Heart Failure Chapter 32 Flashcards
(381 cards)
1
Q
What is acute pericarditis?
A
An inflammation or alteration of the pericardium, the membranous sac that encloses the heart; may be fibrous, serous, hemorrhagic, purulent, or neoplastic.
Acute pericarditis can lead to chest pain and other symptoms related to heart function.
2
Q
Define afterload in the context of cardiac physiology.
A
The pressure or resistance that the ventricles must overcome to eject blood through the semilunar valves and into the peripheral blood vessels; directly related to blood pressure and blood vessel diameter.
Afterload impacts the workload of the heart and can influence cardiac output.
3
Q
What is aortic regurgitation?
A
The flow of blood from the aorta back into the left ventricle during diastole; occurs when the valve leaflets do not close properly during diastole and the annulus is dilated or deformed.
Aortic regurgitation can lead to volume overload of the left ventricle.
4
Q
What is aortic stenosis?
A
Narrowing of the aortic valve orifice and obstruction of left ventricular outflow during systole.
Aortic stenosis can cause symptoms such as chest pain, syncope, and heart failure.
5
Q
What does B-type natriuretic peptide (BNP) indicate?
A
A peptide produced and released by the ventricles when the patient has fluid overload as a result of heart failure.
BNP levels are often used as a diagnostic marker for heart failure.
6
Q
What is cardiac resynchronization therapy (CRT)?
A
The use of a permanent pacemaker alone or in combination with an implantable cardioverter-defibrillator (ICD) to provide biventricular pacing in patients with some types of heart failure.
CRT aims to improve the coordination of heart contractions and enhance cardiac output.
7
Q
What is cardiac tamponade?
A
Compression of the myocardium by fluid that has accumulated around the heart, preventing adequate filling of the atria and ventricles and reducing cardiac output.
Cardiac tamponade can lead to severe hemodynamic compromise.
8
Q
Define cardiomegaly.
A
Enlargement of the heart.
Cardiomegaly can be a sign of various underlying health conditions.
9
Q
What is cardiomyopathy?
A
A subacute or chronic disease of cardiac muscle; classified into four categories: dilated, hypertrophic, restrictive, and arrhythmogenic.
Each category has distinct structural and functional abnormalities.
10
Q
What is diastolic heart failure?
A
Heart failure that occurs when the left ventricle is unable to relax adequately during diastole, preventing proper filling with blood.
This results in inadequate cardiac output despite normal systolic function.
11
Q
What characterizes dilated cardiomyopathy?
A
Inability of the heart to pump effectively due to enlargement (dilation) and weakening of the ventricles.
It is often associated with decreased ejection fraction.
12
Q
What is ejection fraction?
A
Percentage of blood ejected from the left ventricle with each contraction.
It is a key measure of heart function.
13
Q
Define exertional dyspnea.
A
Breathlessness or difficulty breathing that develops during activity or exertion.
It is commonly seen in patients with heart failure.
14
Q
What is heart failure?
A
A general term for the inadequacy of the heart to pump blood throughout the body, causing insufficient perfusion of body tissues with vital nutrients and oxygen.
Heart failure can be classified into systolic and diastolic types.
15
Q
What does hemodynamic monitoring involve?
A
Continuous monitoring of the movement of blood and pressures within the veins, arteries, and chambers of the heart.
Invasive hemodynamic monitoring uses a specialized catheter for detailed measurements.
16
Q
What is high output heart failure?
A
Failure of the heart due to high peripheral demand with a cardiac output that is higher than normal.
It is often seen in conditions like hyperthyroidism.
17
Q
What is hypertrophic cardiomyopathy?
A
Inability of the heart to pump blood effectively due to thickening (hypertrophy) of the heart muscle.
It can lead to arrhythmias and sudden cardiac death.
18
Q
Define infective endocarditis.
A
A microbial infection involving the endocardium, which can be caused by viruses, bacteria, or fungi.
It often affects individuals with pre-existing heart conditions.
19
Q
What is mitral regurgitation?
A
Inability of the mitral valve to close completely during systole, allowing backflow of blood into the left atrium.
This can lead to volume overload of the left atrium and heart failure.
20
Q
What is mitral stenosis?
A
Thickening of the mitral valve due to fibrosis and calcification, narrowing the valve opening.
This condition impairs normal blood flow from the left atrium to the left ventricle.
21
Q
What characterizes mitral valve prolapse?
A
Dysfunction of the mitral valve where the valvular leaflets enlarge and prolapse into the left atrium during systole.
It may lead to regurgitation and other complications.
22
Q
Define myocardial hypertrophy.
A
Enlargement of the cardiac muscle.
It can occur in response to increased workload or stress on the heart.
23
Q
What is orthopnea?
A
Shortness of breath that occurs when lying down but is relieved by sitting up.
Orthopnea is often associated with heart conditions and can indicate heart failure.
24
Q
Define paradoxical pulse.
A
An exaggerated decrease in systolic blood pressure by more than 10 mm Hg during the inspiratory phase of the respiratory cycle.
Normal decrease is 3 to 10 mm Hg; indicative of cardiac tamponade, constrictive pericarditis, and pulmonary hypertension.
25
What is paroxysmal nocturnal dyspnea?
Shortness of breath that develops after lying down for several hours, causing the patient to awaken abruptly with a feeling of suffocation and panic.
## Footnote
Commonly seen in patients with heart disease.
26
What does pericardial effusion refer to?
Accumulation of fluid in the pericardial space.
## Footnote
This condition can lead to cardiac tamponade if the fluid accumulation is significant.
27
What is pericardiocentesis?
Withdrawal of pericardial fluid through a catheter inserted into the pericardial space to relieve pressure on the heart.
## Footnote
This procedure is often performed in cases of pericardial effusion.
28
Define petechiae.
Pinpoint, red or purple spots on the mucous membranes, palate, conjunctivae, or skin caused by bleeding within the dermal or submucosal layers.
## Footnote
Petechiae can be a sign of various medical conditions, including thrombocytopenia.
29
What is pulsus alternans?
A type of pulse in which a weak pulse alternates with a strong pulse despite a regular heart rhythm.
## Footnote
This is typically seen in patients with severely depressed cardiac function.
30
What is restrictive cardiomyopathy?
Inability of the heart to pump effectively due to restrictive filling of the ventricles.
## Footnote
This condition can result from various factors including infiltrative diseases.
31
What characterizes right-sided heart (ventricular) failure?
The inability of the right ventricle to empty completely, resulting in increased volume and pressure in the systemic veins and systemic venous congestion with peripheral edema.
## Footnote
Symptoms may include swelling in the legs and abdomen.
32
What is an S3 gallop?
The third heart sound; an early diastolic filling sound that indicates an increase in left ventricular pressure.
## Footnote
It may be heard on auscultation in patients with heart failure.
33
Define splinter hemorrhage.
Black, longitudinal line or small red streak on the distal third of the nail bed.
## Footnote
This finding is seen in patients with infective endocarditis.
34
What is systolic heart failure?
Heart failure that results when the heart is unable to contract forcefully enough during systole to eject adequate amounts of blood into circulation.
## Footnote
This condition is often associated with reduced ejection fraction.
35
What is a ventricular assist device (VAD)?
Mechanical pump that is surgically inserted with an external power source that supports the function of the ventricles and heart.
## Footnote
VADs are used in patients with severe heart failure.
36
37
What is systolic heart failure?
Systolic heart failure (heart failure with reduced ejection fraction [HFrEF]) occurs when the heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation.
## Footnote
Systolic heart failure is characterized by reduced cardiac output and increased risk of sudden cardiac death.
38
What happens to preload in systolic heart failure?
Preload increases with decreased contractility.
## Footnote
An increase in preload can be a compensatory mechanism due to the heart's inability to pump effectively.
39
What causes an increase in afterload in systolic heart failure?
Afterload increases as a result of increased peripheral resistance, such as hypertension.
## Footnote
Increased afterload makes it more difficult for the heart to eject blood.
40
What is the normal range for ejection fraction?
The normal ejection fraction is between 50% to 70%.
## Footnote
Ejection fraction is a key measurement in assessing heart function.
41
What ejection fraction percentage indicates systolic heart failure?
An ejection fraction below 40% indicates systolic heart failure.
## Footnote
A very low ejection fraction is associated with increased risk of complications.
42
What are the consequences of a decreased ejection fraction?
Consequences include diminished tissue perfusion and accumulation of blood in the pulmonary vessels.
