Heart Failure Flashcards by Kate Burton

What is heart failure?

Inability of the heart to pump and/or fill which leads to an inability of the heart to supply the body tissues with enough oxygen.

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What can heart failure lead to?

Decreased Cardiac Output
Inadequate tissue perfusion
Impaired organ function

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Associated Factors with Heart Failure

CAD and HTN
Valvular Disease
MI
A-Fib

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Most common reason for hospital admission in adults > 65

Heart Failure

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Average length of stay for patients w/ heart failure?

6.5 days

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Risk factors for heart failure

CAD; Advanced age; HTN; DM; cigarette smoking; obesity

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Factors that determine cardiac output

Preload (volume)
After load (pressure/resistance)
Stroke volume
Heart Rate

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Areas of Heart Failure

Systolic Failure
Diastolic Failure
Mixed Systolic and Diastolic Failure

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Heart failure characterized by a defective pumping issue reflecting impaired contractility and increased afterload

Systolic Failure

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What is the hallmark characteristic of systolic heart failure

Low ejection fraction (EF) -> < 45%

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Heart failure caused by chronic HTN seen w/ left ventricular hyper trophy and or cardiomyopathy. The heart has a problem with filling.

Diastolic Failure

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What does diastolic heart failure result in? How does this present?

Decreased stroke volume and cardiac output;

Presented by backup of blood in the pulmonary and systemic systems

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Biventricular failure; issue with the heart’s ability to pump and fill; often seen with cardiomyopathy

Mixed systolic and diastolic failure

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What is the main difference between Systolic and Diastolic HF?

EF is normal in diastolic heart failure because less blood is going into the ventricles so the heart doesn’t have to pump as much and as hard.

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Compensatory Mechanisms of Heart Failure:

Ventricular dilation;
Ventricular Hypertrophy;
Activation of the SNS;
Neurohormonal responses

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Result of high pressures in the heart overtime resulting in the heart becoming overstretched.

Ventricular Dilation

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What is an advantage of Ventricular dilation? What is the disadvantage?

Heart muscle fibers are stretching to increase contractility;
Only helps for a short while and the heart becomes a poor pump because of overstretched ventricle.

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Thickening of the cardiac wall following chronic dilation

Ventricular hypertrophy

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What is an advantage to ventricular hypertrophy? What is a disadvantage?

Initially helps to improve cardiac output;

Decreases Cardiac output over time because of increased workload and stiffening/stretching of the heart wall.

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What does the release of epinephrine and norepinephrine do to the heart?

Increase HR and contractility; vasoconstriction increases systemic vascular resistance

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What is a disadvantage in the activation of SNS on someone with heart failure?

Increased cardiac workload

What system does neurohormonal response target?

Renin-Angiotensin-Aldosterone System (RAAS)

How does activation of RAAS affect someone with heart failure?

Decreases CO to kidneys which ultimately leads to retention of sodium and water leading to fluid overload. This increases cardiac preload.

What is ventricular remodeling? How does this affect someone with heart failure?

Hypertrophy often seen in left ventricle; Makes heart a less effective pump.

Protein Secreted in response to increased pressure in the ventricles caused by the stretching of the heart from increased fluid retention.

Brain Natriuretic Peptide (BNP)

How does BNP try to compensate for compensatory mechanisms of heart failure?

Vasodilation; Dieresis and Natriuresis; Blockage of RAAS

Types of heart failure:

Left-Sided HF | Right-Sided HF

Left-Sided Heart Failure is caused by

Left ventricular dysfunction; backup of blood into left atrium

Signs and Symptoms of left-sided HF

SOA, wheezing/crackles, moist cough, cyanosis (pulmonary edema and congestion)

Cause of right-sided HF

Right ventricle dysfunction; back up of blood in right atrium; result of left-sided or cor pulmonale

Signs and symptoms of right-sided HF

JVD; Peripheral edema; Vascular congestion of GI tract (Asites) Hepatomegaly

Cause of acute decompensated HF

L ventricular failure

Manifestation of acute decompensated Hf

Pulmonary edema

S/S of acute Decompensated HF

Anxious; pale, cool, clammy skin Pulmonary edema Respiratory acidosis

Chronic Heart Failure Symptoms (Faces)

Fatigue; Activity Limitations Chest congestion/Pulmonary Edema Edema Shortness of Breath

Complications of heart failure:

Renal Failure Left Ventricular Thrombus Pleural Effusion Dysrhythmias; Hepatomegaly

Diagnostic studies of HF

History & Physical Chest X-Ray Echocardiogram BNP (normal = 0 - 100 pg/mL)

Care for ACUTE HF

Improve Gas Exchange and Oxygenation Decrease Intravascular Volume/Reduce Preload Decrease Afterload Improve Cardiac Function

What are some things we can do to improve gas exchange and oxygenation

High Fowler’s; Supplemental Oxygen (2-4L); | Morphine

Why would giving patient morphine help improve gas exchange and oxygenation?

Helps to decrease preload & afterload and myocardial oxygen demands

What are some things we can do to decrease intravascular volume and/or reduce preload?

1. High Fowler’s position w/ legs dangling or horizontal in bed 2. Loop Diuretics 3. Vasodilator 4. Fluid Restriction

What are some things we can do to decrease afterload?

Nitroglycerin Sodium Nitroprusside (watch for hypotension; thiocyanate toxicity) Nesiritide (on IV pump; watch for hypotension) ACE Inhibitors: watch for angioedema and cough

Ways to improve cardiac function

Intropic therapy - increase myocardial contractility and CO 1. Digoxin 2. Dobutamne * *Not first choice!!!

Goals for the treatment of Chronic HF

1. Treat cause 2. Maximize CO 3. Symptom management 4. Improve quality of life & Decrease Mortality 5. Preserve Target organ function

Collaborative and nursing care for Chronic HF

Work together on meeting goals;Oxygen Therapy; Improve Activity levels; Drug Therapy (diuretics; ACE inhibitors; vasodilators);Nutritional therapy; Limit Alcohol/Smoking; Avoid Herbals/NSAIDS; Edu s/s acute decompensation; psychosocial issues

How to improve activity levels for stable chronic HF

Start slow then increase few min each day

Drug therapy for HF

Diuretics (loops and thiazides) ACE I’s Vasodilators for patients who cannot tolerate ACE I’s

Nutritional therapy for Chronic HF

Sodium Restriction: < 2Gm/day Fluid Restriction: for class 3-4; < 2L/day Daily Wt./ Monitor Fluid Balance: report wt gain of 3lb over 2 days or 3-5lb per week

Ways to assess fluid balance

Ankle swelling ABD swelling Orthopedic; Paroxysmal Nocturnal Dyspnea; Weight Gain (1st sign)

End Stage/Advanced HF

Biventricular pacing ICD Cardiac Transplantation (strict criteria to meet)

Nursing Diagnoses for Chronic HF

Activity intolerance;Excessive fluid volume; Impaired gas exchange; Anxiety; Decreased Cardiac Output; Knowledge deficit