CH 27: HF

Question 1

is the inability of the ventricles to pump enough blood to meet
the metabolic needs of the body.

Answer 1

heart failure

Question 2

possible disorders causing HF

Answer 2

 Coronary artery disease (CAD)
 Mitral stenosis
 Myocardial infarction (MI)
 Chronic hypertension (HTN)
 Diabetes mellitus
 Dyslipidemia
 Thyroid disorders

Question 3

the degree to which the myocardial fibers are stretched just
prior to contraction is called

Answer 3

Preload

Question 4

the degree of pressure in the aorta that must be overcome
for blood to be ejected from the left ventricle (the amount of peripheral resistance to the contraction of the ventricles)

Answer 4

Afterload

Question 5

change in heart contractility

Answer 5

inotropic effect

Question 6

drugs that increase contractility

Answer 6

positive inotropic agents

Question 7

positive inotropic agent examples

Answer 7

Epinephrine, norepinephrine, thyroid hormone, dopamine

Question 8

drugs that decrease contractility

Answer 8

negative inotropic agents

Question 9

examples of negative inotropic agents

Answer 9

beta blockers -atenolol

Question 10

most common cause of HF

Answer 10

HTN

Question 11

increases the amount of work the heart has to do to push through the pressure

Answer 11

afterload (peripheral resistance)

Question 12

increased after load results in:

Answer 12

left ventricular hypertrophy (LVH) – this weakens the heart –
resulting in fluid in the lungs

Question 13

LVH results in:

Answer 13

fluid in the lungs

Question 14

right side can weaken from increased afterload leading to:

Answer 14

peripheral edema

Question 15

pharmacotherapy for HF is now targeted at:

Answer 15

prevention and slowing the progression

Question 16

when HF begins the ventricles secrete:

Answer 16

B-type natriuretic peptide (BNP)

Question 17

therapeutic effects of digoxin (cardiac glycoside)

Answer 17

Positive inotropic effect. Cause the heart to beat more forcefully.
Lowers heart rate.
Makes contractions more efficient

Question 18

adverse effects of digoxin (cardiac glycoside)

Answer 18

vomiting,
fatigue,
anorexia,
visual disturbances such as seeing halos, a yellow-
green tinge, or blurring.

Question 19

monitoring for digoxin (cardiac glycoside)

Answer 19

MONITOR FOR DIGOXIN TOXICITY**
CHECK SERUM DIGOXIN LEVELS
Monitor for dysrhythmias with hypokalemia

Question 20

safety considerations for digoxin (cardiac glycoside)

Answer 20

NARROW THERAPEUTIC DOSE
DIGOXIN OVERDOSE CAN BE FATAL
Take apical pulse for 1 minute and note rate, rhythm, and quality
WITHHOLD FOR HR LESS THAN 60
Use of digoxin with diuretics can cause hypokalemia or hyperkalemia (depending on which kind) and
dysrhythmias
Use of digoxin with betablockers can cause
additive bradycardia
No potassium supplements unless approved by provider

Question 21

therapeutic effects of vasodilators

Answer 21

vessels and lower blood pressure – reduces preload

Question 22

increase the force of the myocardial contraction = increased
cardiac output

Answer 22

Cardiac Glycosides

Question 23

Increase the force of myocardial contraction = increased cardiac output

Answer 23

Phosphodiesterase inhibitors

Question 24

therapeutic effect of milrinone (Phosphodiesterase inhibitors)

Answer 24

Increase the force of contraction = increased cardiac contractility and vasodilates
Positive inotropic
Decrease left ventricle afterload

Question 25

adverse effects of milrinone (Phosphodiesterase inhibitors)

Answer 25

ventricular dysrhythmia, which may occur in 1 of every 10 patients taking the drug
Blood pressure is also continuously monitored during the infusion to prevent hypotension.
Less serious side effects include headache, nausea, and vomiting.

Question 26

safety and monitoring for milrinone (Phosphodiesterase inhibitors)

Answer 26

CONTINUOUS CARDIAC MONITORING for ventricular dysrhythmias
hypotension
Serious Toxicity can only take for 2 to 3 days – only given IV
Overdose causes hypotension

Question 27

**Signs and symptoms of Digoxin Toxicity:

Answer 27

abdominal pain,
anorexia,
nausea,
vomiting,
visual disturbance (halo), bradycardia,
ECG changes,
dysrhythmia,
headache,
seizure.