Complications from Heart Disease Flashcards
What is heart failure?
inability of the heart to pump sufficient blood to meet the needs of the tissues
Can right sided HF cause left sided HF?
No, but left sided HF can cause right sided HF
What is Left Sided HF?
Congestive HF
Blood flows back into lungs and will start showing pulmonary symptoms
What are the 2 types of LT sided HF?
Systolic HF
Diastolic HF
Causes of LT sided HF
- HTN
- CAD
- valvular disease
Systolic Heart Failure
alteration in ventricular contraction characterized by weakened heart muscle
Diastolic Heart Failure
stiff and non-compliant heart muscle, making is difficult for the ventricle to fill
.S/S of Left Sided HF (DROWNING)
D-dyspnea R-rales/crackles O-orthopnea W-weakness N-nocturnal paroxysmal dyspnea I-increased HR N-nagging cough (frothy/bloody) G-gaining weight
Causes of Right Sided HF
- Left ventricle failure
- Right ventricular MI
- pulmonary HTN
S/S of Right sided HF (SWELLING)
S-swelling of hands, legs, liver W-weight gain E-edema L-large neck veins L-lethargy I-irregular HR (afib) N-nocturia G-girth
What causes High Output Heart Failure?
increased metabolic needs of hyperkinetic conditions
Types of Conditions that would lead to High Output HF
- septicemia
- anemia
- hyperthyroidism
Systolic HF causes the sympathetic nervous system to stimulate the release of what?
epinephrine and norepinephrine
Sympathetic stimulation will also cause vasoconstriction of what?
- skin
- GI tract
- kidneys
A decrease in renal perfusion b/c of low CO and vasoconstriction causes the kidneys to release what?
Renin
Renin promotes the formation of what?
Angiotensin 1
Angiotensin I is converted to what?
Angiotensin II
What does Angiotensin II do for the body?
- potent vasoconstrictor
- stimulates the release of aldosterone
Aldosterone secretion results in what?
Retention of sodium and fluid, excretion of potassium, and stimulation of thirst
-leads to fluid volume overload in HF
Interventions for Impaired Gas Exchange
- ventilation assistance
- positioning
- oxygen
Interventions for Decreased Cardiac Output
- improve/increase cardiac pump effectiveness
- Hemodynamic regulation
- drugs that reduce afterload
What are some drugs that will reduce the Afterload?
- ACE inhibitors
- ARB
- human B-type natriuretic peptides
Interventions that will reduce Preload are?
- nutrition therapy
- drug therapy
- enhancing contractility
What drugs might be used to reduce preload?
Diuretics and venous vasodilators
What drugs will enhance contractility?
- digoxin/other inotropic drugs
- beta-adrenergic blockers
What are some nonsurgical options for treating HF?
- continuous positive airway pressure
- cardiac resynchronization therapy
- gene therapy
What are some surgical management techniques for HF?
- heart transplant
- ventricular assist device
- partial left ventriculectomy
- endoventricular circular patch
- acorn cardiac support device
- myosplint
What happens first with a heart transplant?
- Recipient is placed on cardiopulmonary bypass and their heart is removed
- the posterior walls of the left and right atria are left
How is the recipients new heart attached?
Left atrium of donor heart is anastomosed to recipients posterior atrial wall, other atrial walls, the atrial septum, and the great vessels are joined
Activity Intolerance Interventions
- balance activity and rest
- naps to restore energy
- recognize limits
- conserve energy
- adapt lifestyle to changes
- report adequate endurance
What are the causes of Heart Failure? think F.A.I.L.U.R.E.
F-faulty heart valves A-arrhythmia's I-infarction L-lineage (family hx) U-uncontrolled hypertension R-recreational drug use E-evaders (infections)
What is the problem w/ Left Sided Systolic HF?
The left ventricle is having problems w/ contraction which causes low rejection fraction
What is ejection fraction?
amount of flood that fills in left ventricle that will be pumped out
used to diagnose HF
Normal Ejection Fraction
> 50%
What is the problem w/ Left Diastolic HF?
The ventricle is unable to fill properly because it has become too stiff, but contracts normally
Drug Mnemonic “Always Administer Drugs Before A Ventricle Dies”
A-Ace Inhibitors A-ARB's D-diuretics B-Beta Blockers A-anticoagulants V-vasodilators D-Digoxin
ACE Inhibitors (end in “pril”)
- Usually first line of treatment
- blocks the conversion of Angiotensin I to Angiotensin II
- causes vasodilation and secretion of sodium
Side Effects of ACE Inhibitors
- hyperkalemia
- dry nagging cough
- hypotension
ARB’s (end in “Sartan”)
- block Angiotensin II receptors
- vasodilation
- secretes sodium
Diuretics (Loop or Potassium Sparing)
- helps decrease fluid and sodium retention
- helps the heart pump easier
- will increase urine output
- monitor BUN and Creatinine
Loop Diuretic
Lasix
-potassium wasting
Potassium Sparring Diuretic
Aldactone
- will keep potassium
- monitor w/ ACE Inhibitors and ARB
- limit foods high in potassium
Beta Blockers (end in “Lol”)
- work by blocking the norepinephrine effects on the heart muscle
- slow down HR
- negative inotropic effect
Examples of Potent Diuretics
- Bumex
- Lasix
- Edicrine
- Demidex
Examples of Mild Diuretics
- midamar
- aldactone
- dyrenium
Side Effects of Beta Blockers
- bradycardia
- mask hypoglycemic side effects
- respiratory probs
- do NOT take w/ grape fruit juice
Digoxin
- Positive Inotropic increases hearts ability to contract stronger
- Negative Chronotropic causes the heart to beat slower
- allows heart to rest and pump more blood
What increases the risk for Dig Toxicity?
Hypokalemia
Normal Digoxin Level
0.5-2
S/S of Dig Toxicity
- N/V
- visual changes = Halo effect
- bradycardia/dysrhythmias
- anorexia
What is the antidote for Digoxin?
Digibine
Before giving Digoxin you should always check what first?
The HR is 60 bpm or more
What is a normal calcium level?
8.5-10.5