## Footnote
This can lead to symptoms such as shortness of breath and fatigue.
43
What are common manifestations of systolic dysfunction?
Common manifestations include symptoms of inadequate tissue perfusion or pulmonary and systemic congestion.
## Footnote
Patients may experience symptoms like dyspnea or edema.
44
Why is systolic heart failure referred to as forward failure?
It is referred to as forward failure because cardiac output is decreased and fluid backs up into the pulmonary system.
## Footnote
This term highlights the failure of the heart to effectively pump blood forward.
45
At what ejection fraction percentage are patients considered candidates for an ICD?
Patients with an ejection fraction of less than 30% are considered candidates for an implantable cardioverter/defibrillator (ICD).
## Footnote
This intervention is crucial for preventing sudden cardiac death.
46
What is diastolic heart failure also known as?
Heart failure with preserved left ventricular function (HFpEF)
## Footnote
HFpEF is characterized by the heart's inability to relax properly during diastole.
47
What occurs during diastolic heart failure?
The left ventricle cannot relax adequately during diastole
## Footnote
This inadequate relaxation leads to insufficient ventricular filling.
48
What is the consequence of inadequate relaxation in diastolic heart failure?
Prevents the ventricle from filling with sufficient blood to ensure adequate cardiac output
## Footnote
This results in a lower blood volume being pumped by the heart.
49
What is the ejection fraction in diastolic heart failure?
More than 40%
## Footnote
Despite a preserved ejection fraction, the heart's function is compromised.
50
What happens to the ventricle's compliance over time in diastolic heart failure?
The ventricle becomes less compliant
## Footnote
More pressure is required to move the same volume of blood compared to a healthy heart.
51
What percentage of all heart failure cases does diastolic failure represent?
About 20% to 40%
## Footnote
Diastolic failure is more prevalent in certain populations.
52
Which populations are primarily affected by diastolic heart failure?
Older adults and women with chronic hypertension and undetected coronary artery disease
## Footnote
These factors contribute to the risk of developing diastolic heart failure.
53
How do the signs and symptoms of diastolic heart failure compare to systolic dysfunction?
They are similar
## Footnote
Management strategies may also overlap between the two types of heart failure.
54
What may cause right-sided heart (ventricular) failure?
Left ventricular failure, right ventricular myocardial infarction (MI), pulmonary hypertension
## Footnote
Right-sided heart failure can be a consequence of left-sided issues or direct damage to the right ventricle.
55
What happens in right-sided heart failure?
The right ventricle cannot empty completely, leading to increased volume and pressure in the venous system, resulting in peripheral edema
## Footnote
Peripheral edema is the swelling caused by fluid accumulation in tissues.
56
What distinguishes high-output heart failure from other types?
Cardiac output remains normal or above normal
## Footnote
This contrasts with left- and right-sided heart failure, which are typically associated with low cardiac output.
57
What are common causes of high-output heart failure?
Increased metabolic needs or hyperkinetic conditions, such as:
* Septicemia
* High fever
* Anemia
* Hyperthyroidism
## Footnote
These conditions lead to the heart needing to pump more blood to meet the body's demands.
58
Is high-output heart failure common?
No, it is not as common as other types of heart failure
## Footnote
High-output heart failure is less frequently encountered in clinical practice compared to low-output heart failures.
59
What happens when cardiac output is insufficient to meet the demands of the body?
Compensatory mechanisms work to improve output
## Footnote
These mechanisms may initially increase cardiac output but can eventually damage pump function.
60
Name the major compensatory mechanisms in heart failure.
* Sympathetic nervous system stimulation
* Renin-angiotensin system (RAS) activation
* Other chemical responses
* Myocardial hypertrophy
## Footnote
RAS is also known as renin-angiotensin-aldosterone (RAAS) activation.
61
What does stimulation of the sympathetic nervous system during heart failure result in?
Increased catecholamines
## Footnote
This occurs as a result of tissue hypoxia.
62
What are the effects of adrenergic receptor stimulation in heart failure?
* Increase in heart rate (beta adrenergic)
* Increase in blood pressure from vasoconstriction (alpha adrenergic)
## Footnote
These effects contribute to compensatory mechanisms.
63
How is cardiac output (CO) calculated?
CO = heart rate (HR) x stroke volume (SV)
## Footnote
An increase in HR leads to an immediate increase in CO.
64
What limitation exists regarding heart rate (HR) as a compensatory mechanism for decreased CO?
If HR becomes too rapid, diastolic filling time is limited
## Footnote
This can lead to a decline in CO.
65
What effect does an increase in heart rate have on the myocardium?
Significantly increases oxygen demand
## Footnote
If the heart is poorly perfused, heart failure may worsen.
66
True or False: Myocardial hypertrophy is one of the compensatory mechanisms in heart failure.
True
## Footnote
It is one of the major compensatory mechanisms listed.
67
Fill in the blank: The renin-angiotensin system is also known as _______.
renin-angiotensin-aldosterone (RAAS) activation
## Footnote
This activation is crucial in regulating blood pressure and fluid balance.
68
What is stroke volume (SV)?
The amount of blood pumped by the heart in one contraction
## Footnote
Stroke volume is improved by sympathetic stimulation.
69
How does sympathetic stimulation affect venous return?
It increases venous return to the heart
## Footnote
This causes further stretching of myocardial fibers leading to dilation.
70
What does Starling’s law state?
Increased myocardial stretch results in more forceful contraction
## Footnote
This law explains the relationship between myocardial stretch and contraction strength.
71
What happens to stroke volume (SV) and cardiac output (CO) with more forceful contractions?
They increase
## Footnote
However, after a critical point, further volume and stretch can reduce force of contraction.
72
What is afterload?
The resistance against which the heart must pump
## Footnote
Afterload is a major determinant of myocardial oxygen requirements.
73
What effect does arterial vasoconstriction have?
It maintains blood pressure and improves tissue perfusion in low-output states
## Footnote
However, it increases afterload.
74
What occurs when there is reduced blood flow to the kidneys in low-output states?
Activation of the renin-angiotensin system (RAS)
## Footnote
This leads to pronounced vasoconstriction and sodium/water retention.
75
What is the role of angiotensin II?
It contributes to ventricular remodeling and increases preload and afterload
## Footnote
This can lead to myocardial cell contractile dysfunction over time.
76
What happens in heart failure (HF) related to immune response?
Heart muscle cell injury causes an immune response
## Footnote
Proinflammatory cytokines are released, contributing to ventricular remodeling.
77
What are natriuretic peptides?
Neurohormones that promote vasodilation and diuresis through sodium loss
## Footnote
B-type natriuretic peptide (BNP) is released by ventricles in response to fluid overload.
78
What causes an increase in BNP levels?
Fluid overload from heart failure
## Footnote
BNP levels also increase with age and are generally higher in healthy women than men.
79
What causes decreased cerebral perfusion?
Low cardiac output (CO)
## Footnote
Decreased cerebral perfusion can lead to various neurological deficits.
80
What hormone does the posterior pituitary gland secrete in response to low cardiac output?
Vasopressin (antidiuretic hormone [ADH])
## Footnote
ADH plays a crucial role in regulating water balance in the body.
81
What are the effects of vasopressin on the body?
Causes vasoconstriction and fluid retention
## Footnote
These effects can worsen heart failure (HF).
82
What is secreted by endothelial cells when they are stretched?
Endothelin
## Footnote
Endothelin is a potent vasoconstrictor that increases peripheral resistance.
83
How does endothelin affect heart failure patients?
Increases peripheral resistance and hypertension
## Footnote
This worsens heart failure through increased workload on the heart.
84
What is myocardial hypertrophy?
Enlargement of the myocardium
## Footnote
This can occur with or without chamber dilation.
85
What compensatory mechanism occurs in response to low cardiac output?
Myocardial hypertrophy
## Footnote
The heart thickens its walls to increase muscle mass and forceful contractions.
86
What can result from rapid hypertrophy of cardiac muscle?
Oxygen deprivation
## Footnote
Hypertrophied hearts may not receive adequate blood supply from collateral circulation.
87
What happens when the demand for oxygen increases and myocardial reserve is exhausted?
Signs and symptoms of heart failure develop
## Footnote
This indicates the heart's inability to meet metabolic needs.
88
Fill in the blank: The secretion of vasopressin leads to _______ and fluid retention.
Vasoconstriction
89
What is the most common cause of heart failure (HF)?
Systemic hypertension
## Footnote
Systemic hypertension is a condition where the blood pressure in the arteries is persistently elevated, leading to increased workload on the heart.
