CHF Flashcards
Heart failure (HF)
- A condition in which the heart is unable to pump blood efficiently to meet the body’s needs for oxygen and nutrients
- Can be caused by either the inability of the heart to pump (systolic dysfunction) or the inability to fill adequately (diastolic dysfunction)
Explain why older adults are at increased risk for heart failure.
- Age - Heart’s ability to contract and relax may decrease; stiffening of the heart muscle or the accumulation of scar tissue
- Chronic conditions - more likely to have major risk factors e.g. hypertension, diabetes, coronary artery disease, and valvular diseases
- Decreased compensatory mechanisms - Heart is less able to compensate for stress or increased workload
- Polypharmacy - Taking multiple medications can contribute to fluid imbalances, orthostatic hypotension, or other issues
Compare and contrast right-sided and left-sided heart failure.
LHF
- Primarily caused by HTN
- LV failure leads to blood backing up into the lungs causing pulmonary congestion and impaired gas exchange
- Manifestations: Symptoms of pulmonary congestion - dyspnea, cough, crackles in lungs, paroxysmal nocturnal dyspnea, orthopnea
RHF
- Primarily caused by LHF
- RV failure causes blood to back up into the systemic circulation, leading to venous congestion and fluid accumulation in peripheral tissues and organs
- Manifestations: peripheral edema, jugular vein distention, hepatomegaly (enlarged liver), weight gain, ascites (fluid build up in abdomen)
Explain ways in which the body attempts to compensate for decreased cardiac output that can actually worsen the symptoms of heart failure.
- Catecholamines
- Body releases catecholamines (e.g., norepinephrine) to increase heart rate and contractility
- Chronic activation leads to increased heart workload, arrhythmias, and further myocardial damage
- RAAS
- Decreased cardiac output triggers the activation of the RAAS
- Causes vasoconstriction and fluid retention via aldosterone
- Increases blood volume and pressure, thereby also increasing the heart’s workload
- Can lead to pulmonary congestion, edema, and hypertension
- Ventricular dilation and hypertrophy
- Heart attempts to compensate by enlarging (dilating) to hold more blood and thickening its walls (hypertrophy) to improve pumping efficiency
- Leads to further reduced efficiency, increased oxygen demand, and the stretching of the heart muscle
How is the New York Heart Association classification system used in heart failure care?
The NYHA classification system is used to assess the severity of heart failure and guide treatment decisions based on the patient’s symptoms and functional capacity.
- Class I
- No limitation of physical activity
- Ordinary physical activity does not cause fatigue, palpitations, or dyspnea.
- Class II
- Slight limitation of physical activity
- Comfortable at rest, but ordinary physical activity results in fatigue, palpitations, or dyspnea
- Class III
- Marked limitation of physical activity
- Comfortable at rest, but less than ordinary physical activity causes fatigue, palpitations, or dyspnea
- Class IV
- Unable to perform any physical activity without discomfort
- Symptoms of heart failure are present even at rest
Explain the role of Diuretics in management of heart failure.
- Diuretics help reduce fluid overload by increasing urine output
- Relieves symptoms such as edema, dyspnea, and orthopnea by reducing blood volume and pulmonary congestion
- Common diuretics used in heart failure include furosemide
Explain the role of ACE inhibitors in management of heart failure.
- Angiotensin-converting enzyme (ACE) inhibitors promote vasodilation and decreasing blood volume
- Lower blood pressure and afterload, improving cardiac output
Explain the role of Beta Blockers in management of heart failure.
- Block the effects of adrenaline on the heart
- Lower heart rate and reduce cardiac workload
Explain the role of Cardiac glycosides in management of heart failure.
- Helps increase contractility and slows heart rate
Define cardiac resynchronization therapy and its role in treatment of heart
failure.
Cardiac resynchronization therapy (CRT)
- A treatment for heart failure that uses a biventricular pacemaker to coordinate the contraction of the left and right ventricles
- Improves the heart’s pumping efficiency
Name one non-invasive technique clients in their homes can use to monitor early symptoms of worsening heart failure.
- Daily weight monitoring - Fluid retention may indicate worsening heart failure
