heart failure - powerpoint Flashcards by Christina Fiorelli

heart failure is the inadequate/ insufficient __________/__________ of the heart, and ________ _________/___________ to the tissue.

pumping/ filling; blood supply/ oxygenation

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what are the 2 primary risk factors of developing heart failure?

1.!!Cardiovascular Disease (CAD)!!
(MOST COMMON CAUSE)

2.Hypertension

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what are 7 risk factors of developing heart failure?

advanced age
diabetes
tobacco use
high cholesterol
obesity
CAD
HTN

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anything that interferes with the regulation of ______ ________ or increases the workload of the ventricles can cause someone to go into heart failure.

cardiac output

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what is the only cure for heart failure?

a transplant

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how can a arrhythmia like A-fib contribute to heart failure and be a result from heart failure if left untreated?

contribute - the heart isn’t pumping correctly so there is increased strain on the heart

resulting from - from structural changes and reduced EF

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Which type of HF will have a decreased EF due to the squeezing “ejecting” phase dysfunctioning but the filling/ resting phase is still in tact?

Systolic

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Which type of HF will have a preserved/ normal EF due to the filling phase dysfunctioning but the squeezing “ejecting” phase is still in tact?

Diastolic

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what are the characteristics of MIXED heart failure? (systolic and diastolic)

-seen w/ dilated cardiomyopathy
-EF will be <35%
-pulmonary pressures will be high
-biventricular failure (both ventricles will have poor filling and emptying)

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describe Dilated Cardiomyopathy.

this is where the hearts main pumping chamber, usually the left ventricle, becomes enlarged (dilated) and the walls thin and weaken - structurally changing the heart and leading to poor EF and pump function

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In heart failure will your blood pressure be high or low?

low

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In heart failure will the kidneys be getting enough perfusion?

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Activation of the sympathetic nervous system is the first compensatory mechanism to activate -
1. ___________ + __________ are released
2. __________ heart rate
3. __________ myocardial contractility
4. peripheral ______________

this mechanism is initially helpful but then becomes ________

1.epinephrine + norepinephrine (catecholamines)
2. increased
3. increased
4. vasoconstriction
5. harmful

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when a patient is in decompensated HF what 2 +inotropes can we give them?

digoxin and dopamine - these drugs will help improve cardiac output and perfusion

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the second compensatory mechanism includes neurohormonal responses:
1. the kidney’s release ______ to initiate the RAAS system
2. the posterior pituitary gland releases _______
3. __________ is released by vascular endothelial cells
4. proinflammatory _________ are released

renin - conserve sodium + water + vasoconstrict
ADH - retain water and vasoconstrict
endothelin
cytokines -

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The third step in compensation is __________ ___________.
1. __________ of the ventricles
2. the ventricles are larger BUT don’t pump as __________
3. 2 fatal results of this compensatory mechanism: _________________ + ______________.

ventricular remodeling

hypertrophy
effectively
dysrhythmias + sudden cardiac death

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Another compensatory mechanism is _________, this is where the chambers enlarge due to the elevated pressure in the ventricle. This is initially effective but eventually CO decreases

dilation

_________ is a compensatory mechanism to increase muscle mass and cardiac wall thickness. How does this help compensate HF?

hypertrophy

-increased mass + thickness helps improve force and sustain the added force

hypertrophy is initially effective in compensating, but what can it lead to over time?

-poor contractility
-increased O2 demand
-poor coronary artery circulation
-rx. of ventricular arrythmias

Natriuretic Peptides are a _______________ ______________ of heart failure where ANP and BNP are released as a result of the increased blood volume in the heart. They cause diuresis, vasodilation and lowered BP

counteracting the SNS + RAAS

counter regulatory

(atrial natriuretic peptides and
b-type natriuretic peptides)

BNP should be <100 - >400 = decompensated HF

______ _______ is another counterregulatory mechanism that is released by the vascular endothelium in response to the endothelin to counteract the extreme vasoconstriction

Nitric Oxide (NO)

** a potent vasodilator**

The left side of the heart is SUPPOSED to be pumping blood into arterial circulation with oxygenated blood it receives from the lungs. When the left side of the heart fails, where does blood back up into?

blood backs up into the lungs

Left - Lungs

what are the S/S of LEFT sided heart failure?