90
Besides systemic hypertension, what other condition can lead to heart failure?
Myocardial infarction (MI)
## Footnote
Myocardial infarction, commonly known as a heart attack, occurs when blood flow to a part of the heart is blocked, causing damage to the heart muscle.
91
What are structural heart changes that can cause heart failure?
Valvular dysfunction, particularly pulmonic or aortic stenosis
## Footnote
Valvular dysfunction refers to the improper functioning of the heart valves, which can lead to pressure or volume overload on the heart.
92
List some common direct causes and risk factors for heart failure.
Fluid retention, sodium retention, pulmonary problems
## Footnote
Common causes of heart failure include factors that lead to fluid overload and conditions affecting the lungs.
93
What age group is heart failure particularly common in?
Older adults
## Footnote
The prevalence of heart failure increases with age, making it a significant health concern for the elderly.
94
What impact do NSAIDs have on heart failure in older adults?
Can cause fluid and sodium retention
## Footnote
Non-steroidal anti-inflammatory drugs (NSAIDs) are often used for pain management but can exacerbate heart failure symptoms.
95
How can NSAIDs affect diuretics and ACE inhibitors?
Increase toxicity
## Footnote
The combination of NSAIDs with diuretics or ACE inhibitors may lead to increased side effects or reduced effectiveness.
96
What medications are known to cause fluid and sodium retention?
Thiazolidinediones (TZDs)
## Footnote
TZDs, such as pioglitazone, are used to treat diabetes and can have adverse effects on heart failure patients.
97
What usually causes right-sided heart failure in the absence of left-sided heart failure?
Pulmonary problems such as COPD or pulmonary hypertension
## Footnote
Right-sided heart failure can result from conditions that increase pressure in the pulmonary circulation.
98
What acute condition may lead to right-sided heart failure?
Acute respiratory distress syndrome (ARDS)
## Footnote
ARDS is a severe lung condition that can lead to respiratory failure and has implications for heart function.
99
What is diminished in left ventricular systolic dysfunction?
Cardiac output (CO)
## Footnote
This leads to impaired tissue perfusion, anaerobic metabolism, and unusual fatigue.
100
What should you assess to evaluate activity tolerance in patients with heart failure (HF)?
Ability to perform normal ADLs or climb flights of stairs without fatigue or dyspnea
## Footnote
ADLs refers to activities of daily living.
101
What symptoms may patients with heart failure experience during activity?
Weakness or fatigue, feeling of heaviness in arms or legs
## Footnote
Patients may limit activities unconsciously in response to fatigue or dyspnea.
102
What is a common report from patients with left ventricular failure regarding chest symptoms?
Chest pain, palpitations, skipped beats, or a fast heartbeat
103
What occurs as the amount of blood ejected from the left ventricle diminishes?
Hydrostatic pressure builds in the pulmonary venous system
## Footnote
This leads to fluid-filled alveoli and pulmonary congestion.
104
How do patients in early heart failure typically describe their cough?
Irritating, nocturnal, and usually nonproductive
105
What does expectorating frothy, pink-tinged sputum indicate?
Life-threatening pulmonary edema
106
What causes dyspnea in heart failure patients?
Increasing pulmonary venous pressure and pulmonary congestion
107
What is exertional dyspnea also known as?
Dyspnea upon or on exertion (DUE/DOE)
108
What is orthopnea?
Dyspnea at rest in the recumbent position
109
What should you ask to assess orthopnea in patients?
How many pillows are used to sleep or if they sleep in an upright position
110
What is paroxysmal nocturnal dyspnea (PND)?
Sudden awakening with breathlessness 2 to 5 hours after falling asleep
111
What usually relieves paroxysmal nocturnal dyspnea?
Sitting upright, dangling the feet, or walking
112
What occurs as the right ventricle fails?
Signs of systemic congestion
## Footnote
This includes fluid retention and increased pressure in the venous system.
113
What is a common physical manifestation of fluid retention in patients?
Edema in the lower legs, thighs, and abdominal wall
## Footnote
Patients may experience tighter fitting shoes and indentations from socks.
114
How much fluid may an adult retain before pitting edema occurs?
4 to 7 L (10 to 15 lb [4.5 to 6.8 kg])
## Footnote
This fluid retention is indicative of systemic congestion.
115
What symptoms may result from liver engorgement due to fluid retention?
Nausea and anorexia
## Footnote
These symptoms are commonly reported in patients with heart failure.
116
What advanced condition may develop from severe liver congestion in heart failure?
Ascites and increased abdominal girth
## Footnote
These are signs of advanced heart failure and severe fluid retention.
117
What is diuresis at rest?
Mobilization and excretion of fluid in peripheral tissue
## Footnote
Patients may report frequent awakening at night to urinate.
118
What type of history should be obtained from patients with heart failure?
A careful nutritional history
## Footnote
This includes questions about salt usage and types of food consumed.
119
What daily fluid intake may patients with heart failure experience due to sodium retention?
4000 to 5000 mL/day
## Footnote
Increased thirst leads to excessive fluid consumption.
120
What is right ventricular failure associated with?
Systemic congestion
## Footnote
Includes symptoms like jugular distention and enlarged liver and spleen.
121
List three symptoms of right ventricular failure.
* Jugular (neck vein) distention
* Enlarged liver and spleen
* Anorexia and nausea
122
What is a common symptom of right ventricular failure related to fluid retention?
Dependent edema (legs and sacrum)
## Footnote
This is due to fluid accumulation in the lower extremities.
123
What weight change might occur in a patient with right ventricular failure?
Weight gain
## Footnote
Often due to fluid overload.
124
What is a key feature of left-sided heart failure?
Decreased cardiac output and elevated pulmonary venous pressure
## Footnote
This leads to various clinical manifestations.
125
List four clinical manifestations of left-sided heart failure.
* Weakness
* Fatigue
* Dizziness
* Acute confusion
126
What symptom indicates pulmonary congestion in left-sided heart failure?
Breathlessness
## Footnote
This occurs due to fluid accumulation in the lungs.
127
What is oliguria?
Scant urine output
## Footnote
Commonly seen in left-sided heart failure.
128
What may occur when a patient with left-sided heart failure is at rest?
Nocturia
## Footnote
Increased urination at night due to fluid redistribution.
129
What heart rhythm irregularity might be noted in heart failure?
Tachycardia or pulsus alternans
## Footnote
Pulsus alternans refers to alternating strong and weak heartbeats.
130
What types of irregular heart rhythms are common in heart failure?
* Premature atrial contractions (PACs)
* Premature ventricular contractions (PVCs)
* Atrial fibrillation (AF)
131
What should be noted when taking the apical pulse in heart failure patients?
Any irregularity in heart rhythm
## Footnote
Important for assessing cardiac function.
132
True or False: Increased blood pressure is always present in right ventricular failure.
False
## Footnote
Blood pressure may be increased from excess volume or decreased from heart failure.
133
What is commonly observed with increased heart size?
Displacement of the apical impulse to the left
## Footnote
Increased heart size can indicate underlying heart conditions such as heart failure.
134
What does the third heart sound, S3 gallop, indicate?
An increase in left ventricular pressure
## Footnote
S3 gallop is often the first sign of heart failure (HF).
135
What is a fourth heart sound (S4) a reflection of?
Decreased ventricular compliance
## Footnote
S4 is not a sign of heart failure but indicates stiffening of the ventricles.
136
What lung sounds should be auscultated for signs of heart failure?
Crackles and wheezes
## Footnote
These sounds can indicate fluid in the lungs or narrowing of the bronchial lumen.
137
What do late inspiratory crackles indicate?
Heart failure
## Footnote
These crackles are produced by intra-alveolar fluid and are often noted first in the bases of the lungs.
138
Where are crackles generally first noted in the lungs?
In the bases of the lungs
## Footnote
As heart failure worsens, crackles can spread upward.
139
What do wheezes indicate in the lungs?
Narrowing of the bronchial lumen
## Footnote
This is often caused by engorged pulmonary vessels.
140
What should be identified when auscultating for wheezes?
The precise location of wheezes and whether they are heard on inspiration, expiration, or both
## Footnote
This information can help determine the severity and nature of the lung condition.
141
What is right ventricular failure associated with?
Increased systemic venous pressures and congestion
## Footnote
Right ventricular failure can lead to various signs, including neck vein distention and abdominal issues.
142
What should be assessed in patients with right ventricular failure?
