An introduction to Heart Failure

Question 1

SV - stroke volume is what?

Answer 1

amount of blood pumped out per heartbeat

Question 2

The ejection fraction (EF) is

Answer 2

The ejection fraction (EF) is the amount of blood that is pumped out of the left ventricle (LV) with each heart beat

Question 3

How are ejection fractions (EF) measured? and what can it indicate? **

Answer 3

It is measured in percentages

Normal range is 55 – 70 %

An EF of 40% or less indicates HF

Question 4

What is heart failure

Answer 4

HF is the heart’s inability to consistently pump enough blood to organs & tissues
Cardiac output is insufficient to meet the metabolic demands of the body and accommodate venous return
Occurs from either a structural or functional abnormality of the heart
The resulting decreased blood supply to body impairs organs & tissue function
The dominant feature is inadequate tissue perfusion

Question 5

ischaemia meaning

Answer 5

a restriction in blood supply to tissues, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive)

Question 6

IHD vs HF

Answer 6

IHD
^ Myocardial 02 demand and decrease in coronary artery 02 supply

HF
^ Systemic[body] 02 demand
Decrease in systemic[body] 02 supply

Question 7

There are different classifications of HF

Name them both

Answer 7

HF-REF – Heart Failure Reduced Ejection Fraction

HF PEF – Heart Failure Preserved Ejection Fraction

Question 8

What are the differences between HF-REF – Heart Failure Reduced Ejection Fraction and
HF PEF – Heart Failure Preserved Ejection Fraction

Answer 8

SYSTOLIC HF
Heart failure reduced ejection fraction(HFREF)
a PUMPING problem of the heart

DIASTOLIC HF
Heart failure preserved ejection fraction(HFPEF)
a RELAXING problem of the heart

Question 9

L)HF
The left ventricle (LV) cannot pump blood effectively to the systemic circulation. The blood backs up in the pulmonary system so the pulmonary venous pressure increases resulting in:

Answer 9

↓ EF

Pulmonary congestion/oedema with dyspnoea

Cough

Crackles

Impaired oxygen exchange

Question 10

R)HF

The right ventricle (RV) cannot eject sufficient amounts of blood - blood backs up in the venous system and may result in:

Answer 10

Peripheral oedema

Weight gain but anorexia/nausea may be present

Hepatomegaly enlarged liver)/splenomegaly enlarged spleen)

Ascites[^ fluid in abdomen]

Jugular vein distension

Question 11

Where does the ventricles send blood to in both RHF and LHF?

Answer 11

RHF - backs up in the venous system

LHF - backs up in the pulmonary system

Question 12

PUFFY ANKLES – L OR R HF? ***

Answer 12

Right as RV is failing to pump the blood forward to the lungs, backing up in the body via the RA

Question 13

PERSON HAS CRACKLES/FLUID IN THE LUNGS – L OR R HF? ***

Answer 13

Left as LV is failing to pump the blood forward to the body, is backing up in the lungs via the LA

Question 14

goals of management and why?

Answer 14

Aim to  cardiac function and  myocardial workload – beta blockers

Prevent harmful neuroendocrine responses, e.g.. SNS, RAAS, ventricular remodelling – ACE inhibitors

Manage with medication, daily weigh, O2 if required, fluid restriction, low sodium diet and other lifestyle modifications

Question 15

IF I HAD A MI, WHY MIGHT I GET HF?

Answer 15

damage to the myocardium esp LV – is a piece of steak – ineffective pumping. Depending on the extent of the infarction that would affect the severity of the HF

Question 16

HOW DO YOU KNOW IF SOMEONE HAS HF?

Answer 16

Statements of:
c/p, heavy weight, indigestion, SOB, SOBOE, 
Increased HR (to pump more oxygen around body) 
BP low
Ability to speak
ECG
Oxygen saturations and/or ABG
Cyanosis/colour/diaphoresis 
Sounds (gurgling/snoring/apnoea) 
Agitation/confusion
Anxiety
Dyspnoea

Question 17

WHAT ASSESSMENTS WOULD YOU USE?