DROWNING

D- difficulty breathing
R- rales/ crackles (lung sounds)
O-orthopnea
W- weakness
N- nocturnal paroxysmal dyspnea
I- increased heart rate (due to fluid overload)
N- nagging cough
G- gaining weight (fluid overload)

how can improve a patient experiencing orthopnea, which is where they can’t breath lying in a supine position, especially sleeping?

put them in semi/ high fowlers position and dangle their feet (on the ground) to decrease venous blood return

Nocturnal Paroxysmal Dyspnea can present as sudden "I can't breath" attacks, needing multiple pillows stacked to sleep or needing to sleep upwards in a chair. this is known as a ________ _______ of worsening heart failure

warning sign

Another early warning sign of worsening heart failure is a nagging, productive cough. What will the sputum look like? **this is very BAD**

foamy/ frothy + blood tinged

What are 3 important things to keep in mind when performing daily weights on a patient with heart failure?

-same time of day (morning is best) -use same scale -they shouldn't be gaining more than 2-3 pounds in a day OR more than 5 in a week

The right side of the heart is SUPPOSED to be getting deoxygenated blood from the venous system to give back to the lungs to get reoxygenated. Right sided HF is usually caused by left sided HF. WHY?

fluid pressure is increased and backing up from the left into the right - this is causing the right side to be overworked

what are the S/S of right sided heart failure? **SWELLING**

S- swelling in legs, feet + abdomen W- weight gain E- edema (pitting) - especially in the lower extremities L- large neck vein (JVD) L- lethargic (tired + weak) I- irregular HR + rhythm (increased rx. of A-FIB) N-nausea - due to liver + GI congestion G- girth (swelling of liver + spleen + fluid buildup) **trouble breathing** (ascites)

____ ___________ is a form of right sided heart failure that is caused by lung disorders like COPD, lung disease or recurrent PE's rather than cardiac issues. **right ventricular failure secondary to pulmonary causes**

Cor Pulmonale

Cor Pulmonale includes persistent hypoxia and pulmonary vascular remodeling, these are causing pulmonary HTN, WHICH is forcing the ________ _________ to work harder to pump blood through the lungs.

right ventricle

what does ADHF look like in later stages?

-interstitial edema -->> sob, coughing, difficulty breathing -tachypnea

in further, progressive stages of ADHF, we will see worsening conditions like ____________ ___________ that leads to ___________ __________.

alveolar edema respiratory acidemia

ADHF is most commonly associated with which side of heart failure?

left sided heart failure

If a patient gets a thoracentesis procedure done for pulmonary edema what are 2 complications following this procedure, we need to look out for?

PE and hemothorax

A Pleurevac system is used to manage fluid or air accumulation in the pleural space, this system includes the chest tube and the whole ________ system.

drainage

which acid base imbalance is a ADHF patient at risk of developing?

resp. acidosis

These are S/S of what conditions associated with decompensated heart failure? -anxious, pale, cyanotic -cool, clammy skin -dyspnea -orthopnea -tachypnea -use of accessory muscles -cough w/ frothy, blood-tinged sputum -crackles, wheezes, Ronchi -tachycardia -hypo. or hypertension

pulmonary edema

what are 3 signs that indicate LATE pulmonary edema and need to be addressed urgently?

1. cyanosis 2. use of accessory muscles 3. bloody sputum

A patient in cardiogenic shock due to pulmonary edema: what will their BP and HR look like initially?

low BP and high HR **but then HR will decline**

what are 2 things we want to do for a patient in ADHF?

-!! give O2!! -Iv Lasix **make sure to monitor kidney function (I/O's) and potassium levels

In Flash Pulmonary Edema, there is rapid accumulation of fluid in the _________. Oxygen exchange is severely compromised, acute resp. distress and LOW oxygen levels occur.

alveoli - **this is a life-threatening situation** -oxygen therapy -diuretics -antihypertensives may be needed -mechanical ventilation may be needed