Neck veins for distention and abdominal girth
## Footnote
Additional assessments include hepatomegaly, hepatojugular reflux, and ascites.
143
What is hepatomegaly?
Liver engorgement
## Footnote
It is a condition often assessed in patients with right ventricular failure.
144
What can abdominal fluid accumulation lead to?
Pressure on the stomach and intestines, resulting in early satiety and malnutrition
## Footnote
Abdominal fluid can reach volumes of more than 10 L.
145
Where does dependent edema commonly present in ambulatory patients?
Ankles and legs
## Footnote
In patients on bedrest, edema may accumulate in the sacrum.
146
Why is edema considered an unreliable sign of heart failure?
Because it can vary greatly and may not accurately reflect fluid status
## Footnote
Accurate daily weights are essential for monitoring fluid retention.
147
What is the most reliable indicator of fluid gain and loss?
Weight
## Footnote
Weighing at the same time each morning using the same scale is crucial.
148
Fill in the blank: Edema is an extremely unreliable sign of _______.
HF
## Footnote
HF stands for heart failure.
149
What should be measured to document fluid retention accurately?
Daily weights
## Footnote
Consistency in measuring conditions is vital for accurate assessment.
150
What is the significance of assessing abdominal girth in right ventricular failure?
It helps evaluate fluid accumulation in the abdomen
## Footnote
This can indicate worsening heart failure.
151
What may cause electrolyte imbalance in patients with heart failure (HF)?
Complications of HF or side effects of drug therapy, especially diuretic therapy.
## Footnote
Regular evaluations of serum electrolytes are essential for monitoring.
152
Which serum electrolytes are essential to evaluate in patients with heart failure?
* Sodium
* Potassium
* Magnesium
* Calcium
* Chloride
## Footnote
Regular evaluations are crucial for patient management.
153
What does impairment of renal function indicate in heart failure patients?
Elevated blood urea nitrogen and serum creatinine, and decreased creatinine clearance levels.
## Footnote
This can result from inadequate perfusion.
154
What tests should be performed to identify heart failure resulting from anemia?
Hemoglobin and hematocrit tests.
## Footnote
Low hematocrit levels may occur due to fluid volume excess and hemodilution.
155
What is B-type natriuretic peptide (BNP) used for in patients with acute dyspnea?
Diagnosing heart failure, particularly diastolic HF.
## Footnote
BNP elevation indicates decreased cardiac output from ventricular dysfunction.
156
What does an absence of elevation in BNP indicate?
Rules out heart failure as the cause of acute dyspnea and points to primary lung dysfunction.
## Footnote
This finding should be considered alongside history and physical examination.
157
What may urinalysis reveal in patients with heart failure?
* Proteinuria
* High specific gravity
## Footnote
These findings can indicate kidney function and fluid balance issues.
158
What is microalbuminuria an early indicator of?
Decreased compliance of the heart.
## Footnote
It occurs before BNP rises and serves as an early warning signal.
159
What thyroid levels should be assessed in older adults with heart failure?
* Thyroxine (T4)
* Thyroid-stimulating hormone (TSH)
## Footnote
Hypothyroidism or hyperthyroidism can aggravate heart failure.
160
What do arterial blood gas (ABG) values often reveal in heart failure patients?
Hypoxemia due to impaired oxygen diffusion.
## Footnote
Respiratory alkalosis and acidosis may also occur.
161
What imaging assessment is helpful in diagnosing left ventricular failure?
Chest x-rays showing cardiomegaly.
## Footnote
Enlarged heart indicates hypertrophy or dilation.
162
What is considered the best tool for diagnosing heart failure?
Echocardiography.
## Footnote
It can diagnose cardiac valvular changes and measure ejection fraction.
163
What do multigated acquisition (MUGA) scans provide information about?
Left ventricular ejection fraction and velocity.
## Footnote
These are typically low in patients with heart failure.
164
What does an electrocardiogram (ECG) show in heart failure patients?
* Ventricular hypertrophy
* Dysrhythmias
* Myocardial ischemia, injury, or infarction
## Footnote
It is not useful for determining the presence or extent of heart failure.
165
What does invasive hemodynamic monitoring assess in acutely ill patients?
Cardiac function and volume status.
## Footnote
Important hemodynamic pressures confirm diagnosis and guide management.
166
What are the priority collaborative problems for patients with heart failure?
* Decreased gas exchange due to ventilation/perfusion imbalance
* Potential for decreased perfusion due to inadequate cardiac output
* Potential for pulmonary edema due to left-sided HF
## Footnote
These problems are critical to address in patient care.
167
What is the primary reliance of nonsurgical management in heart failure?
A variety of drugs
## Footnote
Includes drugs that improve stroke volume, reduce afterload, reduce preload, and improve cardiac muscle contractility.
168
What is a major role of the nurse in drug therapy for heart failure?
Administer medications as prescribed and monitor for therapeutic and adverse effects
## Footnote
Additionally, teaching the patient and family about drug therapy is crucial.
169
How do arterial vasodilators improve cardiac output?
By relaxing the arterioles and reducing afterload
## Footnote
This decreases resistance to left ventricular ejection.
170
What are the primary drugs used to reduce afterload in heart failure?
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs)
## Footnote
Examples include enalapril, captopril, valsartan, irbesartan, and losartan.
171
What is the drug of choice in the treatment of heart failure?
Angiotensin-converting enzyme (ACE) inhibitors
## Footnote
Due to significant clinical experience with this drug class.
172
What adverse effect is commonly associated with ACE inhibitors?
Hypotension
## Footnote
Volume-depleted patients should start on a low dose.
173
What is the role of angiotensin receptor neprilysin inhibitor (ARNI) in heart failure treatment?
It reduces death and hospitalization in patients with chronic heart failure
## Footnote
The combination drug sacubitril/valsartan is an example.
174
Fill in the blank: Both ACE inhibitors and ARBs work more effectively for ______ than for African-American populations.
Euro-Americans
175
What should be monitored when prescribing ACE inhibitors or ARBs?
Blood pressure, hyperkalemia, and renal dysfunction
## Footnote
Monitor for hypotension especially in patients with low initial systolic BP.
176
What is the primary nutrition therapy goal in heart failure management?
Reducing sodium and water retention
## Footnote
This decreases the workload of the heart.
177
What is the recommended sodium intake for heart failure patients?
About 3 g daily
## Footnote
May be further reduced to 2 g daily if necessary.
178
What class of drugs is used to reduce preload in heart failure?
Diuretics and venous vasodilators
## Footnote
Morphine sulfate may also be used in acute heart failure.
179
What type of diuretics are most effective for treating fluid volume overload in heart failure?
Loop diuretics
## Footnote
Examples include furosemide, torsemide, and bumetanide.
180
True or False: Thiazide diuretics are commonly prescribed for older adults with mild volume overload.
True
181
What is a common sign of hypokalemia from diuretic therapy?
Generalized weakness
## Footnote
Other signs include depressed reflexes and irregular heart rate.
182
What should be monitored in patients receiving both ACE inhibitors or ARBs and diuretics?
Serum potassium and creatinine levels
## Footnote
To prevent hyperkalemia and renal failure.
183
Fill in the blank: The first dose of ACE inhibitors or ARBs may cause a rapid drop in ______.
Blood pressure
184
What is the relationship between weight change and fluid retention in heart failure?
1 kg of weight gain or loss equals 1 L of retained or lost fluid
## Footnote
Daily weighing is important for monitoring fluid status.
185
What is the recommended action if a patient experiences a systolic blood pressure of less than 90 mm Hg after starting ACE inhibitors?
Place the patient flat and elevate legs
## Footnote
This helps increase cerebral perfusion and promote venous return.
186
What class of drugs may be prescribed for a patient with HF who has persistent dyspnea?
Venous vasodilators (e.g., nitrates)
## Footnote
Nitrates help alleviate symptoms of heart failure by affecting venous and arterial blood flow.
187
What compensatory mechanism occurs due to reduced cardiac output (CO) in heart failure?
Significant constriction of venous and arterial blood vessels
## Footnote
This constriction is a physiological response to maintain blood pressure and perfusion.
188
What are the benefits of venous vasodilators in heart failure?
* Returning venous vasculature to a more normal capacity
* Decreasing the volume of blood returning to the heart
* Improving left ventricular function
## Footnote
These benefits contribute to symptom relief in heart failure patients.
189
How can nitrates be administered?
IV, orally, or topically
## Footnote
IV nitrates are often used for acute heart failure situations.
