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D & D exam 4 > Ch. 20 Heart Failure and Circulatory Shock > Flashcards

Ch. 20 Heart Failure and Circulatory Shock Flashcards

1
Q

Heart Failure & Circulatory Shock

A
  • go hand in hand
  • either both are in healthy states or both are in unhealthy states
  • a structural disorder (defect in form) leads to a functional disorder and vise versa
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2
Q

What is a common initial functional disorder? and the resulting structural disorder?

A

HTN, the result is thickening of the heart muscle

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3
Q

pumping against abnormally high pressure puts excess strain on what chamber of the heart?

A

left ventricle

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4
Q

What is heart failure? what does it result in?

A

functional and structural disorder that results in….

  • low cardiac output
  • systemic or pulmonary congestion
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5
Q

What are some common causes of heart failure?

A
  • CAD
  • HTN
  • Dilated Cardiomyopathy
  • Valvular heart disease
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6
Q

What does heart failure mean?

A
  • decreased pumping ability of the heart and compromised compensatory mechanisms needed to maintain cardiac output
  • occurs because the cardiac output is low and the body becomes congested with fluid due to an inability of heart output to properly match venous return
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7
Q

Cardiac Output=

A

stroke volume + heart rate

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8
Q

What are some cardiac performance indicators?

A
  • preload and afterload
  • cardiac output and cardiac reserve
  • myocardial contractility
  • ejection fraction
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9
Q

preload

A
  • volume(loading capacity) of the ventricles at the end of diastole (filling)
  • volume coming into the heart
  • primarily increased venous back pressure
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10
Q

afterload

A
  • force of contraction required to eject (circulate) blood

- supplying adequate arterial perfusion

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11
Q

Central Venous Pressure (CVP)

A
  • indicator of preload

- when volume is decreased, CVP will be low

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12
Q

Pulmonary Vascular Resistance

A
  • resistance to the lungs

- back up before the heart, increased afterload

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13
Q

Cardiac Output

A
  • the amount of blood pumped out of the heart each time

- stroke volume + HR =cardiac output

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14
Q

Cardiac Reserve

A
  • the ability of the heart to increase it’s output during increased activity
  • people with heart failure lose this ability
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15
Q

What is the pathophysiology behind heart failure?

A

interaction between decreased ability to pump and decreased compensatory mechanism to maintain cardiac output

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16
Q

Myocardial Contractility

A
  • ability to squeeze
  • contractile performance of the heart
  • inotrope: force of contraction
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17
Q

Inotrope is synonymous with what word?

A

contractility

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18
Q

Stroke volume

A

volume pumped out each time

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19
Q

What is the normal cardiac output?

A

4-8 liters per minute

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20
Q

What are some example of stimulations of the sympathetic nervous system and how does it affect the heart?

A
  • anger, pain, fear, caffeine

- increase HR, increase contractility, increase speed of induction

21
Q

What are some example of stimulations of the parasympathetic nervous system and how does it affect the heart?

A
  • vomiting, medications, full bladder, Val Salva maneuver (what you do during a BM)
  • decreased HR, Decreased force
22
Q

Ejection Fraction =

A

amount of blood pumped out of the ventricles
____________________________________
the total amount of blood in ventricles

23
Q

how is the ejection fraction monitored and what is a normal value?

A
  • cardiac imaging

- 55% - 75%

24
Q

What are the types of Heart Failure?

A
  • Systolic v Diastolic
  • Right v Left Ventricular
  • High-output v Low-output
25
Q

Systolic Dysfunction

A
  • impaired contraction (will have backup in the atriums, the preload areas)
  • ejection fraction <40%
  • causes backup in atria and the pulmonary system (congestion)
  • increases preload
26
Q

Diastolic Dysfunction

A

-Abnormality in the ventricular relaxation and filling
(ventricle can’t expand therefore can’t fill up during diastole)
-increased intra-ventricular pressure
-pulmonary back up and congestion
-influenced by heart rate

27
Q

what causes systolic dysfunction?

A
  • ischemic heart disease (plaques, atherosclerosis)
  • cardiomyopathy (floppy heart)
  • HTN
  • valvular problems
28
Q

what causes diastolic dysfunction?

A
  • pericardial effusion

- constrictive pericarditis

29
Q

Which type of heart failure is often referred to as the “ failure of pump action”?

