Cardiomyopathy/Heart Failure Flashcards
Heart cannot pump enough blood/oxygen causing tissue perfusion
Heart failure
Impaired contractility
Thin/weak heart muscle
Low ejection fraction
S3 gallop
Etiologies- ischemic heart disease, chronic HTN, dilated cardiomyopathy, myocarditis
Systolic dysfunction
Impaired filling/relaxation
Stiff/thick heart muscle
Normal ejection fraction
S4 gallop
HTN w/ LV hypertrophy, restrictive and hypertrophic cardiomyopathies, fibrosis, amyloidosis, sarcoidosis, constrictive pericarditis, hemochromatosis, valvular disease
Diastolic dysfunction
The amount of blood pumped from the ventricles in one minute
cardiac output
The number of ventricular contractions per minute
heart rate
The volume of blood ejected with each heartbeat
stroke volume
The amount of cardiac muscle fiber stretches just prior to contraction affected by volume
preload
The resistance against which the heart must eject blood volume during contraction
afterload
The ability of heart muscles to shorten and contract. Any effect on the ability of the heart to contract results in some type of heart failure.
contractility
The percentage of blood in the ventricle that is ejected during systole, normal is > 50-60%.
ejection fraction
Hypertrophic cardiomyopathy
-diastolic dysfunction
-risk of sudden death in young athletes
-thickened left ventricular wall
Dilated cardiomyopathy
-systolic dysfunction
-enlargement of all cardiac chambers
-most common type
Restrictive cardiomyopathy
-diastolic dysfunction
-rigid ventricular walls
-least common type
Formula to calculate CO
CO= (HR x SV)/1000
Formula to calculate HR
HR= (CO x 1000)/SV
Formula to calculate SV
SV= (CO x 1000)/HR
Crackles, S3 heart sound, blood tinged sputum, exertional dyspnea, restlessness, cyanosis
Left sided ventricular heart failure
Pulmonary HTN, ascites, distended jugular veins, weight gain, tight shoes, decrease in urine output, splenomegaly, hepatomegaly
Right sided ventricular heart failure
AKA Cor pulmonale
The faces of heart failure
Fatigue, limited activity, chest congestion & cough, edema, and SOB
What type of cardiomyopathy?
Fatigue & weakness
L sided HF
Dysrhythmias
Systemic or PE
S3 or S4 gallops
Moderate to severe cardiomegaly
Dilated cardiomyopathy
Treatment options for dilated cardiomyopathy
Treat HF symptoms, vasodilators, & heart transplant
What type of cardiomyopathy?
Dyspnea
Angina
Fatigue, syncope, palpitations
Mild cardiomegaly
S4 gallop
Sudden death common
HF
Hypertrophic obstructive cardiomyopathy
Treatment options for hypertrophic obstructive cardiomyopathy
Treat HF symptoms, beat blockers, mitral valve replacement, digoxin, nitro
What type of cardiomyopathy?
Dyspnea and fatigue
R sided HF
Heart block
Emboli
S3 and S4 gallops
Mild to moderate cardiomegaly
Restrictive cardiomyopthy
Treatment options for restrictive cardiomyopthy
Treat HF & HTN symptoms, exercise restrictions
Labs & diagnostics
H&H
WBC
Electrolytes and Creatinine
LFTs
Urinalysis
Ferritin level
Lipid panel
BNP testing
Digoxin level
ABGs
Chest X-ray
Echocardiogram
Cardiac cath
Cardiac magnetic imaging
Levels for BNP testing
B-type natriuretic peptide
less than 100 = normal
100-300 = mild heart failure
300-700 = moderate heart failure
700+ =severe heart failure
Signs of digoxin toxicity
anorexia, nausea, visual disturbances, bradycardia, changes in mental status
May cause PVCs or nearly any dysrhythmias
Digoxin is a cardiac glycoside that provides symptomatic benefits for patients w/ chronic heart failure. Benefits include: increased contractibility, reduced HR, slowing of conduction, inhibition of sympathetic activity & enhancement of parasympathetic activity. What levels need to be monitored to identify toxicity?
Serum digoxin and potassium levels.
Hypokalemia potentiates digoxin toxicity.
Medications
Goal is to decrease afterload, decrease preload, and increase contractility
ACEis & ARBs
Beta blockers
Oxygen
Nitrates
Calcium channel blockers
Hydralazine
Diuretics
Procedures
- Cardiac Resynchronization Therapy (CRT)
- Ultrafiltration in HF - Aquapheresis
- Ventricular assist device (VAD)
Heart Failure Self-Management Education
MAWDS
Medications
Avoid NSAIDS to prevent sodium & fluid retention
Take meds as prescribed
Know purpose and side effects of meds
Activity
Don’t overdo it
Know your limits
Be able to carry on a conversation while exercising
Weight
Weigh each day at the same time on the same scale
Diet
Limit daily sodium to 2-3 grams
Limit fluid intake to 2L
Symptoms
Notify provider of any new or worsening sx
Action alert for HF
Symptoms that could indicate worsening or recurrent heart failure
Report to provider immediately
-rapid weight gain (3lb in one week or 1-2lb overnight)
-decrease in exercise tolerance lasting 2-3 days
-cold sx lasting 2-3 days
-excessive awakening at night to urinate
-development of dyspnea or angina at rest
-increased swelling of feet, ankles, or hands
