CCRN HF Flashcards
Definition of HF?
Clinical syndrome characterized by symptoms assoc w/ high intracardiac pressures and decreased CO
HF w/systolic dysfunctions is characterized by?
-Prob with ejection ,
EF <40%
dilated chamber –>mitral valve insufficiency
HF w/diastolic dysfunctions characterized by:
EF>50%,
prob w/filling, hypertrophied chamber or septum
CXR systolic HF may look like?
Large, dilated heart or a normal heart size on the chest film. If it’s an enlarged heart, it’s associated with shift of the PMI from midclavicular to left
CXR of diastolic HF may look like?
It typically look normal. Remember EF is normal as well.
Heart sound typically associated with systolic HF?
S3. Ventricular gallop.
Heart sound typically associated with diastolic HF?
S4 with HTN. BP is often high with diastolic HF.
Which HF can you use positive inotropes?
In systolic. Remember diastolic doesn’t have a ejection problem. They have a filling problem.
What kind of medications do you want to avoid in systolic HF?
-negative inotropes like CC blockers
Dilated cardiomyopathy is most similar like what type of HF?
Systolic HF, enlarged atria/ventricles. Mitral valve regard is common d/t enlarged L ventricle. TX similar to systolic HF
Hypertrophic Cardiomyopathy is similar to what HF?
Diastolic HF.
increased thickening of heart muscle and septum at expense of LV. There is increased risk of sudden cardiac death from arrhythmia.
Def cardiogenic shock
extreme heart failure. occurs when the heart fails to maintain cardiac output
Etiologies of cardiogenic shock? (6)
acute MI, CHF, cardiomyopathy, dysrhythmia, cardiac tamponade, papillary muscle rupture (obliterates mitral valve)
What are Compensatory Stages of Cardiogenic Shock? (7)
BP maintained
Tachycardia, Tachypnea, Crackles, mild hypoxemia, cool skin, UOP down
Progressive Stage of Cariogenic Shock? (7)
HYPOTENSION, worst crackles, worse tachycardia and tachypnea, metabolic acidosis, skin clamp or mottled, oliguria
Both Compensatory Stage and Progressive Stage (3)
Neck vein distension, S3, NARROW PULSE PRESSURE
Cardiogenic Shock Tx Goals: (4)
- ID cause and treat it
- manage arrhythmia
- Reperfusion if STEMI
- emergent surgery if d/t mechanical problem -ruptured papillary muscle, ventricular septal defect
Cardiogenic Shock: How do you enhance effectiveness of the pump(3)
- Positive inotropic support: norepinephrine, dopamine 4-10 mcg/kg/min, dobutamine, milrinone
- AVOID neg inotropic agent
- use vasodilators w/IABP and + inotropic agents if pt is in progressive stage with hypotension
Cardiogenic Shock: How to decrease demand on the pump? (6)
-preload and after load reduction, O2 optimization, mech ventilation, treat pain, IABP for short term support
Benefits of IABP inflation (2)
- increases coronary artery perfusion
- inflate at dicrotic notch of arterial waveform (beg of diastole)
Benefits of IABP deflation (2)
- decreases after load
- deflates right before systole begins
3 etiologies of cardiac tamponade
- surgical (post op cardiac surgery)
- medical cause (pericarditis)
- trauma
S/S of cardiac tamponade (5)
- NARROWED PULSE PRESSURE
- PULSUS PARADOXUS (excessive drop in sBP >12 during inspiration)
muffled heart tones - low BP
-Increased JVD - equalization of CVP, PAD, PAOP
Tx cardiac tamponade
- pericardiocentesis
for pot op return to OR
Difference between pericarditis and myocardial contusion
Myocardial contusion has signs of trauma, pain, ST elevation in area of injury. Whereas pericarditis may have low grade temp, ST elevation in ALL leads. Pericardial effusion lead to cardiac tamponade. Pericaditis may have Dressler’s syndrome.
