CHF Flashcards
What is the definition of congestive heart failure?
Inability of the myocardium to pump sufficient blood to the tissues of the body to meet metabolic demands
What does aldosterone do?
Tells the kidneys to retain sodium and water
What happens when there is a drop in BP?
Compensatory vasoconstriction and reflex tachycardia
What is dangerous about having an enlarged heart?
Lung can’t fully expand/pressure is being put on the lungs from the heart
How much does 1L of fluid weigh?
1 kg/2.2 lb
What is the etiology of CHF?
Anything that induces chronic increased volume/pressure/metabolic demand on myocardium
Ex: HTN, Coronary heart disease, Idiopathic cardiomyopathy, Valvular heart disease, Thyrotoxicosis, anemia, hypoxia
What is idiopathic cardiomyopathy?
Enlargement of the heart with no known cause
What is cardio output?
Volume of blood in liters pumped by the heart in 1 min
What is cardiac index?
CO adjusted for BSA
Where does the afterload of the LV comes from?
The aorta
Constricted aorta -> high afterload
Where does the afterload of the RV come from?
The pulmonary artery
Where does central venous pressure come from?
RA
What is a normal CVP (preload RV)?
2-8 mmHg
What is a normal PAWP (preload LV)?
6-12 mmHg
What is a normal SVR (afterload LV)?
800-1200 dynes/sec/cm
What is a normal PVR (afterload RV)?
<250 dynes/sec/cm
How should a nurse respond to a high CVP?
Taking off fluid because there’s overload
How should a nurse response to a low CVP?
Isotonic solution
What is PAWP?
Pulmonary artery wedge pressure
Camera inserted with a deflated balloon
Pressure measured when you insert a pulmonary catheter with a balloon into the pulmonary artery
Looking at workload of the left side of the heart
What is SVR?
Systemic vascular resistance
Afterload of LV
What could a high SVR indicate?
Stenosis or vasoconstriction pressent
What could a low afterload/SVR indicate?
Vasodilation
What is PVR?
Pulmonary vascular resistance
Afterload of RV
In a normal heart, ___ and ___ are reflective of each other
CVP/PAWP
What is cardiac output?
HR x SV
What can lead to increased preload?
Aortic regurgitation
Ventricular septal defect
What can lead to increased afterload?
(Leftover volume)
Aortic stenosis
HTN
What can lead to decreased contractility?
MI
Cardiomyopathy
What can cause systolic HF?
Impaired contraction (MI) Increased afterload (HTN) Mechanical abnormality (valve disease)
What is a hallmark sign of systolic HF?
Decreased LV EF
What is the EF in systolic HF?
<45%
Who is more commonly affected in systolic HF?
Men>women
What can cause diastolic HF?
Stuff ventricles, leading to high filling pressure LVH secondary to HTN Myocardial ischemia Valve disease Cardiomyopathy
What are 2 hallmark signs of diastolic HF?
Decreased stroke volume and CO
HF with normal EF
Who is more commonly affected in diastolic HF?
Women>men
What are 3 compensatory mechanisms for CHF?
^ sympathetic adrenergic activity
^ preload secondary to activation of renin-angiotensin-aldosterone system
Ventricular hypertrophy
What are symptoms of left-sided heart failure?
Fatigue Edema Weight gain Cough Dyspnea Sleeplessness Angina Palpitations
What are symptoms of right-sided heart failure?
Fatigue Edema Dyspnea in extreme late-stage Sleeplessness Angina Palpitations
How do you manage HF?
Lifestyle mod
Symptom monitoring
What are pharmacological treatments for HF?
ACEIs Diuretics Beta blockers Digoxin/Lanoxin ARBs Morphine Anticoagulants
What are ACEIs and what do they do?
Angiotensin converting enzyme inhibitors
“pril” drugs”
Prevent AGT II from forming -> lower BP
What are some examples of diuretics?
Thiazides and loops
HCTZ or furosemide/Lasix
What are beta blockers?
“olol” drugs
What are Digoxin/Lanoxin and what do they do?
Positive inotrope
Decrease HR, increase contractility to decrease workload and O2 consumption
*Watch for low K+/HR
What are ARBs and what do they do?
Angiotensin II receptor blockers
“sartan” drugs
Lower BP
What will you see in left-sided HF?
Pulmonary edema SOB Cough Sleeping with pillows Pink, frothy sputum if there’s flash pulmonary edema
What will you see in right-sided HF?
Peripheral edema
Ascites
JVD
