Week 5 Heart failure and dysrhythmias

Question 1

What are the classic signs of Heart failure?

Answer 1

1. Edema
2. Pulmonary edema (auscultate lungs for crackles)
3. SOB
4. Crackles

Question 2

What the 2 risk factors for HF?

Answer 2

1. CAD
2. HTN

Question 3

What is cardiomyopathy and what are the 2 reasons it occurs?

Answer 3

damage to the heart muscle so it can’t pump efficiently
1. Stenosis - tight valve - increased workload
2. Loose valve- back flow

Question 4

What 2 chronic conditions cause contractility heart issues?

Answer 4

1. CAD
2. Cardiomyopathy - stenosis/loose valve

Question 5

What 2 acute conditions cause contractility heart issues?

Answer 5

1. acute MI (STEMI)
2. Myocarditis - inflammation

Question 6

What 2 things impact afterload?

Answer 6

HTN
Pulmonary disease (ex COPD)

Question 7

What affects preload that leads to HF?

Answer 7

1. hypotension
2. valve disease

Question 8

what 4 events cause a lack of O2 to the heart coronary system?

Answer 8

1. CAD
2. Heart block
3. heart Failure
4. arrythmia

Question 9

what is HF with reduced EF?

Answer 9

<40%
pump issue - systolic dysfunction

Question 10

What is HF with preserved EF?

Answer 10

<40%
filling issue - dystolic dysfunction

Question 11

What are the 4 HF compensatory mechanisms

Answer 11

1. SNS
2. RAAS
3. Ventricular Dilation - LV enlarges - stretch too far = ventricular remodeling
4. Ventricular hypertrophy- enlarged heart =dysrhythmias

Question 12

what type of meds do we use to help reduce compensatory mechanisms?

Answer 12

1. SNS- beta blockers
2. RAAS - ACE/ARB/ARNI
3. ventricular dilation-
4. ventricular hypertrophy -

Question 13

what are the signs of LSHF perfusion issue?

Answer 13

fatigue
confused
tachy (SNS compensation)
angina (less O2 to heart)
Oliguria <400ml in 24 hrs
pallor
cool
weak pulse

Question 14

what are the signs of LSHF congestion issue?

Answer 14

cough
dyspnea (alveoli take on water)
orthopnea - can’t breathe laying down
paroxythal nocturnal dyspnea -waking at night SOB
adventisia in lungs
pink sputum - frothy
S3 & S4 sounds

Question 15

how does LSHF happen?

Answer 15

blood backs up to the pulmonary system
issue with Left ventricle

Question 16

how does RSHF happen?

Answer 16

blood backs up to the venous system
issue with right ventricle

Question 17

What are the signs of RSHF?

Answer 17

weight gain - edema
increase BP - affects afterload
JVD
N&V- acities
distended abdomen
liver & speen enlarged
Polyuria at night b/c gravity at kidneys
dependent edema

Question 18

Does hyperkalemia and hypokalemia slow heart impulses or increase heart impulses?

Answer 18

both SLOW impulses

Question 19

What are the most common indicators of hypokalemia?

Answer 19

1. *U wave
2. low T wave
3. PQ elongated
4. QT increased

Question 20

What are the most common indicators of hyperkalemia ?

Answer 20

1. *T wave peak
2. P- very low
3. PQ elongated
4. QRS wider

Question 21

What is the most common dysrythmia?

Answer 21

afib

Question 22

What are the after load drugs (blue)?

Answer 22

ARNI- sacubiteil/valsartanw(entresto)
ACE- captopril
ARBS- losartin (cozar)
Beta blocker- metoprolol
Calcium Chanel blocker - verapramil
Vasodilation - hydralazine

Question 23

What are the preload drugs (green) ?

Answer 23

1. Morphine
2. SLGT-2 - canagliflozin
3. Diuretics- all 3
4. Beta blocker - metoprolol
5. Nitrates - nitro spray - relaxes vasoapasm in coronary arteries only & veins ( isosorbide dineitrate)

Question 24

what is the 3 goals of meds for heart failure?

Answer 24

1. reduce cardiac workload (afterload)
2. control pain (preload)
3. prevent/destroy clots

Question 25

what do contractility meds help with?

Answer 25

forward flow

Question 26

what is an example of a contractility med?

Answer 26

digoxin

Question 27

what are the 3 drugs for Afib that slow ventricular rate?

Answer 27

beta-adrinergic blockers calcium channel blockers digoxen

Question 28

What drug helps prevent blood clots in Afib?

Answer 28

warfarin

Question 29

why are vasodilators taken short term?

Answer 29

tolerance develops

Question 30

what is the adverse affect of vasodilators (Hydralazine) and how do we prevent it?

Answer 30

reflex tachy with beta blocker

Question 31

what does aldosterone cause?

Answer 31

sodium & water uptake

Question 32

what does angiotension II cause?

Answer 32

vasoconstriction

Question 33

what is ventricular remodeling?

Answer 33

when there is to much blood so the ventricles stretch and the cells start to change. The ventricle changes because the cells are changing

Question 34

why is ventricular remodeling bad?

Answer 34

because it causes the cells to change and demand more O2. so ischemia and arrythmias

Question 35

what do cardiac cells release to help compensate?

Answer 35

naturetic peptide

Question 36

blocking RAAS causes sodium and water to do what?

Answer 36

leave the body

Question 37

What does P wave represent?

Answer 37

Atrial depolarization (SA to AV)

Question 38

what must we know BEFORE giving Dig and why?

Answer 38

K+ level! hypokalemia will cause hypereffect with dig hyperkalemia will compete with Dig and reduce affect

Question 39

what 2 conditions is dig used in?

Answer 39

HF and Afib

Question 40

what 3 patients cannot have tPA?

Answer 40

1. intracranial hemorrhage 2. recent stroke (<3 months) 3. active internal bleeding