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Nur 336 > Cardiac - Unit 2 - Heart Failure and Cardiomyopathy > Flashcards

Cardiac - Unit 2 - Heart Failure and Cardiomyopathy Flashcards

1
Q

What is heart failure?

A

The heart is unable to pump blood throughout the body causing insufficient perfusion to organs with vital nutrients and O2. It results in low cardiac output.

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2
Q

what are the three types of CHF?

A

Left-sided, right sided, and high output.

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3
Q

Left-sided heart failure (aka….) - info? The two type?

A

Congestive Heart Failure - the left ventricle is failing. It causes pulmonary congestion - it can be acute or chronic - might be caused by MI, heart enlargment, etc.
The two types are systolic heart failure and diastolic heart failure.

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4
Q

What is sytolic heart failure? what does it cause?

A

Causes decreased contractility and ejection fraction. Results in increased diastolic volume and ventricle dilation and wall tension. They fill with blood but pump less.

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5
Q

What does diastolic heart failure do?

A

Small ventricular chamber - decreases ventricular compliance —- ventricular stiffening! So they pump about 60% of the blood - but may be lower than normal.

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6
Q

What are some underlying causes of systolic heart failure?

A

CAD, DM, HTN, arrhythmia’s, valvular stenosis, myocarditis, heart disease, recreational drug use, etc.

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7
Q

What are some underlying causes of diastolic heart failure?

A

CAD, DM, HTN, aortic stenosis, hypertrophic & restrictive cardiomyopathy.

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8
Q

What are some signs and symptoms of left heart failure?

A

Fatigue, confusion/restlessness, exertional dyspnea, orthopnea, dyspnea at rest, oliguria while awake (small amounts of urine), angina, pallor, weak peripheral pulses.

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9
Q

Pulmonary edema - what is it? Info

A

Life-threatening - failure of left ventricle to eject blood so it accumulates causing a rise of pressure in lungs - and the fluid leaks across the pulmonary capillaries.

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10
Q

What are some signs and symptoms of pulmonary edema?

A

Frothy-pink sputum, dyspnea/breathlessness, tachypnea, crackles and wheezes in lungs, feelings of drowning!

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11
Q

How do we treat pulmonary edema?

A

High fowlers, auscultate lung sounds, IV access, O2, Iv diuretics, document output, monitor, provide comfort, etc.

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12
Q

Right-Sided HF - what is it?

A

Caused by left-sided HF, a right ventricular MI, or pulmonary congestion.

The right ventricle does NOT empty - so the pressure and volume increases in the systemic veins causing congestion and peripheral edema.

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13
Q

What are some signs and symptoms of right heart failure?

A

fatigue, weakness, breathlessness, edema starting in feet, up to ankles, thighs and abdominal wall (ascites), JVD, anorexia, nausea, weight gain, polyuria, increase in BP.

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14
Q

What is high output heart failure?

A

cardiac output is NORMAL but is caused by an increased need for increased CO - maybe from septicemia, anemia or hyperthyroidism.

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15
Q

1 liter of fluid = ___ lbs.

A

2.2 lbs

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16
Q

Ejection Fraction = the measurement of _____________

A

percentage of blood ejected after the ventricles contract - normally 65%.

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17
Q

What are some labs/diagnostics for high output hf?

A

Serum electrolytes, BUN, creat, H&H, BNP (counterbalances RAS compensating mechanism, released by the ventricles to decrease preload), ABG’s

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18
Q

What are some drugs to reduce afterload?

A

ACE inhibitors, ARB’s and human B-Type natriuretic peptides (Nesiritide)

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19
Q

What do ACE inhibitors do? What drugs?

A

OPRILS.

They suppress the renin-angiotensin system - they increase stroke volume by causing arterial dilation and arterial resistance —> reducing afterload. THESE CAUSE THE COUGH

20
Q

What do ARB’s do? What drugs?

A

SARTANS.

They suppress the RAS by blocking angiotensin 2 in the lungs.

21
Q

Diuretics - should we watch potassium levels?

A

YES

22
Q

What are some drugs that enhance contractility of the heart?

