19 Heart Failure and Dysrhythmias

Question 1

Heart Failure [HF]

Answer 1

inability of heart to maintain sufficient CO to meet metabolic demands of tissues + organs
-results in congestion of BF in the systemic or pulmonary venous circulation, inability to increase CO to meet demands of activity/incr tissue metab

Question 2

RHF vs LHF

Answer 2

RHF: affects systemic venous circulation
LHF: affects pulmonary venous circulation

Question 3

most common reason for hospitalization in those >65 yrs old

Answer 3

HEART FAILURE

-increasing incidence as you age

Question 4

compensatory mechanism + remodeling of HF

Answer 4

SNS activation + RAAS system

-helpful in restoring normal CO

Question 5

management of HF

Answer 5

directed towards reducing the harmful consequences of these compensatory responses:
1 SNS activation
2 increased preload
3 myocardial hypertrophy

Question 6

SNS process fr HF

Answer 6

HF> Baroreceptor Response> Brain> SNS activation> incr hrt rt + contractility> incr CO

Question 7

RAAS process fr HF

Answer 7

HF> RAAS activation + decr GFR> kidney> fluid retention> incr preload> incr CO

Question 8

Myocardial Hypertrophy process fr HF

Answer 8

HF> incr Ventricular wall tension> heart> myocyte growt> hypertrophy> incr CO

Question 9

which type of HF is most common?

Answer 9

Left ventricular failure is most common

-often leads to Right ventricular failure

Question 10

Forward failure

Answer 10

insufficient cardiac pumping

• manifested by poor CO/hypoxia
• insufficient CO may be manifested as confusion, fatigue, tachycardia, reduced urine output, + poor peripheral circulation

Question 11

Backward Failure

Answer 11

congestion of blood behind the pumping chamber/edema

Question 12

LHF

Forward Effects

Answer 12

• systemic hypoxia
• SNS activation

-fatigue, oliguria, anxiety, confusion, HR increasement

Question 13

LHF

Backward Effects

Answer 13

Pulmonary congestion + edema
—dyspnea on exertion, orthopnea, + paroxysmal nocturnal dyspnea

-cough, respiratory crackles (rales), hypoxemia, high left-atrial pressure, cyanosis, S3 sound (high-pitched)

Question 14

RHF

Backward Effects

Answer 14

congestion in the Systemic Venous System/Systemic Edema
—edema, ascites, jugular veins distended, impaired mental functioning, hepatomegaly, splenomegaly, hepatojugular reflux test

Question 15

which heart failure has both hypoxemia + hypoxia?

Answer 15

Left-sided heart failure

Question 16

Cor Pulmonale*****

Answer 16

Right ventricular hypertrophy from RHF

Question 17

RHF

Forward Effects

Answer 17

cause low output to left ventricle leading to low CO

-systemic hypoxia

Question 18

Biventricular Failure

Answer 18

combo of LHF + RHF

• most often fr left side that progressed to right side
• reduced CO in both ventricles

Question 19

reduced CO in biventricular failure is due to…

Answer 19

1 pulmonary congestion due to left-sided HF

2 systemic venous congestion due to right-sided HF

Question 20

HF

treatment

Answer 20

1 improve CO + contractility - DIGITALIS
2 inhibit SNS effect/reduce Afterload - Beta blockers
3 reduce Preload - Diuretic
4 reduce effects of ANG II - Ace inhibitors + ARBs
5 Pacemakers

Question 21

Digitalis

Answer 21

drug that improves CO + contractility

Question 22

Beta Blockers

Answer 22

inhibit SNS effects

-reduce afterload

Question 23

Diuretics

Answer 23

reduce preload

Question 24

Ace Inhibitors

Answer 24

prevent activation of ANG I to ANG II

Question 25

ARBs

Answer 25

ANG II blockers

Question 26

pacemakers

Answer 26

synchronize ventricular contraction

Question 27

RSHF

Answer 27

congestion of BF in the systemic + pulmonary circulation

• most common
• dangerous

Question 28

LSHF

Answer 28

CONGESTION OF VENOUS CIRCULATION

-backward effect [Lft Atrium> Pulmonary V> Lungs]