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
A severe form of treatment for HF would be what?
A phlebotomy
What is Pulmonary Edema?
condition caused by excess fluids in the lungs making it difficult to breath
In most cases Pulmonary Edema is caused by what?
Heart problems; Heart Failure
What is Cardiogenic Pulmonary Edema?
type of PE caused by increased pressures in the heart
Causes of Cardiogenic Pulmonary Edema
- Coronary Artery Disease
- Cardiomyopathy
- Heart valve probs
- High BP
Coronary Artery Disease
The heart is weakened either due to a heart attack from a blood clot that was caught in the narrowed vessels or the narrowed arteries weakened the LV muscle
Cardiomyopathy
your heart muscle has been damaged so it may not be able to respond to conditions requiring it to work harder
What is Aortic or Mitral Stenosis?
the valves that regulate blood flow in the left side of your heart may not open wide enough
What is Aortic or Mitral Regurgitation?
that valves may not close completely, allowing blood to flow backwards through the valve
Non-Heart related causes of Pulmonary Edema
- ARDS
- High Altitudes
- Nervous system conditions
- Adverse drug reactions
- Negative pressure pulmonary edema
- Pulmonary embolism
- Viral infections
- Toxins/Smoke
- Near Drowning
Complications of Cardiogenic Pulmonary Edema
- pulmonary hypertension that leads to right sided HF
- lower extremity/abdominal swelling
- pleural effusion
- congestion and swelling of liver
- death if left untreated
What are ways to prevent pulmonary edema?
- prevent cardiovascular disease
- control high BP
- watch blood cholesterol
- don’t smoke
- eat heart healthy diet
- limit salt
- exercise
S/S of Pulmonary Edema
- dyspnea
- feeling of suffocating/drowning
- wheezing/gasping
- cold, clammy skin
- anxiety/restlessness
- cough w/ frothy, blood tinged sputum
- blue tinged lips
- rapid irregular HR
When should patients w/ Acute pulmonary edema see a doctor? S/S
- immediately
- SOB especially if occurs suddenly
- dyspnea
- bubbly, wheezing, gasping sound w/ breathing
- pink frothy sputum w/ cough
Acute pulmonary edema is considered a what?
Medical emergency
-life threatening
When should patients see a doctor w/ Chronic Pulmonary Edema see a doctor?
- breathing difficulty w/ profuse sweating
- blue/gray skin tone
- confusion
- significant drop in BP causing lightheaded, dizzy, weakness, or sweating
- sudden worsening of any symptoms
What is Aortic Stenosis?
“tight” aortic valve
-does not open all of the way
Causes of Aortic Stenosis
- bicuspid aortic valve
- age related calcification
- rheumatic heart disease
S/S of Aortic Stenosis (SAD)
- syncope
- angina
- dyspnea
- small/weak slow pulse
- Systolic Ejection Murmur
What type of murmur is heard w/ Aortic Stenosis?
Systolic Ejection Murmur
Systolic Ejection Murmur
- heard at right 2nd ICS
- feel slight vibration up into neck
- loud, hard murmur
When does an Aortic Stenosis murmur occur?
during systole
What is Aortic Regurgitation?
“floppy”/”leaky valve
-blood flows back through aortic valve into left ventricle
Causes of Aortic Regurgitation
- widening of valve
- endocarditis
- Rheumatic fever
S/S of Aortic Regurgitation
- fatigue
- syncope
- orthopnea
- SOB
- palpations
When and where is an Aortic Regurgitation murmur heard?
- early diastole
- 2nd ICS right sternal border
- soft high pitch blowing sound
What is Mitral Stenosis?
- valve is really tight and does not open completely
- decreases cardiac output
What can happen due to Mitral Stenosis?
LV can not pump all the blood needed which leads to LA becoming congested which backs up into pulmonary veins causing pulmonary edema leading to HTN leading to HF
Causes of Mitral Stenosis
- Rheumatic Fever/Heart disease
- endocarditis
S/S of Mitral Stenosis
- fatigue
- SOB
- weakness
- cough
- Right sided HF
- recurrent respiratory infections
What type of murmur is heard w/ Mitral Stenosis and where?
-4th ICS midclavicular line
-low, rumbling sound
During diastole
What is Mitral Regurgitation?
Valves do not close all the way (leaky valves)
-increase in volume in LA and decreased CO
Mitral Regurgitation causes what?
- LA enlargement
- hypertrophy of cardiac muscle
- irregular pulses/A-fib
- blood clots
When does Mitral regurgitation occur?
Systole
Where can Mitral Regurgitation be heard and how does it sound?
4th ICS MCL
loud high pitch rumbling
Systole, S1
What is mitral valve prolapse?
a condition in which the two valve flaps of the mitral valve do not close smoothly or evenly, but instead bulge (prolapse) upward into the left atrium
What would a mitral valve prolapse sound like?
Clicking sound
When would Mitral Valve Prolapse become a problem?
