Cardiomyopathy/Heart Failure

Question 1

Heart cannot pump enough blood/oxygen causing tissue perfusion

Answer 1

Heart failure

Question 2

Impaired contractility
Thin/weak heart muscle
Low ejection fraction
S3 gallop
Etiologies- ischemic heart disease, chronic HTN, dilated cardiomyopathy, myocarditis

Answer 2

Systolic dysfunction

Question 3

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

Answer 3

Diastolic dysfunction

Question 4

The amount of blood pumped from the ventricles in one minute

Answer 4

cardiac output

Question 5

The number of ventricular contractions per minute

Answer 5

heart rate

Question 6

The volume of blood ejected with each heartbeat

Answer 6

stroke volume

Question 7

The amount of cardiac muscle fiber stretches just prior to contraction affected by volume

Answer 7

preload

Question 8

The resistance against which the heart must eject blood volume during contraction

Answer 8

afterload

Question 9

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.

Answer 9

contractility

Question 10

The percentage of blood in the ventricle that is ejected during systole, normal is > 50-60%.

Answer 10

ejection fraction

Question 11

Hypertrophic cardiomyopathy

Answer 11

-diastolic dysfunction
-risk of sudden death in young athletes
-thickened left ventricular wall

Question 12

Dilated cardiomyopathy

Answer 12

-systolic dysfunction
-enlargement of all cardiac chambers
-most common type

Question 13

Restrictive cardiomyopathy

Answer 13

-diastolic dysfunction
-rigid ventricular walls
-least common type

Question 14

Formula to calculate CO

Answer 14

CO= (HR x SV)/1000

Question 15

Formula to calculate HR

Answer 15

HR= (CO x 1000)/SV

Question 16

Formula to calculate SV

Answer 16

SV= (CO x 1000)/HR

Question 17

Crackles, S3 heart sound, blood tinged sputum, exertional dyspnea, restlessness, cyanosis

Answer 17

Left sided ventricular heart failure

Question 18

Pulmonary HTN, ascites, distended jugular veins, weight gain, tight shoes, decrease in urine output, splenomegaly, hepatomegaly

Answer 18

Right sided ventricular heart failure

AKA Cor pulmonale

Question 19

The faces of heart failure

Answer 19

Fatigue, limited activity, chest congestion & cough, edema, and SOB

Question 20

What type of cardiomyopathy?

Fatigue & weakness
L sided HF
Dysrhythmias
Systemic or PE
S3 or S4 gallops
Moderate to severe cardiomegaly

Answer 20

Dilated cardiomyopathy

Question 21

Treatment options for dilated cardiomyopathy

Answer 21

Treat HF symptoms, vasodilators, & heart transplant

Question 22

What type of cardiomyopathy?

Dyspnea
Angina
Fatigue, syncope, palpitations
Mild cardiomegaly
S4 gallop
Sudden death common
HF

Answer 22

Hypertrophic obstructive cardiomyopathy

Question 23

Treatment options for hypertrophic obstructive cardiomyopathy

Answer 23

Treat HF symptoms, beat blockers, mitral valve replacement, digoxin, nitro

Question 24

What type of cardiomyopathy?

Dyspnea and fatigue
R sided HF
Heart block
Emboli
S3 and S4 gallops
Mild to moderate cardiomegaly

Answer 24

Restrictive cardiomyopthy

Question 25

Treatment options for restrictive cardiomyopthy

Answer 25

Treat HF & HTN symptoms, exercise restrictions

Question 26

Labs & diagnostics

Answer 26

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

Question 27

Levels for BNP testing

B-type natriuretic peptide

Answer 27

less than 100 = normal
100-300 = mild heart failure
300-700 = moderate heart failure
700+ =severe heart failure

Question 28

Signs of digoxin toxicity

Answer 28

anorexia, nausea, visual disturbances, bradycardia, changes in mental status

May cause PVCs or nearly any dysrhythmias

Question 29

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?

Answer 29

Serum digoxin and potassium levels.

Hypokalemia potentiates digoxin toxicity.

Question 30

Medications

Goal is to decrease afterload, decrease preload, and increase contractility

Answer 30

ACEis & ARBs
Beta blockers
Oxygen
Nitrates
Calcium channel blockers
Hydralazine
Diuretics

Question 31

Procedures

Answer 31

• Cardiac Resynchronization Therapy (CRT)
• Ultrafiltration in HF - Aquapheresis
• Ventricular assist device (VAD)

Question 32

Heart Failure Self-Management Education

MAWDS

Answer 32

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

Question 33

Action alert for HF

Symptoms that could indicate worsening or recurrent heart failure

Report to provider immediately

Answer 33

-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