CCRN HF Flashcards

1
Q

Definition of HF?

A

Clinical syndrome characterized by symptoms assoc w/ high intracardiac pressures and decreased CO

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2
Q

HF w/systolic dysfunctions is characterized by?

A

-Prob with ejection ,
EF <40%
dilated chamber –>mitral valve insufficiency

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3
Q

HF w/diastolic dysfunctions characterized by:

A

EF>50%,

prob w/filling, hypertrophied chamber or septum

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4
Q

CXR systolic HF may look like?

A

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

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5
Q

CXR of diastolic HF may look like?

A

It typically look normal. Remember EF is normal as well.

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6
Q

Heart sound typically associated with systolic HF?

A

S3. Ventricular gallop.

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7
Q

Heart sound typically associated with diastolic HF?

A

S4 with HTN. BP is often high with diastolic HF.

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8
Q

Which HF can you use positive inotropes?

A

In systolic. Remember diastolic doesn’t have a ejection problem. They have a filling problem.

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9
Q

What kind of medications do you want to avoid in systolic HF?

A

-negative inotropes like CC blockers

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10
Q

Dilated cardiomyopathy is most similar like what type of HF?

A

Systolic HF, enlarged atria/ventricles. Mitral valve regard is common d/t enlarged L ventricle. TX similar to systolic HF

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11
Q

Hypertrophic Cardiomyopathy is similar to what HF?

A

Diastolic HF.
increased thickening of heart muscle and septum at expense of LV. There is increased risk of sudden cardiac death from arrhythmia.

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12
Q

Def cardiogenic shock

A

extreme heart failure. occurs when the heart fails to maintain cardiac output

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13
Q

Etiologies of cardiogenic shock? (6)

A

acute MI, CHF, cardiomyopathy, dysrhythmia, cardiac tamponade, papillary muscle rupture (obliterates mitral valve)

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14
Q

What are Compensatory Stages of Cardiogenic Shock? (7)

A

BP maintained

Tachycardia, Tachypnea, Crackles, mild hypoxemia, cool skin, UOP down

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15
Q

Progressive Stage of Cariogenic Shock? (7)

A

HYPOTENSION, worst crackles, worse tachycardia and tachypnea, metabolic acidosis, skin clamp or mottled, oliguria

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16
Q

Both Compensatory Stage and Progressive Stage (3)

A

Neck vein distension, S3, NARROW PULSE PRESSURE

17
Q

Cardiogenic Shock Tx Goals: (4)

A
  • ID cause and treat it
  • manage arrhythmia
  • Reperfusion if STEMI
  • emergent surgery if d/t mechanical problem -ruptured papillary muscle, ventricular septal defect
18
Q

Cardiogenic Shock: How do you enhance effectiveness of the pump(3)

A
  • 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
19
Q

Cardiogenic Shock: How to decrease demand on the pump? (6)

A

-preload and after load reduction, O2 optimization, mech ventilation, treat pain, IABP for short term support

20
Q

Benefits of IABP inflation (2)

A
  • increases coronary artery perfusion

- inflate at dicrotic notch of arterial waveform (beg of diastole)

21
Q

Benefits of IABP deflation (2)

A
  • decreases after load

- deflates right before systole begins

22
Q

3 etiologies of cardiac tamponade

A
  • surgical (post op cardiac surgery)
  • medical cause (pericarditis)
  • trauma
23
Q

S/S of cardiac tamponade (5)

A
  • NARROWED PULSE PRESSURE
  • PULSUS PARADOXUS (excessive drop in sBP >12 during inspiration)
    muffled heart tones
  • low BP
    -Increased JVD
  • equalization of CVP, PAD, PAOP
24
Q

Tx cardiac tamponade

A
  • pericardiocentesis

for pot op return to OR

25
Q

Difference between pericarditis and myocardial contusion

A

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.