CMO and HF (Module 4) Flashcards
HF
heart cannot pump enough blood/O2 leading to impaired tissue perfusion
left sided HF: impaired left ventricle
right sided HF: impaired right ventricle
Left Sided HF (Systolic)
thin, weak LV cannot squeeze (impaired contractility) and doesn’t empty all the blood out
increased diastolic volume and pressure leading to decreased SV/CO/EF
causes fluid to back up into lungs (raises lung venous pressures) causing impaired gas exchange
HF with reduced EF <40%
Left Sided HF (Diastolic)
stiff/thick LV doesn’t relax enough to fill during diastole
could lead to decreased SV/CO and increased LV end-diastolic pressure at rest or during exertion, EF IS NORMAL causing back up of fluid into lungs
HF with preserved EF >50%
Right Sided HF (Systolic)
thin, weak RV cannot squeeze (impaired contractility) causing back up of fluid into venous circulation (venous engorgement)
Right Sided HF (Diastolic)
stiff/thick RV doesn’t relax during diastole to fill, causing back up of fluid into venous circulation (venous engorgement)
Cardiac Output (CO)
the amount of blood pumped from ventricles in one minute (preload and afterload)
HR times SV
Cardiomyopathy
most often results in HF; myocardium
hypertrophic
dilated (causes symptoms of LVHF)
restrictive
Preload
the amount of cardiac muscle fiber stretches just prior to contraction affected by volume
Afterload
the resistance against which the heart must eject blood volume during contraction
Stroke Volume (SV)
the volume of blood ejected with each heartbeat
Left Sided HF Findings
crackles in lungs
S3 heart sound (ventricular gallop: early sign of HF in >35 yo); rapid filling of ventricle causes vasodilation
Right Sided HF Findings
cor pulmonale (when right sided HF caused by pulmonary HTN)
peripheral edema
splenomegaly
hepatomegaly
weight gain
nausea
decrease in urine O
JVD
Stages of HF/NY Heart Association (NYHA) Classification System
used by providers to stage how bad HF is
Dilated Cardiomyopathy S/S
fatigue and weakness
HF (left sided)
dysrhythmias
systemic or PE
S3/S4 gallops
moderate to severe cardiomegaly
Dilated Cardiomyopathy Tx
treat HF symptoms
vasodilators
heart transplant
Hypertrophic Cardiomyopathy S/S
dyspnea
angina
fatigue, syncope, palpitations
mild cardiomegaly
S4 gallop
sudden death common
HF
Hypertrophic Cardiomyopathy Tx
treat HF symptoms
beta blockers
mitral valve replacement
dig, nitro and other vasodilators CI with obstructive form
obstructed
same and mitral regurg murmur and A Fib (?)
Restrictive Cardiomyopathy S/S
dyspnea and fatigue
HF (right sided)
heart block
emboli
S3/S4 gallops
mild to moderate cardiomegaly
Restrictive Cardiomyopathy Tx
treat HF/HTN symptoms
exercise restrictions
HF Labs and Diagnostics
H&H, WBC
electrolytes and creatinine
LFTs
urinalysis (proteinuria/increased specific gravity)
ferritin lvl (iron overload vs HF)
lipid panel (CAD)
BNP/B-type natriuretic peptide (helpful when symptoms are unclear in diagnosis; released in blood when ventricles are dilated with fluid overload)
dig lvl
ABGs
chest X-ray (enlarged heart, pleural effusion)
echocardiogram (EF % and valves)
cardiac catheterization
cardiac magnetic imaging
Meds Goals
decrease afterload, preload and increase contractility
digoxin: watch for signs of toxicity; anorexia, nausea, changes in mental status (especially elderly), visual disturbances and brady
Drugs that Enhance Contractility
positive inotropic drugs
for chronic HF, low dose beta blockers are most commonly used
digoxin may be prescribed to improve symptoms, thereby decreasing dyspnea and improving functional activity
Digoxin
cardiac glycoside for chronic HF with sinus rhythm and A Fib
potential benefits include increased contractility, reduced HR, slowing of conduction through the AV node, and inhibition of sympathetic activity while enhancing parasympathetic activity
many drugs like antacids interfere with absorption
Digoxin Toxicity
increased cardiac automaticity occurs with toxic digoxin lvls or in presence of hypokalemia
carefully monitor apical pulse rate and HR
monitor serum digoxin and K lvls
Other Meds
ACEi/ARBs
BBs
O2
nitrates
CCBs
hydrazine
diuretics
Cardiac Resynchronization Therapy (CRT)
biventricular pacing; similar to PM insertion, but 3 leads are used (RA, LV, RV)
paces both ventricles simultaneously; restores synchronized contraction
Ultrafiltration in HF (Aquapheresis)
removal of water and Na from pt with fluid overload
Procedures
CRT
ultrafiltration in HF
ventricular assist devices (VAD) or cardiac transplants
HF Nursing Care
prevention of exacerbations; identify symptoms
dyspnea
orthopnea
cough
hemoptysis
adventitious breath sounds
pulmonary congestion
Joint Commission Requirements
Echo LVSD <40% -> ACE/ARB required for decreased CO and ineffective tissue perfusion
smoking cessation
self management teaching
F/U appointments
med education
activity
weight and diet, fluid restrictions: daily weights are most accurate; edema is unreliable
symptoms
family/significant other support
lifestyle and habits
EOL planning
