10 minute topic Heart failure Flashcards
Heart failure
cardiac muscle is unable to pump effectively and unable to maintain adequate circulation to meet tissue needs
Result of HF
inadequate cardiac output
myocardial hypertrophy
pulmonary/systemic congestion
Causes of HF
can be acute or chronic
HTN, MI, Pulmonary HTN, dysrhythmias, valve disease, pericarditis, cardiomyopathy
Class I HF
Client exhibits no symptoms with activity
Class II HF
Client has symptoms with ordinary exertion
Class III HF
Client displays symptoms with minimal exertion
Class IV HF
Client has symptoms at rest (SOB and chest pain at rest)
Low-output heart failure
can initially occur on either the left or right side of the heart
Left sided (ventricular) HF
results in inadequate left ventricle (cardiac) output and inadequate tissue perfusion
Systolic failure
ejection fraction below 40%, pulmonary and systemic congestion
Diastolic failure
inadequate relaxation or “stiffening” prevents ventricular filling
Right Sided (ventricular) HF
inadequate right ventricle output and systemic venous congestion (peripheral edema)
Risk Factors for Left-sided (ventricular) HF (left = lungs)
Hypertension Coronary artery disease Angina MI Valvular disease (mitral and aortic)
Risk Factors for right-sided (ventricular) HF
Left-sided heart (ventricular) failure – it backs up to the right
Right ventricular MI
Pulmonary problems (COPD, pulmonary fibrosis)
Risk factors for high output HF
Increased metabolic needs
Septicemia (fever)
Anemia
Hyperthyroidism
Risk factors for cardiomyopathy
Coronary artery disease Infection or inflammation of the heart muscle Various cancer treatments (cause) Prolonged alcohol use Heredity
Cardiomyopathy sx
Fatigue Weakness Heart failure Heart block Gallop Cardiomegaly
Human B-type natriuetic peptides (hBNP)
used to Dx HF from other respiratory problems and to monitor effectiveness of tx
Human B-type natriuetic peptides (hBNP) levels
100 < 300 pg/mL suggest HF is present.
> 300 pg/mL indicates mild HF
> 600 pg/mL indicates moderate HF
> 900 pg/mL indicates severe HF
Hemodynamic monitoring
done in the ICU to dx HF
Cardiac ultrasound or ECG
measures both systolic & diastolic function of the heart
Left ventricular ejection fraction (LVEF)
The volume of blood pumped from the left ventricle into the arteries upon each beat. Normal is 55% to 70%
Right ventricular ejection fraction (RVEF)
The volume of blood pumped from the right ventricle to the lungs upon each beat. Normal is 45% to 60%.
HF nursing care
Position to maximize ventilation (high fowlers, sit them up)
Bedrest until stable
Fluid and Na+ restrictions
Provide O2
HF medications
preload and afterload reducing agents Inotropic agents Vasodilators Anticoagulants hBNP
Medication to reduce preload
diuretics
Medication to reduce afterload
ACE inhibitors, ARBs to help the heart pump more easily by altering the resistance to the contraction
Inotropic agents
digoxin which will increase contractility and increase cardiac output
Vasodilators
will help to reduce preload and afterload and decrease myocardial demand (Nitro)
Anticoagulants
Coumadin – especially if they have a history of thrombus formation
nesiritide (Natrecor)
hBNP
used to treat acute HF, it causes natriuresis (loss of NA and vasodilation)
hBNP – nesiritide (Natrecor)nursing considerations,
hypotension, VT & bradycardia – on monitor & close VS monitoring
BNP levels will rise while on med
Give in separate IV d/t incompatibility with other meds (HEPARIN)
Ventricular assist device (VAD)
surgically implanted mechanical pump that assists a heart that is too weak to pump blood through the body.
Heart transplantation
End stage HF patients get this
The new hearts will often develop CAD
Will need increased K+ intake