When it becomes accompanied w/ regurgitation
Nonsurgical Management of Valvular Heart Disease
- drug therapy
- prophylactic antibiotics
- management of A-fib
- anticoagulant
- rest
Surgical Management of Valvular Heart Disease
- balloon valvuloplasty
- direct or open commissurotomy
- mitral valve annuloplasty
- replacement procedures
When a patient receives a mechanical valve they must begin taking what?
anticoagulants
What is Infective Endocarditis?
bacterial, viral, or fungal infection enters into the blood stream affecting the heart valves
Who is most at risk for developing endocarditis?
- IV drug abusers
- had valve replacements
- experienced systemic infections (rheumatic fever)
- have structural cardiac defects
S/S of Endocarditis “PATHOGENS”
P-petechiae A-anorexia T-tired/weak H-high fever/HF O-oster's nodes G-finGernails (clubbing) E-embolic events/erythmateus N-night sweats/New cardiac murmur S-splenomegaly
What is the most reliable criteria for diagnosing endocarditis?
- positive blood cultures
- new regurgitant murmurs
- evidence of endocardial involvement by ECG
Nursing Interventions for Endocarditis
- antimicrobials/antibiotics
- anticoagulants
- balance patient activities w/ rest
Surgical Management for Endocarditis
- removing infected valve
- repairing or removing congenital shunts
- repairing injured valves or chordae tindineae
- draining abscesses
What are the 2 types of infective endocarditis?
Acute and Subacute
Who does Acute IE typically effect?
pts w/ healthy heart valves
What is the onset of Acute IE like?
Sudden and severe
Sub Acute IE
- affects patients w/ preexisting heart conditions
- S/S subtle and onset is slow
What is Pericarditis?
inflammation or alteration of the pericardium layer of the heart
Causes of Pericarditis
- illness (virus, bacteria)
- trauma (MI,heart surgery, physical)
- Autoimmune (Lupus)
- unknown-idiopathic
Acute Pericarditis
- develops for less than 6 weeks
- most common
- usually caused by virus
- sudden severe, constant pain
Chronic Pericarditis
- lasts longer than 6 months
- leads to constrictive pericarditis
What is Pericardial Effusion?
too much fluid fills around the heart in pericardial sac
A pericardial effusion can cause what?
Pericardial tamponade
Treatment for Pericardial effusion
Pericardiocentesis
Pericardiocentesis
procedure to remove excess fluid from pericardial sac
S/S of Pericarditis (FRICTION)
F-friction rub/fever R-radiating substernal pain I-increased pain in supine position C-chest pain T-trouble breathing lying down I-inspiration/coughing causes pain O-overall feeling sick N-noticeable ST segment elevation
What does a pericardial friction rub sound like?
2 balloons/sandpaper rubbing together
Nursing Interventions for Pericarditis
- assess pain
- keep in high fowler’s position
- monitor for Cardiac Tamponade
What is Cardiac Tamponade
accumulation of fluid around the heart causing increased pressure
S/S of Cardiac Tamponade
- pulsus paradoxus-drop in BP during inspiration
- JVD
- heart sounds muffled
- tachycardia
- hypotension
Causes of Cardiac Tamponade
- severe chest injury
- heart attack/aortic aneurysm
- hypothyroidism
- pericarditis
- infection
- TB
- kidney failure
- cancer/lupus
The three classic signs of Cardiac Tamponade are known as what?
Beck’s Triad
Beck’s Triad Symptoms for Cardiac Tamponade
- low BP
- muffled heart sounds
- JVD
Medications for Pericarditis
- Aspirin or NSAID
- Colchine
- Corticosteroids
- Digoxin
- Diuretic
Treatment for Cardiac Tamponade
- pericardiocentesis
- pericardiectomy
- thoracotomy
What is Rheumatic Carditis?
inflammation in all layers of the heart
Rheumatic Carditis causes what?
- impaired contractile function
- thickening of pericardium
- valvular damage
- formation of Aschoff bodies
Aschoff Bodies
small nodules in Myocardium that are replaced by scar tissue
Dilated Cardiomyopathy S/S
- syncope
- ALOC
- angina
- pulmonary edema
- fatigue
- cardiomegally
- hypotension
Dilated Cardiomyopathy
dysfunction in the heart muscles ability to contract
- heart chambers are dilated b/c decreased EF
- systolic failure
Caused of Dilated Cardiomyopathy
- genetic
- infections
- alcohol/drugs
- CAD
- chemo
- idiopathic
Hypertrophic Cardiomyopathy
genetic abnormality of muscle cell proteins
- don’t allow muscle to contract properly
- heart muscle hypertrophy which means thicker ventricles
- diastolic HF
What type of inherited disorder is Hypertrophic Cardiomyopathy?
dominant autosommal inherited
S/S of Hypertrophic Cardiomyopath
- asymptomatic
- dyspnea
- syncope
- sudden death
What type of heart murmur is heard w/ Hypertrophic Cardiomyopathy?
Systolic ejection murmur/mitral regurgitation murmur
Restrictive Cardiomyopathy
- prob w/heart muscle:scarring, infiltration, etc
- ventricles fail to relax (dilate/stretch)
- decreased output during systole
What type of Cardiomyopathy are Nitrates contraindicated?
Hypertrophic