190
What should be monitored when starting nitrate therapy or increasing the dosage?
The patient’s blood pressure
## Footnote
Monitoring is crucial to avoid hypotension and other adverse effects.
191
What common side effect may patients report when starting nitrate therapy?
Headache
## Footnote
Tolerance typically develops, reducing the severity of this side effect over time.
192
What is a recommended strategy to prevent tolerance to nitrates?
At least one 12-hour nitrate-free period out of every 24 hours
## Footnote
This is usually done overnight to maintain efficacy.
193
What type of drug therapy can enhance contractility of the heart?
Positive inotropic drugs
## Footnote
These drugs are often used alongside vasodilators and beta-adrenergic blockers.
194
What is the most commonly used beta blocker for chronic heart failure?
Low-dose beta blockers
## Footnote
These help manage heart failure symptoms effectively.
195
What is digoxin and what is its role in heart failure?
A cardiac glycoside that provides symptomatic benefits for patients with chronic heart failure
## Footnote
Digoxin can improve symptoms and reduce hospitalizations.
196
What are some potential benefits of digoxin?
* Increased contractility
* Reduced heart rate (HR)
* Slowing of conduction through the atrioventricular node
* Inhibition of sympathetic activity while enhancing parasympathetic activity
## Footnote
These effects contribute to improved heart function and symptom relief.
197
How is digoxin absorbed and what factors can interfere with its absorption?
Absorbed from the GI tract erratically; many drugs, especially antacids, interfere with its absorption
## Footnote
This irregular absorption can complicate dosing and efficacy.
198
How is digoxin primarily eliminated from the body?
Renal excretion
## Footnote
Renal function is crucial in determining appropriate dosing.
199
What patient populations should be maintained on lower doses of digoxin?
* Older patients
* Those with impaired renal function
* Those with low lean body mass
## Footnote
These groups are at higher risk for digoxin toxicity.
200
True or False: Digoxin is considered a first-line agent for treating heart failure.
False
## Footnote
Digoxin is considered a second-line agent due to potential toxicity.
201
What type of drugs are used for short-term treatment of acute heart failure?
Beta-adrenergic agonists, such as dobutamine
## Footnote
Dobutamine improves cardiac contractility and thus cardiac output and myocardial-systemic perfusion.
202
What is milrinone and its function in treating acute heart failure?
A vasodilator/inotropic agent with phosphodiesterase activity that increases cAMP to enhance calcium entry into myocardial cells
## Footnote
Milrinone is given IV and is more potent than beta-adrenergic agonists.
203
What effect do beta-adrenergic blockers have on heart failure patients?
Improve morbidity, mortality, and quality of life
## Footnote
They reverse the negative effects of sympathetic stimulation and catecholamines.
204
Which beta blockers are approved for the treatment of heart failure?
Carvedilol, extended-release metoprolol succinate, bisoprolol
## Footnote
Do not confuse metoprolol tartrate with metoprolol succinate.
205
What is a key monitoring concern when starting beta blockers for heart failure?
Monitor for bradycardia or hypotension after the first dose
## Footnote
The first dose is extremely low.
206
What should patients be instructed to do daily when taking beta blockers?
Weigh daily and report any signs of worsening heart failure
## Footnote
The primary health care provider gradually increases the drug dose if HF worsens.
207
What are aldosterone antagonists and their role in heart failure treatment?
Potassium-sparing diuretics like spironolactone or eplerenone that reduce symptoms associated with HF
## Footnote
They block aldosterone's effects, decreasing water and sodium retention.
208
What should be monitored in patients taking aldosterone antagonists?
Hyperkalemia and renal failure
## Footnote
The medication may need to be stopped if potassium or creatinine levels rise.
209
What is ivabradine and its purpose in heart failure treatment?
An HCN channel blocker that slows heart rate and reduces hospitalization rates
## Footnote
Approved for symptomatic stabilized chronic heart failure with specific criteria.
210
What are the side effects of ivabradine?
Bradycardia, hypertension, atrial fibrillation, luminous phenomena
## Footnote
Patients should take it with meals and monitor their heart rate.
211
What nonsurgical options are available for heart failure treatment?
Continuous positive airway pressure (CPAP), cardiac resynchronization therapy (CRT), CardioMEMS implantable monitoring system, investigative gene therapy
## Footnote
These options may complement drug therapy.
212
How does CPAP benefit heart failure patients?
Improves cardiac output and ejection fraction by decreasing afterload and preload
## Footnote
It also addresses obstructive sleep apnea, which is correlated with coronary artery disease.
213
What is cardiac resynchronization therapy (CRT)?
A treatment using a permanent pacemaker to improve ventricular contractions
## Footnote
It is indicated for patients with Class III or IV HF and improves EF and CO.
214
What does the CardioMEMS device do?
Allows daily reading of pulmonary artery pressure and transmits data for medication management
## Footnote
It helps detect increases in pulmonary pressures before symptoms appear.
215
What is the purpose of gene therapy in heart failure?
To replace damaged genes with normal or modified genes in end-stage HF patients
## Footnote
It may improve exercise tolerance and cardiac cell regrowth.
216
Fill in the blank: The resting heart rate (HR) should remain between ______ and ______.
55 and 60
217
True or False: Beta blockers should be stopped abruptly in heart failure patients.
False
## Footnote
Stopping them abruptly can increase the risk of clinical decompensation.
218
What is a common therapeutic effect observed with beta blockers in heart failure patients?
Improved ejection fraction, decreased hospital admissions, and symptom improvement
## Footnote
These benefits are seen over a long period.
219
What are common symptoms of pulmonary edema?
* Crackles
* Dyspnea at rest
* Disorientation or acute confusion
* Tachycardia
* Hypertension or hypotension
* Reduced urinary output
* Cough with frothy, pink-tinged sputum
* Premature ventricular contractions and other dysrhythmias
* Anxiety
* Restlessness
* Lethargy
## Footnote
Disorientation or acute confusion is especially noted in older adults as an early symptom.
220
What medication is administered if the patient's systolic blood pressure is above 100?
Sublingual nitroglycerin (NTG) every 5 minutes for three doses
## Footnote
This is to decrease afterload and preload while establishing IV access for additional drug therapy.
221
How should furosemide be administered to avoid ototoxicity?
IV push (IVP) over 1 to 2 minutes
## Footnote
Bumetanide may also be administered IVP over 1 to 2 minutes or as a continuous infusion.
222
What vital signs should be monitored frequently in patients with pulmonary edema?
Vital signs should be monitored at least every 30 to 60 minutes
## Footnote
This is crucial while administering medications such as IV morphine sulfate or IV NTG.
223
What is the purpose of administering IV morphine sulfate in pulmonary edema?
To reduce venous return (preload), decrease anxiety, and reduce the work of breathing
## Footnote
Respiratory rate and blood pressure should be monitored closely during administration.
224
What may be used in severe cases of fluid overload and renal dysfunction?
Ultrafiltration
## Footnote
This procedure also has specific nursing implications to consider.
225
What are the benefits of ultrafiltration?
* Decrease in cardiac filling pressures
* Decrease in pulmonary arterial pressure
* Increase in cardiac index
* Reduction in norepinephrine, renin, and aldosterone
## Footnote
These benefits help improve cardiac function in patients with heart failure.
226
What is a critical aspect of care coordination for patients with heart failure?
Preparing patients adequately for discharge and ensuring community support for self-management
## Footnote
This is vital to reduce the risk of repeated hospital admissions.
227
What two interventions have been shown to reduce readmission rates for heart failure patients?
* Early and intensive nursing care
* At least one visit on the day of discharge and at least three nursing visits in the first week
## Footnote
These interventions help ensure proper follow-up and management.
228
True or False: Patients with heart failure are at low risk for readmission after discharge.
False
## Footnote
There is a high risk of readmission even after acute issues are resolved.
229
What are signs of heart failure related to vital signs?
• Heart rate >100 beats/min at rest
• New atrial fibrillation
• Blood pressure <90 or >150 systolic
## Footnote
These vital sign changes indicate potential heart failure exacerbation.
230
What are indications of poor tissue perfusion in heart failure?
• Fatigue
• Angina
• Activity intolerance
• Changes in mental status
• Pallor or cyanosis
• Cool extremities
## Footnote
These symptoms suggest inadequate blood flow and oxygen to tissues.
231
What are the signs of congestion in heart failure?
• Presence of cough or dyspnea
• Weight gain
• Jugular venous distention
• Peripheral edema
## Footnote
Congestion indicates fluid build-up, often in lungs or extremities.