Answer 17

Rapid Ax, Posterior Chest Ax, Peripheral vascular Ax, Apical pulse – PMI, if sond displaced then eg of ventricular hypertrophy

Question 18

Internal jugular vein ACTS as what to what?

Answer 18

barometer measuring fluid overload

Question 19

Raised Jugular Venous Pressure (JVP) measurement indicates ….. and which type of HF is it most common in?

Answer 19

Raised JVP indicates fluid overload

Common in right sided heart failure

Question 20

What is heart failure?

**

Answer 20

Inability of the heart to maintain CO to meet the body’s needs

Question 21

In left sided HF, where does the blood back up to? and what are symptoms of this?
**

Answer 21

Pulmonary system. Doesn’t go forward to the systemic system
Decrease EF
Pulmonary congestion/oedema with dyspnoea[SOB]
Cough
Crackles

Question 22

In right sided HF where does the blood back up to? and what are symptoms of this?
**

Answer 22

Systemic circulation. Doesn’t pump forward to the lungs
Peripheral oedema
Weight gain, nausea or anorexia
Hepatomegaly/splenomegaly[enlargement of liver and spleen]
Ascites[^fluids in abdomen]
Jugular vein distenstion

Question 23

Name two compensatory systems in HF? and how they compensate

**

Answer 23

SNS
SNS activation results in:
↑ Heart rate and ↑ contractility which ↑ blood pressure

RAAS
↑ blood volume by inhibiting urine excretion by ↑ sodium and therefore water reabsorption

Question 24

What is the goal of management in HF?

**

Answer 24

Treat the underlying cause!

Question 25

EXAM SCENARIO - You have been allocated Manu a 58 year old man admitted with heart failure who has oedema and SOB. What is the underlying patho that results in Manu's clinical manifestations?

Answer 25

L)HF Inability of LV[left ventricle] to pump blood to systemic circulation. Blood then backs up in the pulmonary system increasing pulmonary venous pressure

Question 26

EXAM SCENARIO - You have been allocated Manu a 58 year old man admitted with heart failure who has oedema and SOB. Identify four priority nursing assessments with rationale

Answer 26

Rapid Ax - to assess pt's presenting concerns. Evaluate what the priorities are Posterior Chest Ax - to assess if crackles are present which would coincide with LHF COLDSPA - to assess pain levels and evaluate effectiveness of pain relief Vital signs - assess RR depth and pattern, Sp02 to measure blood within the body.

Question 27

EXAM SCENARIO - You have been allocated Manu a 58 year old man admitted with heart failure who has oedema and SOB. Based on the assessments identified [Rapid AX, posterior AX, COLDSPA, Vital signs] list four prioerity nursing interventions you would implement as part of your care during this acute phase and give the rationale for each

Answer 27

Administer prescribed ACE inhibitors to decrease blood volume and BP Administer beta blockers to Slow the HR, lower the BP and reduce the force of contraction Administer antiplatelet [ASPIRIN] to prevent platelet aggregation and emerging/subsequent thrombosis, which impedes blood flow Administer Diuretics [frusomide] to ^ sodium and water exrection by kidneys to assist with fluid overload Administer 02 if prescribed if Sp02 <93% and RR is over 20. Administer nitrates - GTN, to relieve angina and ioncrease blood flow Others: anxiety reduction.

Question 28

``` Your patient has had a STEMI and: is tachypnoeic (RR > 21) is tachycardic (HR>101) is oliguric has chest pain (6/10) ``` He goes on to become SOB with a cough How does the underlying pathophysiology relate to these signs and symptoms? exam q

Answer 28

A STEMI results in myocardial cell death, reduced myocardial contractility and reduced CO (the myocardium is not pumping as efficiently as it should) In an attempt to maintain an adequate CO the SNS & RAAS respond causing the ↑RR, ↑HR,↓UO SOB & the cough relate to L)sided heart failure → hydrostatic pressure forces fluid into the lungs → impaired gas exchange