulates more synchronized contraction and improves ejection fraction.  Can be used with ICD.                      
 

21

more medical treatment for HF


•Heart transplant for end stage HF
•Ventricular assist devices (VADs)- mechanical pump is implanted to work with patient’s own heart.  Can be used short term while waiting for transplant or long term to increase quality of life.
•Heart reduction surgery (partial left ventriculectomy  PLV )-removes a section of the weakened heart in left lateral ventricle to reduce size and wall tension.
 

22

more heart failure treatments


•Endoventricular circular patch cardioplasty-portions of the septum and left ventricular wall are removed  and a synthetic circular patch is grafted into opening, Makes more normal shape for left ventricle and improves ejection fraction.
•Acorn cardiac support device- polyester mesh jacket placed over ventricles to prevent them from overstretching.  Reduces hypertrophy and improves ejection fraction.
 

23

and yet more heart failure treatments


•Myosplint- recently approved.  Electrical stimulation of several tension pads on the outside of the ventricle changes it to more normal shape and improves function.
•Gene Therapy-Investigative.  For those not candidates for heart transplant.  Replaces damaged genes with normal ones by injecting growth factor into the ventricle.  Improves exercise tolerance and regrowth of cardiac cells.
 

24

commonly used drugs for systolic HF


•Angiotensin-converting enzyme (ACE) inhibitors or angiotensin- receptor blockers (ARBs)
•Diuretics- loops, thiazides, and potassium sparing
•Human B-type natriuretic peptides
•Nitrates
•Inotropics
•Beta-adrenergic blockers
 

25

loop diurectics

powerful.  very powerful.

if someone is on one, they usually have a catheter in.  If no catheter then strict monitor I & O

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positive inotropic drug

increases contraction

27

beta blockers have 

a negative inotropic effect

therefor it can make CHF worse

28

Nursing assessment for HF


•Assess for mental status changes, pulmonary congestion, breathlessness,  oliguria, renal function, edema
•Monitor vital signs, O2 sat, cardiac rhythm,
•Assess proportional pulse pressure as follows:

                      Systolic BP – Diastolic BP

                            Systolic BP                                          

Pressure less than 25% indicates severely compromised cardiac output


•Assess for extra heart sounds (S3, S4)
•Auscultate  for crackles and wheezes of the lungs.  Note state of breathlessness
•Inspect for JVD, hepatomegaly, ascites, dependent edema
•Psychological assessment of patient and family for anxiety and depression.
•Assess activity level
•Assess laboratory data
 

29

Nursing diagnosis for heart failure 


•Impaired gas exchange
•Decreased cardiac output
•Activity Intolerance
•Excess fluid volume
•Acute confusion related to delirium
•Anxiety
•Ineffective cerebral tissue perfusion
 

30

Nursing interventions for HF


•Monitor vital signs, Os sat, heart sounds
•Give prescribed meds as ordered
•Monitor for adventitious breath sounds
•Monitor weight every day. Report increase of 2lbs/day and 5lbs/week.  Monitor I&O
•Monitor for JVD and edema
•Provide oxygen as ordered
•Place in fowler’s or semi-fowler’s position

•Explore patient feelings about effects of HF on life style
•Elevate legs when sitting.  Encourage position changes.  Keep skin soft and supple to prevent breakdown.
•Plan for rest periods.  Gradually increase activity.  Assist with ADL’s as needed
•Give sodium restricted diet as prescribed.  Maintain fluid restriction if ordered

•Provide small frequent feedings.  Prevent constipation
•Teach patient and family about nature of HF and reason for various treatments, self monitoring for worsening of HF, how to remain active yet avoid fatigue, management of medications and diet restrictions, and need for follow-up care