Heart Failure Flashcards
(54 cards)
Major cause of mortality and morbidity in the US
Over 5 million Americans currently
African Americans are twice as likely to develop
550,000 cases each year
heart failure
broadly describe heart failure
Heart pump actually fails
The heart is unable to pump blood in sufficient amounts from the ventricles to meet the body’s metabolic needs
Results in decreased CO
causes of HF
Cardiac defect: Myocardial infarction Valve deficiency Defect outside the heart: Coronary artery disease Pulmonary hypertension Diabetes
decrease C.O., increased pressure in lungs, DOE, cough, inc. PCWP
Most heart failure begins with failure of this ventricle and progresses to failure of both
left sided heart failure
backs up from Left, to body, edema, organ congestion, inc. CVP
High output heart failure – caused by increased metabolic needs, septicemia, anemia and hyperthyroidism
right sided heart failure
treatments for HF
O2, meds: diuretics, vasodilators, ACE & Beta blocker, digoxin
Monitor wt gain & activity level
HF can result from:
Ischemic heart disease, MI 1/3 of all MI patients Chronic HTN 75% of cases Valve disease Third most common cause Cardiomyopathy Myocarditis Rheumatoid arthritis, Lupus erythematosis Substance abuse
pathophysiology of HF
Decreased tissue perfusion from poor cardiac output and pulmonary congestion occurs r/t increased pressure in the pulmonary vessels
two types of left HF
Systolic heart failure
Diastolic Heart Failure
cardiac output is decreased, fluid backs up into the pulmonary system
forward failure
Heart can’t contract forcefully to eject enough blood (decreased ejection fraction to <40%), What can cause this??
Preload increases and afterload increases because of peripheral resistance from compensatory mechanisms
Tissue perfusion diminishes and blood accumulates
Forward failure-
systolic heart failure
Preserved LV function
Left ventricle can’t relax during diastole becomes stiff
Prevents the ventricle from filling with enough blood to maintain the cardiac output
Ejection fraction is >40%, becomes stiffer with time
Usually the result of chronic HTN
diastolic heart failure
Caused by left ventricular failure, right ventricular MI or pulmonary hypertension
RV can not empty, increased volume and pressure develops in the venous system, peripheral edema results
right sided heart failure
AHA Stages of Heart Failure
Class 1 NYHA- high risk for developing heart failure
Class II NYHA- cardiac structural abnormalities or remodeling who have not developed HF symptoms
Class III NYHA- current or prior symptoms of heart failure
Class IV NYHA- refractory end-stage heart failure
describe stimulation of sympathetic NS as a compensatory mechanism
Catecholamines, epinephrine and norepinephrine to increase HR and BP- immediate response
Increasing HR causes a decrease in fill time increase preload
Increased SV increased stretch and Hypertrophy
Arterial vasoconstriction occurs to maintain BP and low C.O. increased afterloadLV overworks and SV may decline
Reduced blood flow to the kidneys causes the RAAS system to activate vasoconstriction and water and sodium retention
Preload and afterload increase
Angiotensin II ventricular remodeling myocyte contractile dysfunction (can’t contract)
RAAS system (compensatory mechanism)
Immune response r/t heart cell injury Cytokines, TNF and interleukins IL-1 and 6, these contribute to ventricular remodeling Natriuretic Peptides (neurohormones) promote vasodilation and diuresis through Na loss in the kidneys BNP B-type natriuretic peptide released by the ventricles when fluid overload, levels raise dramatically ADH (vasopressin) levels and Endothelin levels also rise in response to low fluid output and stretch of myocardial fibers worsening HF
chemical response (compensatory mechanism)
specific questions to ask regarding signs/symptoms of heart failure
FACES: Fatigue Activity intolerance Chest congestion Edema Shortness of breath
visual inspection of assessment
Altered LOC Respiratory distress JVD, how do you measure this?? Cyanosis Peripheral edema Tachypnea with minimal exertion
palpation during assessment
Enlarged, laterally displaced PMI
Thrill may be felt along left sternal border
Palpate abdomen
Ascites
Hepatomegaly
Check for presence of edema in lower extremities
Check peripheral pulses
Check for lower extremity cyanosis
Note ADL’s, can they climb stairs, how far can they walk?
Exertional Dyspnea, Orthopnea and PND (paroxysmal nocturnal dyspnea),
auscultation during assessment
S3, why would they have this? Mitral murmur Holosystolic Heard best at apex Radiating to axilla Cardiac rhythm irregularities A fib / PVC / ventricular tachycardia / v fib Crackles, wheezes, decreased breath sounds Cough may be present Indicative of pulmonary edema
clinical manifestations of left sided failure
Decreased Cardiac Output: Fatigue Weakness Oliguria in day and nocturia at night Angina Confusion Dizziness/tachycardia Weak pulses and cool extremities Pulmonary Congestion: Hacking cough, worse at night Dyspnea/breathlessness/tachypnea Crackles/wheezes Frothy pink sputum S3 and S4 gallop
clinical manifestations in right sided failure
Systemic Congestion JVD Enlarged liver and spleen Anorexia and nausea, why?? Dependent edema Distended abdomen Swollen hands and fingers Polyuria at night Weight gain Increased BP at first from volume, then decreased BP from output
diagnostic testing for HF
ECG, CXR, CBC, UA, serum creatine, albumin, electrolytes
