19 Heart Failure and Dysrhythmias Flashcards
Heart Failure [HF]
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
RHF vs LHF
RHF: affects systemic venous circulation
LHF: affects pulmonary venous circulation
most common reason for hospitalization in those >65 yrs old
HEART FAILURE
-increasing incidence as you age
compensatory mechanism + remodeling of HF
SNS activation + RAAS system
-helpful in restoring normal CO
management of HF
directed towards reducing the harmful consequences of these compensatory responses:
1 SNS activation
2 increased preload
3 myocardial hypertrophy
SNS process fr HF
HF> Baroreceptor Response> Brain> SNS activation> incr hrt rt + contractility> incr CO
RAAS process fr HF
HF> RAAS activation + decr GFR> kidney> fluid retention> incr preload> incr CO
Myocardial Hypertrophy process fr HF
HF> incr Ventricular wall tension> heart> myocyte growt> hypertrophy> incr CO
which type of HF is most common?
Left ventricular failure is most common
-often leads to Right ventricular failure
Forward failure
insufficient cardiac pumping
- manifested by poor CO/hypoxia
- insufficient CO may be manifested as confusion, fatigue, tachycardia, reduced urine output, + poor peripheral circulation
Backward Failure
congestion of blood behind the pumping chamber/edema
LHF
Forward Effects
- systemic hypoxia
- SNS activation
-fatigue, oliguria, anxiety, confusion, HR increasement
LHF
Backward Effects
Pulmonary congestion + edema
—dyspnea on exertion, orthopnea, + paroxysmal nocturnal dyspnea
-cough, respiratory crackles (rales), hypoxemia, high left-atrial pressure, cyanosis, S3 sound (high-pitched)
RHF
Backward Effects
congestion in the Systemic Venous System/Systemic Edema
—edema, ascites, jugular veins distended, impaired mental functioning, hepatomegaly, splenomegaly, hepatojugular reflux test
which heart failure has both hypoxemia + hypoxia?
Left-sided heart failure
Cor Pulmonale*****
Right ventricular hypertrophy from RHF
RHF
Forward Effects
cause low output to left ventricle leading to low CO
-systemic hypoxia
Biventricular Failure
combo of LHF + RHF
- most often fr left side that progressed to right side
- reduced CO in both ventricles
reduced CO in biventricular failure is due to…
1 pulmonary congestion due to left-sided HF
2 systemic venous congestion due to right-sided HF
HF
treatment
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
Digitalis
drug that improves CO + contractility
Beta Blockers
inhibit SNS effects
-reduce afterload
Diuretics
reduce preload
Ace Inhibitors
prevent activation of ANG I to ANG II
ARBs
ANG II blockers
pacemakers
synchronize ventricular contraction
RSHF
congestion of BF in the systemic + pulmonary circulation
- most common
- dangerous
LSHF
CONGESTION OF VENOUS CIRCULATION
-backward effect [Lft Atrium> Pulmonary V> Lungs]