232
What functional abilities should be assessed in a patient with heart failure?
• Performance of ADLs
• Mobility and ambulation
• Cognitive ability
## Footnote
Assessing these abilities helps determine the impact of heart failure on daily life.
233
What nutritional aspects should be assessed in heart failure patients?
• Food and fluid intake
• Intake of sodium-rich foods
• Alcohol consumption
• Skin turgor
## Footnote
Nutritional status is crucial for managing heart failure.
234
What home environment factors should be assessed for heart failure patients?
• Safety hazards related to oxygen therapy
• Structural barriers affecting functional ability
• Social support
## Footnote
A safe home environment can significantly affect patient outcomes.
235
What should be assessed regarding a patient's adherence and understanding of their illness?
• Signs and symptoms to report
• Dosages and effects of medications
• Reporting for laboratory and health care visits
• Ability to weigh self
• Presence of advance directive
• Use of home oxygen
## Footnote
Understanding treatment and adherence is key to managing heart failure.
236
What are the components of the MAWDS health teaching for heart failure self-management?
• Medications
• Activity
• Weight
• Diet
• Symptoms
## Footnote
MAWDS is an acronym used to remember important self-management strategies.
237
What medication-related advice is given to heart failure patients?
• Take medications as prescribed
• Know the purpose and side effects of each drug
• Avoid NSAIDs
## Footnote
Proper medication management is crucial to prevent complications.
238
What activity guidelines are recommended for heart failure patients?
• Stay as active as possible
• Know your limits
• Be able to converse while exercising
## Footnote
Activity must be balanced to avoid overexertion.
239
Fill in the blank: Heart failure patients should weigh each day at the same time on the same _______.
[scale]
240
What dietary recommendations are made for heart failure patients?
• Limit daily sodium intake to 2 to 3 g
• Limit daily fluid intake to 2 L
## Footnote
These dietary restrictions help manage fluid retention.
241
What should heart failure patients do regarding new or worsening symptoms?
Notify the health care provider immediately
## Footnote
Prompt reporting can prevent serious complications.
242
What should patients and caregivers report to the primary health care provider?
Any symptoms indicating worsening or recurrent heart failure
## Footnote
Symptoms include rapid weight gain, decreased exercise tolerance, prolonged cold symptoms, excessive nighttime urination, dyspnea or angina at rest, and increased swelling.
243
What is considered a rapid weight gain that should be reported?
3 lb in a week or 1 to 2 lb overnight
## Footnote
Rapid weight gain can indicate fluid retention, a common issue in heart failure.
244
How long should a decrease in exercise tolerance last before reporting?
2 to 3 days
## Footnote
A significant and persistent decrease in exercise tolerance may signal heart failure exacerbation.
245
What duration of cold symptoms should prompt a report to the healthcare provider?
More than 3 to 5 days
## Footnote
Prolonged cold symptoms may complicate heart failure management.
246
What symptom related to urination should be reported?
Excessive awakening at night to urinate
## Footnote
This may indicate fluid overload or worsening heart failure.
247
What should be reported if dyspnea or angina develops?
Dyspnea or angina at rest or worsening angina
## Footnote
These symptoms indicate a potential worsening of heart failure.
248
What increased swelling should be reported?
Increased swelling in the feet, ankles, or hands
## Footnote
This can indicate fluid retention related to heart failure.
249
What are the acquired valvular dysfunctions?
Mitral stenosis, mitral regurgitation, mitral valve prolapse, aortic stenosis, aortic regurgitation
## Footnote
The tricuspid valve is less commonly affected, though dysfunction can occur after endocarditis in IV drug misuse.
250
What is the most common cause of mitral stenosis?
Rheumatic fever
## Footnote
Mitral stenosis usually results from rheumatic carditis causing valve thickening.
251
What changes occur to the mitral valve in mitral stenosis?
Valve leaflets fuse, become stiff, and chordae tendineae contract and shorten
## Footnote
These changes narrow the valve opening, preventing normal blood flow.
252
What are the consequences of mitral stenosis on heart pressure?
Left atrial pressure rises, left atrium dilates, pulmonary artery pressures increase, right ventricle hypertrophies
## Footnote
This leads to pulmonary congestion and right-sided heart failure.
253
What are the initial symptoms of mitral stenosis?
Dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, palpitations, dry cough
## Footnote
Hemoptysis and pulmonary edema may occur as the condition progresses.
254
What physical examination finding is noted in mitral stenosis?
A rumbling, apical diastolic murmur
## Footnote
Changes to heart rhythm, such as atrial fibrillation, require immediate notification to a healthcare provider.
255
What is the primary cause of mitral regurgitation?
Mitral valve prolapse, rheumatic heart disease, infective endocarditis, myocardial infarction, connective tissue diseases
## Footnote
Secondary causes include ischemic and nonischemic heart disease.
256
How does mitral regurgitation affect blood flow during systole?
Allows backflow of blood into the left atrium
## Footnote
Incomplete closure of the valve occurs during systole.
257
What symptoms occur when the left ventricle fails in mitral regurgitation?
Fatigue, chronic weakness, dyspnea on exertion, orthopnea
## Footnote
Patients may also report anxiety, atypical chest pains, and palpitations.
258
What is a significant auscultation finding in mitral regurgitation?
A high-pitched systolic murmur at the apex with radiation to the left axilla
## Footnote
Severe regurgitation may exhibit a third heart sound (S3).
259
What late signs indicate right-sided heart failure in mitral regurgitation?
Distended neck veins, hepatomegaly, pitting edema
## Footnote
These signs develop as the condition progresses.
260
True or False: Patients with mild mitral stenosis are usually symptomatic.
False
## Footnote
They are typically asymptomatic until the condition progresses.
261
Fill in the blank: Mitral stenosis usually results from _____ carditis.
rheumatic
## Footnote
This condition leads to thickening of the valve.
262
What is mitral valve prolapse (MVP)?
A condition where the valvular leaflets enlarge and prolapse into the left atrium during systole
## Footnote
MVP is usually benign but may progress to pronounced mitral regurgitation in some patients.
263
What are some conditions associated with mitral valve prolapse?
* Marfan syndrome
* Other congenital cardiac defects
* Familial tendency
## Footnote
Usually, no other cardiac abnormality is found.
264
What symptoms may patients with mitral valve prolapse report?
* Chest pain
* Palpitations
* Exercise intolerance
* Dizziness
* Syncope
## Footnote
Chest pain is usually atypical, described as sharp pain localized to the left side of the chest.
265
What physical examination findings are associated with mitral valve prolapse?
* Normal heart rate
* Normal blood pressure
* Midsystolic click
* Late systolic murmur at the apex of the heart
## Footnote
The intensity of the murmur is not related to the severity of the prolapse.
266
What is aortic stenosis?
The narrowing of the aortic valve orifice, obstructing left ventricular outflow during systole
## Footnote
It is the most common cardiac valve dysfunction in the United States.
267
What are the consequences of aortic stenosis?
* Increased resistance to ejection
* Ventricular hypertrophy
* Fixed cardiac output
* Left ventricular failure
* Pulmonary congestion
* Right-sided heart failure
## Footnote
Symptoms develop as stenosis worsens.
268
What are the classic symptoms of aortic stenosis?
* Dyspnea
* Angina
* Syncope on exertion
* Marked fatigue
* Debilitation
* Peripheral cyanosis
## Footnote
A narrow pulse pressure is noted when BP is measured.
269
What type of murmur is associated with aortic stenosis?
A diamond-shaped, systolic crescendo-decrescendo murmur
## Footnote
This is usually noted on auscultation.
270
What is aortic regurgitation (insufficiency)?
A condition where aortic valve leaflets do not close properly during diastole, allowing blood flow from the aorta back into the left ventricle
## Footnote
The annulus may be dilated, loose, or deformed.
271
What are the common causes of aortic regurgitation?
* Infective endocarditis
* Congenital aortic valvular abnormalities
* Hypertension
* Marfan syndrome
## Footnote
Aortic insufficiency usually results from nonrheumatic conditions.
272
What symptoms may develop as aortic regurgitation progresses?
* Exertional dyspnea
* Orthopnea
* Paroxysmal nocturnal dyspnea
* Palpitations
* Nocturnal angina with diaphoresis
## Footnote
Patients may remain asymptomatic for many years due to compensatory mechanisms.
273
What is a characteristic finding on palpation in aortic regurgitation?