A

Digitalis, dopamine, dobutrex, beta-blockers (olols)

23
Q

What does digitalis do?

A

increases contractility, reduces HR, inhibits the sympathetic nervous system, slows conduction through the AV node, etc.

24
Q

What are some things we need to educate our patients on with HF?

A

risk factors, meds, diet, fluid restriction, adl’s, signs of pulmonary edema, indications to seek medical attention.

25
Q

What are some core measures for heart failure?

A

Adult smoking cessation, evaluation of ventricular function, ACE or ARB, discharge instructions (stop smoking, diet/activity, weight monitoring, worsening symptoms = report, F/U instructions)

26
Q

What is cardiomyopathy?

A

Disease of the cardiac muscle.

27
Q

What are the three types of cardiomyopathy?

A

Dilated, Hypertrophic and Restrictive

28
Q

What is dilated cardiomyopathy?

A

87% of cases = ventricle wall thickness is normal, but dilation occurs in chambers causing improper contractility - caused by booze, chemo.

29
Q

What is hypertrophic cardiomyopathy?

A

Still left ventricle that causes abnormalities in diastolic filling time - obstruction due to mitral vale incompetence or hypertrophied septum - causes sudden cardiac arrest in athletes.

30
Q

What is restrictive cardiomyopathy?

A

Similar to pericarditis - the heart can’t contract or expand, it’s basically frozen!

31
Q

What is the treatment for cardiomyopathy?

A

Diuretics, vasodilating agents, cardiac glycosides, defibrillators, surgery

32
Q

Who has the best prognosis for a heart transplant?

A
33
Q

Heart transplant donors must have…

A

no history of heart disease, cardiac trauma/problems, a body size equal to recipient, no transmittable diseases and the heart can be ischemic for less than 4 hours.

34
Q

What’s the leading cause of death in people the first year after transplant?

A

Infection

35
Q

What’s the difference between stenosis and regurgitation?

A

Stenosis - hardening.

Regurg - blood flow back.

36
Q

What are some symptoms of mitral stenosis?

A

Dyspnea, fatigue, weakness, diastolic murmur, A-Fib

37
Q

What is mitral insufficiency?

A

Blood leaking from left ventricle to left atrium - usually asymptomatic but might have a systolic murmur, pulmonary congestion and decreased CO. Treated with digitalis, sodium restriction, limit activity, etc.

38
Q

What are some symptoms for atrial insufficiency?

A

Diastolic murmur, dyspnea on exertion, angina, diaphoresis, DeMussets Sign (the pt. will nod to the beat of their heart because they can feel it!), Widening Pulse Pressure

39
Q

What is inefective endocarditis? Risk factors?

A

Infection occurring on the valve leaflets or inside lining of the heart. Risk factors include cardiac surgery, prosthetic valves, prolonged IV therapy, etc.

40
Q

How do we prevent infective endocarditis?

A

Antibiotic prophylaxis

41
Q

What are some symptoms of infective endocarditis?

A

High fever, heart failure, murmurs, Osler’s nodes (painful red lesions), janeway’s lesions (red spots but not as painfuL), roth’s spots (retinal hemorrhages with white or pale centers)

42
Q

How do we diagnose/treat infective endocarditis?

A 
Diagnose = cultures
Treat = antibiotics
43
Q

What is rheumatic fever?

A

Systemic, inflammatory disorder that usually develops after a throat infection caused by Group A Strep Infection

44
Q

What are symptoms of rheumatic fever?

A

Poly-arthritis, sub-Q nodules, carditis, chorea (jerky muscle movements - shoulders, hip and face), erythema marginatum (rash), fever

45
Q

How do we treat rheumatic fever?

A

Antibiotics, bedrest, anti-inflammatory drugs.

46
Q

What is myocarditis? Symptoms?

A

Inflammation of the heart muscle - symptoms include fever, dyspnea, palpitations, malaise, athralgia (pain in a joint), CHF symptoms.

47
Q

How do we diagnose/treat myocarditis?

A

CXR, Echo, Blood cultures - treat with rest, antibiotics, O2

Nur 336 (26 decks)

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