Test three b Flashcards by Caleigh Justen

Two types of HF based on cause

Primary causes = underlying cardiac props (CAD, cardiomyopahy)

Precipitating causes = anemia, pulmonary disease, hypervolemia

Others: diabetes, tobacco, obesity, lipids, age
NOT GENETICS

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Systolic HF

Pathophysiology: heart has thin walls, so LV can’t pump well

Etiology: impaired contractile function (MI); increased afterload (HTN), cardiomyopathy, or mechanical abnormalities

Diagnosis: decrease in LV EF

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Diastolic HF

Pathophysiology: heart has thick walls, so ventricals can’t relax and fill –> decreases SV and CO –> venous engorgement in pulmonary and systemic systems

Etiology: LV hypertrophy from chronic htn, aortic stenosis, or hypertrophic cardiomyopathy

Diagnosis: presence of HF symptoms with normal EF

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Mixed HF

Pathophysiology: Poor systolic function is further compromised by dilated LV walls that are unable to relax

Etiology: seen in disease states such as dilated cardiomyopathy

Symptoms: Low systemic BP, low CO, and poor renal perfusion

Compensation: Ventricular dilation, ventricular hypertrophy, activation of SNS and RAAS

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Left sided HF

most common
blood backs up into LA and pulmonary veins
pulmonary congestion and edema

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Right sided HF

usually caused by LSHF, but not always
blood backs up into RA and venous circulation
peripheral edema, hepatomegaly, JVD
**cor pulmonale can also cause RSHF

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Manifestations of HF

Fatigue and anemia
edema
skin changes
behavioral changes
angina

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LSHF signs and symptoms

Signs
-LV heaves
-pulsus alternans
-elevated HR
-PMI displaced inferiorly and posteriorly
-crackles
-S3 and S4
-pleural effusion
-mental status changes
-restlessness/confusion
-shallow respirations, dry cough, pink sputum

Symptoms
-dyspnea and orthopnea
-wekaness
-paradoxical nocturnal dyspnea
-nocturia

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RSHF signs and symptoms

Signs
-RV heaves
-murmurs
-JVD
-edema
-weight gain
-elevated HR
-ascites
-anasarca

Symptoms
-fatigue
-anxiety/depression
-anorexia and GI bloating
-nausea
-dependent, bilateral edema
-RUQ pain
-hepatomegaly

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Clinical manifestations of Acute Decompensated Heart Failure

CAD –> LV failure –> Pulmonary edema where alveoli fill with serosanguineous fluid

-anxiety, pallor, cyanosis, cold/clammy skin
-dyspnea, RR over 30, orthopnea
-coughing with blood tinged sputum
-lung crackles, wheezes, rhonchi
-tachycardia, htn, hpotn,

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Etiology of mitral valve stenosis

rheumatic heart disease usually

also:
congenital mitral stenosis
rheumatoid arthritis
systemic lupus erythematosus

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mitral valve regurgitation etiology

MI
rheumatic heart disease
mitral valve prolapse
ischemic papillary muscle dysfunction
infective endocarditis

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aortic valve stenosis etiology

congenital aortic valve stenosis in kids

in older ppl, its bc of rheumatic fever or degeneration

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aortic valve regurgitation etiology

Acute: IE, trauma, aortic dissection

chronic: htn, rheumatic heart disease, congenital bicuspid aortic valve, syphilis, chronic arthritic conditions

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results of mitral and aortic stenoses

mitral
-higher pulmonary vascular pressure due to backup

aortic
-left ventricular hypertrophy and increased myocardial oxygen consumption from increased myocardial mass

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results of mitral and aortic regurgitation

mitral (chronic)
-left atrial enlargement
-LV dilation, hypertrophy, and decreased CO

aortic
-volume overload
-declining myocardial contractility and increased volume in LA/lungs
-pulmonary htn
-RV faliure

Mitral valve stenosis clinical manifestations

dyspnea on exertion
hemoptysis
fatigue
afib
palpitations
loud S1
low diastolic murmur

mitral valve regurgitation manifestation

Acute
-new systolic murmur with rapid dvlpmt of pulmonary edema and cardiogenic shock

