WK 1: Heart Failure Flashcards
Heart Failure is defined as?
Clinical syndrome involving impaired cardiac pumping, filling or both. “Weak heart that doesn’t pump as well”
What is Systolic Heart failure - Reduced Ejection Fraction (HF-REF)?
- Most common form of HF
- Heart can’t pump blood effectively – impaired contractile function, increased afterload (hypertension), cardiomyopathy and mechanical abnormalities
- Left ventricle loses ability to generate enough pressure to eject blood forward through aorta
- Hallmark is reduction in ejection fraction (EF) <40% (normal EF is >55%)
What is Diastolic Dysfunction - Preserved Ejection Fraction (HEF-PEF)?
- Aka diastolic HF – inability of ventricles to relax and fill during diastole
- Decreased filling results in decreased stroke volume and cardiac output (CO)
- Results in venous engorgement in both pulmonary and vascular systems
- Most often results from left ventricular hypertrophy (due to hypertension), myocardial ischemia, valve disease, or cardiomyopathy
What are common Risk Factors for Heart Failure?
· Coronary artery disease (CAD)
· Hypertension (HTN)
· Diabetes
· Smoking
· Obesity
High serum cholesterol
What are Causes of Heart Failure?
· Hypertension
· Coronary Artery Disease
Cardiomyopathy
What are common Signs and Symptoms of Heart Failure?
· Dyspnea (shortness of breath): Caused by pulmonary pressures.
· Fatigue: Due to decreased CO, impaired perfusion to vital organs, decreased oxygenation, and anemia.
· Edema: Dependent areas, abdomen, lungs, sacral and scrotal areas.
Pulmonary Crackle
Symptoms of Left Sided Heart Failure VS Right Sided Heart Failure
· Left Sided HF
§ Crackles
§ Wheezing
§ Diminished lung sounds
§ Shortness of Breath
§ Fatigue
· Right sided HF
§ Weight Gain
§ Peripheral edema
§ Distended Jugular Veins
§ Hepatomegaly
Splenomegaly
What are the Diagnostic Criteria for Heart Failure?
- ECG: Distinguish HFrEF from HFpEF
- Chest X-ray: Can help distinguish pleural effusions from other causes of dyspnea (i.e., pneumonia), can also visualize cardiomegaly.
- BPN levels: Help distinguish dyspnea caused by HF from other causes of dyspnea
ACE Inhibitors for HF?
ramipril [Atlace], perindopril [Coversyl]
First-line therapy in HF
- useful in both systolic and diastolic HF)
- Block conversion of angiotensin I to angiotensin II, reducing aldosterone levels.
- Reduces systemic vascular resistance, maintains tissue perfusion, ventricular filling pressure
Beta Blockers for HF
metoprolol, bisoprolol
Block negative effects of SNS on the failing heart including increased HR
Loop diuretics for HF
- Act on the ascending loop of Henle to promote excretion of sodium, chloride, and water
- used in acute HF and pulmonary edema, risk for hypokalemia
- Keep an eye on Potassium
Digoxin for HF
Mechanism of Action: increase in intracellular sodium that will drive an influx of calcium in the heart and cause an increase in contractility.
Monitoring:
- lab values and Vitals etc
- Only measure digoxin level 6-10 days after initiation of therapy or following a dose change to insure serum concentration reflects steady state.
Therapeutic levels:
- 0.8 to 2 ng/mL.
Digoxin toxicity risk factors
- Hypothyroidism/hyperthyroidism.
- Advanced age.
- MI.
- Renal insufficiency.
- Hypercalcemia.
- Alkalosis.
- Hypoxemia.
- Acidosis.
Nursing Assessments for Heart Failure
- Assess vital signs, cardiac rhythm, and hemodynamic measurements.
- Monitor skin and pulses.
- Monitor mental status changes.
- Apply oxygen.
- Administer medications.
- Instruct on ways to reduce the workload of the heart.
- Educate on risk factors and lifestyle modifications.
Treatments/interventions (acute HF)
- Decrease intravascular volume: Loop diuretics
- Decrease Venous return: Elevating the head of the bed with feet dangling = blood pools in extremities and increases thoracic capacity for improved ventilation
- Decrease Afterload: Monitor vital signs - decreased systemic vascular resistance (lower BP) reduces afterload; however, BP must be adequate to maintain renal and cerebral perfusion
- Improving Gas Exchange: Morphine can reduce preload and afterload and decrease myocardial oxygen demand. Administer oxygen if sats <90%
- Improving Cardiac Function: Aggressive complex therapies including inotropic therapies and hemodynamic monitoring
- Reduce Anxiety: Calm approach, IV morphine
What are common complications associated with Heart Failure?
- Pleural Effusion: Fluid leaking into pleural space
- Dysrhythmias: Enlargement of heart changes normal electrical pathways (i.e., atrial fibrillation, ventricular tachycardia)
- Left Ventricular Thrombus: Increased LV and decreased CO increase risk of thrombus formation, emboli can develop from thrombus leading to stroke
- Hepatomegaly: Venous system backing up into liver leading to impaired liver function, cirrhosis can develop
- Renal Failure: Decreased CO leads to hypoperfusion of kidneys = renal insufficiency or failure