A 'bounding' arterial pulse
## Footnote
The pulse pressure is usually widened, with elevated systolic pressure and diminished diastolic pressure.
274
What is the classic auscultatory finding in aortic regurgitation?
A high-pitched, blowing, decrescendo diastolic murmur
## Footnote
This is a key indicator of aortic regurgitation.
275
What is echocardiography?
The noninvasive diagnostic procedure of choice to visualize the structure and movement of the heart.
276
What are the two types of echocardiography mentioned?
* Transesophageal echocardiography (TEE)
* Transthoracic echocardiography (TTE)
277
What is the purpose of exercise tolerance testing (ETT) and stress echocardiography?
To evaluate symptomatic response and assess functional capacity.
278
When might cardiac catheterization be indicated?
To assess the severity of mitral or aortic stenosis and its other effects on the heart.
279
What findings might a chest x-ray show in patients with mitral stenosis?
* Left atrial enlargement
* Prominent pulmonary arteries
* Enlarged right ventricle
280
What does a chest x-ray reveal in mitral regurgitation?
An increased cardiac shadow, indicating left ventricular and left atrial enlargement.
281
What changes may be seen on a chest x-ray in the later stages of aortic stenosis?
* Left ventricular enlargement
* Pulmonary congestion
282
What findings appear on the chest x-ray of patients with aortic regurgitation?
* Left atrial dilation
* Left ventricular dilation
283
What is a common ECG finding in patients with mitral stenosis?
Atrial fibrillation.
284
In which conditions may atrial fibrillation develop?
* Mitral stenosis
* Mitral regurgitation
* Aortic stenosis (due to left atrial dilation)
285
Why are nitrates administered cautiously to patients with aortic stenosis?
Due to the potential for syncope associated with a reduction in left ventricular volume (preload)
## Footnote
Nitrates can decrease preload, which may lead to inadequate cardiac output in these patients.
286
What vasodilators may be used to reduce regurgitant flow in patients with aortic or mitral stenosis?
Calcium channel blockers
## Footnote
These medications help alleviate symptoms by reducing the volume of backflow through the valves.
287
What is the importance of prophylactic antibiotic therapy for patients with valve disease?
It is crucial before any invasive dental or oral procedure
## Footnote
This is especially important for patients with a history of endocarditis and those who have received cardiac transplants or valve replacements.
288
Are prophylactic antibiotics recommended before GI procedures?
No
## Footnote
Prophylactic antibiotics are not recommended before procedures such as upper GI endoscopy or colonoscopy.
289
What is a major concern in valvular heart disease if atrial fibrillation develops?
Maintaining cardiac output (CO)
## Footnote
Atrial fibrillation can lead to decreased CO and heart failure due to ineffective atrial contraction.
290
What does a controlled ventricular response (HR < 100) indicate?
It indicates that heart rate is being managed effectively
## Footnote
This is a goal in managing patients with atrial fibrillation and valvular heart disease.
291
What may be prescribed to slow ventricular rate in patients with atrial fibrillation?
Low-dose amiodarone
## Footnote
Other options may include procainamide hydrochloride and beta-blocking agents.
292
What is the role of anticoagulation therapy in valvular heart disease with atrial fibrillation?
To prevent thrombus formation
## Footnote
Thrombi can form in the atria or on defective valve segments, leading to systemic emboli.
293
What is balloon valvuloplasty used for?
To treat stenotic mitral and aortic valves
## Footnote
It is an invasive nonsurgical procedure that may improve valve function and cardiac output.
294
What is the typical patient profile for aortic valvuloplasty?
Usually older patients at high risk for surgical complications
## Footnote
This procedure offers temporary benefits and is often a bridge to valve replacement.
295
What is transcatheter aortic valve replacement (TAVR)?
An alternate treatment for aortic stenosis for patients who are not surgical candidates
## Footnote
It involves placing a bioprosthetic valve percutaneously over the damaged valve.
296
What is the post-procedure care for patients after TAVR?
Patients remain on bedrest for 6 hours and are monitored overnight for complications
## Footnote
Lifelong antiplatelet therapy with aspirin and clopidogrel is also required for the first 6 months.
297
What is one of the risks associated with atrial fibrillation in patients with mitral valvular disease?
Stasis of blood and thrombi in the left atrium
## Footnote
This can lead to an increased risk of stroke if a thrombus travels to the brain.
298
Fill in the blank: The primary care provider usually starts drug therapy first to control the heart rate and maintain _______.
Cardiac output (CO)
## Footnote
This is crucial for managing patients with valvular heart disease and atrial fibrillation.
299
True or False: Synchronized countershock (cardioversion) may be attempted if atrial fibrillation is rapid and unresponsive to medical treatment.
True
## Footnote
This is a potential intervention for managing rapid atrial fibrillation.
300
What is a common consequence of ineffective atrial contraction in patients with atrial fibrillation?
Decreased cardiac output and heart failure
## Footnote
Atrial contraction is essential for left ventricular filling.
301
What is direct (open) commissurotomy?
A procedure accomplished with cardiopulmonary bypass during open-heart surgery, involving visualization of the valve, removal of thrombi, incision of fused commissures, and débridement of calcium.
302
What is the primary procedure for acquired mitral insufficiency?
Mitral valve annuloplasty (reconstruction).
303
What does annuloplasty involve?
Making the annulus smaller by suturing leaflets to an annuloplasty ring or taking tucks in the annulus.
304
How are elongated and shortened leaflets addressed in mitral valve repair?
* Elongated leaflets may be shortened.
* Shortened leaflets may be repaired by lengthening the chordae.
305
What is the outcome of annuloplasty and leaflet repair?
An annulus of appropriate size and leaflets that can close completely, eliminating or markedly reducing regurgitation.
306
What types of valves can be used for aortic valve replacement?
Only prosthetic valves for symptomatic adults with aortic stenosis and aortic insufficiency.
307
What are the types of biologic valve replacements?
* Xenograft (from other species)
* Porcine valve (from a pig)
* Bovine valve (from a cow).
308
What is a disadvantage of xenografts?
They are not as durable as prosthetic valves and usually need replacement every 7 to 10 years.
309
What factors affect the durability of xenografts?
The age of the recipient and the presence of calcium in the blood.
310
What must patients have before valve replacement surgery?
A preoperative dental examination.
311
What should patients on oral anticoagulants do before surgery?
Stop taking them at least 72 hours before the procedure.
312
What are the nursing priorities for patients with mitral stenosis during ventilator weaning?
Monitor respiratory status closely.
313
What is a critical safety priority for patients with aortic valve replacements?
Be alert for bleeding due to a higher risk for postoperative hemorrhage.
314
What is the importance of monitoring cardiac output after valve replacement?
Patients are more likely to have significant reductions in CO, especially those with aortic stenosis or left ventricular failure.
315
What is required for patients with mechanical valves after surgery?
Lifelong anticoagulant therapy with warfarin.
316
What is the therapeutic goal for INR in patients with mechanical heart valves?
3.0 to 4.0.
317
True or False: Direct oral anticoagulants (DOACs) are recommended for patients with valve replacements.
False.
318
What should patients with valvular heart disease be educated about?
* The disease process and HF risk
* Drug therapy
* Prophylactic use of antibiotics
* Activity and rest plan.
319
What precautions should patients with defective or repaired valves take to prevent infective endocarditis?
Inform all health care providers of their history and require antibiotic administration before invasive dental procedures.
320
What should patients avoid if they have prosthetic valves?
Invasive dental procedures for 6 months and procedures using magnetic resonance unless the latest technology is available.
321
What should patients do to manage their anticoagulant therapy?
Learn to manage drug therapy, including nutritional considerations and prevention of bleeding.
322
What are common emotional responses after valve surgery?
Altered self-image and adjustment to the audible clicking sound of the prosthetic valve.
323
What is a common complication patients with valvular heart disease may face post-surgery?
Fatigue.
324
Fill in the blank: Patients with valvular heart disease may require help with _______ if they live alone or are older.
ADLs.
325
What is infective endocarditis?
A microbial infection of the endocardium caused by organisms like viruses, bacteria, and fungi
## Footnote
The most common infective organisms are Streptococcus viridans and Staphylococcus aureus.
326
What are the primary risk factors for infective endocarditis?
Risk factors include:
* Injection drug use (IDU)
* Valve replacements
* Systemic alterations in immunity
* Structural cardiac defects
## Footnote
The incidence is rising in conjunction with the opioid epidemic.
327
What is a vegetative lesion in infective endocarditis?
