ch 34 heart failure

Question 1

what is considered a reduced ejection fraction

Answer 1

less than 50%

Question 2

primary risk factors HF (6)

Answer 2

• CAD
• HTN
• rheumatic heart disease
• congenital heart defects
• pulmonary HTN
• hyperthyroidism

Question 3

other risk factors HF (just for reference - 6)

Answer 3

• anemia
• smoking
• obesity
• infection
• dysrhythmias
• diabetes

Question 4

what body system will L sided heart failure affect

Answer 4

pulmonary

Question 5

what body system will R sided heart failure affect

Answer 5

systemic (all of body)

Question 6

L sided HF S+S (10)

Answer 6

• pulmonary edema
• hypoxia
• SOB
• crackles
• pink frothy sputum
• cough
• tachypnea
• orthopnea
• cyanosis
• paroxysmal nocturnal dyspnea

Question 7

R sided HF S+S (6)

Answer 7

• JVD
• hepato+splenomegaly
• ascites
• peripheral edema
• weight gain
• heart murmurs

Question 8

how does hypertrophic cardiomyopathy affect bp

Answer 8

affects diastolic bp

muscle enlarged, less room in ventricles

Question 9

how does dilated cardiomyopathy affect bp

Answer 9

affects systolic bp

stretching and thinning of muscles

Question 10

FACES of HF - when the pt should call hcp

Answer 10

Fatigue
A limited activity
Chest congestion + cough
Edema
Shortness of breath

Question 11

2 ways to diagnose HF

Answer 11

• echocardiogram (transthoracic or transesophageal)

- blood test for BNP

Question 12

what BNP is indicative of HF

Answer 12

> 100

Question 13

what type of echocardiogram is better to see ventricles

Answer 13

transthoracic

Question 14

what type of echocardiogram is better to see atria

Answer 14

transesophageal

Question 15

what does decreased cardiac output lead to (with kidneys)

Answer 15

kidneys conserve water, fluid overload

Question 16

complications of HF (4)

Answer 16

• fluid volume overload (pleural effusion, pulmonary edema)
• atrial fibrillation
• loss of atrial contraction (reduces CO by 10-20%)
• fatal dysrhythmias

Question 17

HF + ?% EF is high risk for fatal dysrhythmias

Answer 17

EF <35%

Question 18

how to treat fluid volume overload (2)

Answer 18

• loop diuretic

- O2

Question 19

how would a thiazide diuretic help treat HF (2)

Answer 19

• decreases bp

- treats fluid volume overload

Question 20

how would a ACE inhibitor or ARB help treat HF (2)

Answer 20

• decreases bp

- treats fluid volume overload

Question 21

how would vasodilators (nitrate, hydralazine) help treat HF (1)

Answer 21

-addresses CAD

Question 22

how would b blockers help treat HF (1)

Answer 22

-decreases HR

Question 23

how would positive inotropes (dobutamine, digoxin) help treat HF (1)

Answer 23

-increase force of contraction

Question 24

how would anticoagulants help treat HF (1)

Answer 24

-stroke prevention for Afib

Question 25

for what amount weight gain should pt call hcp

Answer 25

within 1 week: 3-5 lbs | overnight: 1-2 lbs

Question 26

max salt intake per day for HF pts

Answer 26

2.5 g

Question 27

S+S acute decompensated HF (8)

Answer 27

- pulmonary edema - orthopnea - dyspnea - cough - pink sputum - crackles - wheezes - increased or decreased bp

Question 28

what ethnicities develop HF at earlier age and have higher mortalities (2)

Answer 28

- black | - hispanic

Question 29

what is normal ejection fraction %

Answer 29

55-65%

Question 30

most common cause of HF in men and best way to treat it

Answer 30

ischemic heart disease (MI, CAD) | treat with ACE inhibitor

Question 31

most common cause of HF in women

Answer 31

HTN

Question 32

S+S digoxin toxicity (5)

Answer 32

- confusion - lethargy - N/V - blurred vision - yellow halos in vision

Question 33

fluid overload S+S (6)

Answer 33

- edema - ascites - JVD - S3 heart sound - crackles - hypoxia

Question 34

indications for heart transplant (4)

Answer 34

- end stage HF - severe inoperable valvular heart disease - recurrent life threatening dysrhythmias unresponsive to medical treatment or defibrillators - heart abnormalities that severely limit normal function and/or have mortality risk of 50%+ within 2 years

Question 35

absolute contraindications for heart transplant (5)

Answer 35

- 70 yo + - life threatening illness with survival of <5 years - advanced cerebral or peripheral vascular disease - active infection (including HIV) - severe pulmonary disease that will require ventilator support