Chronic
-weakness
-fatigue
-exertional dyspnea
-palpitations
-S3 gallop
-murmur throughout systole

Aortic valve stenosis manifestations

angina
syncope
dyspnea on exertion
normal or soft S1
diminished or absent S2
systolic murmur
S4

Aortic valve regurgitation manifestation

Acute:
-abrupt onset of dyspnea, chest pain
-LV failure and cardio shock

Chronic
-fatigue
-exertional dyspnea
-orthopnea
-parxysmal nocturnal dyspnea
-water hammer pulse
-heaving precordial impulse
-diminished or absent S1, S3, or S4
-Austin Flint murmur

Drugs for atrial dysrhythmias

ccb
bb
digoxin
antidysrhythmic drugs
electrical cardioversion

Non drug treatment for valve issues

percutaneous transluminal balloon valvuloplasty
-through femoral artery to stenotic valve
-inflate and separate leaflets
-good for old ppl who can’t handle surgery

surgeries for valve issues

mitral commissurotomy (stenosis)
open surgical valvuloplasty (regurgitation)
annuloplasty

what should INR be?

2.5 to 3.5

PAD

progressive narrowing of the arteries from the thickening of arterial walls

PAD risk factors

tobacco!!!!! CKD DM HTN high cholesterol female black high CRP fam history hypertriglyceridemia age hcy boesity sedentary stress

leading cause of PAD

atherosclerosis -in femoral popliteal area (in non diabetics) -below knees in DM

PAD clinical manifestations

intermittent claudication (from muscular anaerobic respiration) Atypical leg symptoms (burning, tightness, weakness) Neuropathy (tingling, numbness, shooting, burning) -loss of bloodflow to neurons reduces pain sensation Skin gets thin, shiny, taught, and hairless - pallor on elevation and vice versa Rest pain often at night due to limb elevation Critical limb ischemia = rest pain for more than 2 weeks, ulcers, gangrene --> more likely if HF, DM, or history of stroke

Complication of peripheral artery disease

atrophy of skin and muscles delayed healing, wound infection, and necrosis -ulcers on bony prominences --> develop gangrene -uncontrolled pain, sepsis, or osteomyelitis indicate amputation need

Diagnostic studies for PAD

Doppler Ultrasound Segmental blood pressure --> PAD if drops more than 30 Ankle brachial index -> divide ankle SBP by higher brachial SBP --> PAD is under 0.9 -->old ppl and those w/ DM have false high ABI Angiography: contrast and fluroscopy Angiography and magnetic resonance angiography determine location and extent of PAD

Risk factor modification for PAD

Stop tobacco use Manage DM (keep HbA1C below 7%) Manage Lipids (statins) Manage HTN (below 140/90 if normal ppl; below 130/80 if DM or kidney issues) --> ACE inhibitors

Drug therapy for PAD

ANTIPLATLET AGENTS -aspirin or clopidogrel NO ANTICOAGULANTS Cilostazol (don't use if HF) and Pentoxifylline for claudication

Priority when giving anticoagulation meds

draw baseline labs first do bleeding time test --> will increase once meds taken --> platelets won't decrease

Exercise therapy for PAD

super important- esp for women -30-45 mins at least 3x a week for 3 months

Interventional radiology catheter based procedures for PAD

PTA --> balloon pumps up narrowed vessel Stents --> placed after balloon pump Atherectomy --> can use disk or laser Cryoplasty --> PTA with coldness to limit restonosis

Surgeries for PAD

Peripheral artery bypass surgery Femoral popliteal bypass endarterectomy and patch graft angioplasty amputation

Post op for PAD surgeries

check extremity every 15 mins and then hourly for color, temp, cap refill, peripheral pulses, sensation, and movemnt bleeding, hematoma, thrombosis, emolization, compartment syndrome ABI not recommended bc could cause thrombosis

Nursing interventions for PAD

Pain management --> may be aggressive Positioning --> get them walking; not too much time with dependent leg Supportive care --> graduated compression stockings Infection prevention