A growth formed by platelets and fibrin adhering to denuded endocardium due to bacteria trapped during bacteremia.
328
What complications can arise from infective endocarditis?
Complications include:
* Valvular insufficiency
* Embolization
* Heart failure
* Neurologic changes
## Footnote
Emboli can travel to organs like the spleen, kidneys, and brain.
329
What are key features of infective endocarditis?
Key features include:
* Fever with chills and night sweats
* Anorexia and weight loss
* Cardiac murmur
* Evidence of systemic embolization
* Petechiae
* Splinter hemorrhages
* Osler nodes
* Janeway lesions
* Roth spots
* Positive blood cultures
330
What is the most common complication of infective endocarditis?
Heart failure (HF)
## Footnote
Assess for signs of both right-sided and left-sided HF.
331
What is acute pericarditis?
Inflammation or alteration of the pericardium that can be fibrous, serous, hemorrhagic, purulent, or neoplastic.
332
What are common causes of acute pericarditis?
Common causes include:
* Infective organisms
* Post-myocardial infarction syndrome
* Postpericardiotomy syndrome
* Systemic connective tissue disease exacerbations
333
What are the signs and symptoms of acute pericarditis?
Signs and symptoms include:
* Substernal precordial pain
* Grating and oppressive pain
* Pain aggravated by breathing, coughing, and swallowing
* Pericardial friction rub
* Elevated white blood cell count
* Fever
334
What diagnostic criteria are proposed for acute pericarditis?
Diagnostic criteria include:
* Pericardial chest pain
* Presence of pericardial rub
* New ST elevation in ECG leads
* New or worsening pericardial effusion
335
What is chronic constrictive pericarditis?
A condition where chronic pericardial inflammation causes fibrous thickening, preventing adequate ventricular filling.
336
What are signs of chronic constrictive pericarditis?
Signs include:
* Right-sided heart failure
* Elevated systemic venous pressure
* Jugular distention
* Dependent edema
* Exertional fatigue and dyspnea
337
What is cardiac tamponade?
A condition where fluid accumulates in the pericardial space, leading to decreased cardiac output.
338
What are findings of cardiac tamponade?
Findings include:
* Jugular venous distention
* Paradoxical pulse
* Tachycardia
* Muffled heart sounds
* Hypotension
339
What is the initial management for acute cardiac tamponade?
Management may include increased fluid volume administration and echocardiogram or x-ray for diagnosis.
340
What is the purpose of a pericardiocentesis?
To remove fluid from the pericardial space to relieve pressure on the heart.
341
What is rheumatic carditis?
A sensitivity response that develops after an upper respiratory tract infection with group A beta-hemolytic Streptococci.
342
What is the purpose of a window procedure in relation to pericardial fluid?
To remove a portion of the pericardium to permit excessive pericardial fluid to drain into the pleural space
343
What is rheumatic carditis also called?
Rheumatic endocarditis
344
What is the primary cause of rheumatic carditis?
Sensitivity response after an upper respiratory tract infection with group A beta-hemolytic Streptococci
345
What are Aschoff bodies?
Small nodules in the myocardium that are replaced by scar tissue
346
What are common signs and symptoms of rheumatic carditis?
* Tachycardia
* Cardiomegaly
* New or changed murmur
* Pericardial friction rub
* Precordial pain
* Electrocardiogram changes
* Indications of heart failure
* Evidence of streptococcal infection
347
What antibiotic is the drug of choice for treating rheumatic fever?
Penicillin
348
What is cardiomyopathy?
A subacute or chronic disease of cardiac muscle
349
List the four categories of cardiomyopathy.
* Dilated cardiomyopathy
* Hypertrophic cardiomyopathy
* Restrictive cardiomyopathy
* Arrhythmogenic right ventricular cardiomyopathy
350
What is the most common structural abnormality in cardiomyopathy?
Dilated cardiomyopathy (DCM)
351
What are the cardinal features of hypertrophic cardiomyopathy (HCM)?
* Asymmetric ventricular hypertrophy
* Disarray of myocardial fibers
352
What is a common symptom of HCM?
Exertional dyspnea
353
What is the prognosis for restrictive cardiomyopathy?
Poor
354
True or False: Arrhythmogenic right ventricular cardiomyopathy primarily affects the left ventricle.
False
355
What are the primary symptoms of dilated cardiomyopathy?
* Dyspnea on exertion
* Decreased exercise capacity
* Fatigue
* Palpitations
356
What type of surgery is commonly performed for obstructive HCM?
Ventricular septal myectomy
357
What is the recommended management for patients with obstructive HCM?
* Beta-adrenergic blocking agents
* Calcium antagonists
* Avoid strenuous exercise
* Avoid excess alcohol intake
358
Fill in the blank: The type of cardiomyopathy characterized by stiff ventricles is called _______.
Restrictive cardiomyopathy
359
What are the consequences of prolonged P-R interval in ECG changes?
Indications of heart failure
360
What is the role of genetic counseling for patients with HCM?
To screen first-degree relatives for the presence of HCM
361
What are the non-surgical management strategies for cardiomyopathy?
* Diuretics
* Vasodilating agents
* Cardiac glycosides
362
What is the primary treatment for arrhythmogenic right ventricular cardiomyopathy if drug therapy fails?
Radiofrequency catheter ablation or placement of an implantable defibrillator
363
What should patients with cardiomyopathy report to their healthcare provider?
Any palpitations, dizziness, or fainting
364
What is a significant risk factor for sudden death in patients with HCM?
High incidence of ventricular dysrhythmias
365
What is the alternative antibiotic for penicillin-sensitive patients with rheumatic fever?
Erythromycin
366
What is heart transplantation?
Surgical replacement with a donor heart for severe DCM or other end-stage heart diseases
## Footnote
Includes coronary artery disease, valvular disease, or congenital heart disease.
367
What are the criteria for candidate selection for heart transplantation?
* Life expectancy less than 1 year
* Age generally younger than 65 years
* NYHA Class III or IV
* Normal or slightly increased pulmonary vascular resistance
* Absence of active infection
* Stable psychosocial status
* No evidence of current drug or alcohol misuse
368
What is the most common technique used in heart transplantation?
Bicaval technique, preserving the intact right atrium of the donor heart
## Footnote
Anastomoses are made at the recipient's superior and inferior venae cavae.
369
What is a key characteristic of the transplanted heart?
Denervated and unresponsive to vagal stimulation
## Footnote
This affects postoperative management and heart rate support.
370
Which medications are not used after heart transplantation due to the heart's denervation?
* Atropine
* Digoxin
* Carotid sinus pressure
371
What are the signs and symptoms of heart transplant rejection?
* Shortness of breath
* Fatigue
* Fluid gain
* Abdominal bloating
* New bradycardia
* Hypotension
* Atrial fibrillation
* Decreased activity tolerance
* Decreased ejection fraction (late sign)
372
What is the median survival rate for adults following cardiac transplantation?
11 years and rising
## Footnote
Source: Pham, 2018.
373
What is cardiac allograft vasculopathy (CAV)?
A form of coronary artery disease presenting as diffuse plaque in the donor heart's arteries
## Footnote
Involves immunologic and nonimmunologic processes.
374
What are recommended lifestyle changes for patients to delay the development of CAV?
* Strict adherence to nutritional modifications
* Drug regimens
* Regular exercise program
375
What is the role of exercise tolerance tests in heart transplant patients?
To identify cardiac allograft vasculopathy (CAV)
## Footnote
Regularly scheduled tests and angiography are required.
376
What type of collaborative approach is involved in discharge planning for heart transplant patients?
Interdisciplinary approach for extensive health teaching and community support
## Footnote
Includes counseling and support groups for coping with organ rejection fears.
377
What is the purpose of immunosuppressants in heart transplant recipients?
To suppress natural defense mechanisms and prevent transplant rejection
## Footnote
Patients require a combination of these for life.
378
True or False: Patients with a heart transplant usually experience angina.
False
## Footnote
The heart is denervated, which affects pain perception.
379
Fill in the blank: The transplanted heart is disconnected from the body's _______.
[autonomic nervous system]
380
What is a common postoperative complication that nurses must monitor for in heart transplant patients?
Occult bleeding into the pericardial sac with potential for tamponade
## Footnote
The pericardium may have stretched due to the diseased heart.
381
What should be performed frequently after heart transplantation according to agency protocol?
Comprehensive cardiovascular and respiratory assessments
## Footnote
Critical for early detection of complications.