A

systolic dysfunction

30
Q

Right Ventricular Heart Failure

A
  • pulmonary congestion is minimal maybe even clear
  • patients will have weight gain due to peripheral edema and suffer from bilateral pitting peripheral edema
  • most common cause is left sided heart failure
  • systemic and hepatic accumulation
31
Q

Fluid build up in the body and hepatic system is related to what type of heart failure?

A

right sided

32
Q

Left Ventricular Heart Failure

A
  • diminished cardiac output
  • progressive accumulation of blood within the pulmonary circulation (crackles)
  • most common cause of left sided heart failure is Acute MI
  • # 2 is HTN
  • could be caused by valvular problems
33
Q

In which type of heart failure will you see pulmonary edema and hear crackles when auscultating the lungs?

A

left sided heart failure

34
Q

What is it called when right sided failure is caused by only pulmonary issues and not left sided failure?

A

Cor Pulmonale

35
Q

S/S of Right Sided Heart Failure

A
  • fatigue
  • Increase peripheral venous pressure (aka CVP)
  • ascites (big belly)
  • enlarged liver and spleen
  • distended jugular veins (sign of increased CVP, doesn’t always mean it is Right sided heart failure, could be other cause)
  • anorexia and complains of GI distress
  • weight gain (fluid in the 3rd space)
  • dependent edema (whatever part is down)
36
Q

S/S of Left Sided Heart Failure

A
  • paroxysmal nocturnal dyspnea
  • pulmonary congestion: cough, crackles, wheezes, blood-tinged sputum
  • tachypnea
  • restlessness
  • confusion
  • orthopnea
  • tachycardia
  • exertional dyspnea (no reserve)
  • fatigue
  • cyanosis
37
Q

Congestive Heart Failure

A
  • CHF or CCF (congestive cardiac failure)
  • heart is unable to provide necessary pumping to provide body with adequate supple of blood

Chronic: progressive slowly after MI, return to ER a lot, swollen ankles, tired

Acute: suddenly after MI, pulmonary embolism or some type of arrhythmia

38
Q

How do you diagnose congestive heart failure?

A
  • physical exam
  • confirmed with echocardiogram
  • blood tests to determine cause
39
Q

Treatment of Acute Decompensating CHF?

A
  • managed with urgent therapy (Meds,O2, hospitalization)
40
Q

Treatment of Chronic CHF in stable situation?

A
  • stop smoking
  • light exercise
  • dietary changes(less animal fat, more vegetable fat, less calories)
  • pharmacological modalities(diuretics, inotropes, antihypertension)
  • pacemaker
  • if heart is shot then a heart transplant is needed
41
Q

What is an LVAD?

A
  • left ventricle assist device

- usually patient is on before a transplant

42
Q

High-Output

A
  • uncommon type
  • excessive need for cardiac output
  • output is normal but not enough to meet demand

-compensatory for anemia

43
Q

Low-Output

A
  • caused by disorders that impair the pumping ability of the heart such as heart disease and cardiomyopathy
  • clinical evidence of systemic vasoconstriction (body tries to keep pressure at cold)

ex: cold, pale, cyanosis of extremities

44
Q

Frank-Starling Mechanism

A
  • increased volume of blood stretches the ventricular wall, causing cardiac muscle to contract more forcefully
  • stroke volume increases in response to increase blood volume filling the heart
  • will see state as a “curve”
45
Q

other compensatory mechanisms

A

a lot of mechanisms run 24/7 in the body

-body is constantly adjusting to maintain cardiac output

46
Q

What are some things that affect the Frank-Starling Mechanism?

A

-CAD, HTN, DCM, valvular heart disease

all of these things…

  • increase workload of heart
  • decrease ability to compensate
  • decrease contractility
  • ultimately overloading ventricles
47
Q

Why is the Frank-Starling Mechanism important?

A

allows cardiac output to be synchronized with the venous return without depending on any external regulation controls. it is right there in the heart

48
Q

Acute Pulmonary Edema

A
  • AKA: Flash Pulmonary Edema
  • (left sided - lung)
  • capillary fluid moves into alveoli
  • shortness of breath and cyanosis
  • tachycardia, cyanosis, skin moist and cool
  • confusion, stupor, air hunger

D & D exam 4 (4 decks)

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