Congestive Heart Failure

Question 1

what is congestive heart failure?

Answer 1

aute or chronic and progressive reduction in the heart ability to pump blood through body to meet demands of homeostasis

caused by underlying conditions that compromise pumping action of heart, resulting in heart failure and inadequate perfusion (common acute cause is MI, chronic causes r hypertensions, CAD, COPD, cardiac valve damage, arrhythmias (dysrhythmias) and cardiomyopathy

Question 2

risk factors for congestive heart failure?

Answer 2

advanced age, heart disease, hypertension, atherosclerosis, and diabetes

Question 3

s/s of congestive heart failure?

Answer 3

Normal s/s - ankle swelling, and shortness of breath with exertion, cardiac and respiratory rates increase, pt becomes anxious

advanced s/s - SOB at rest, fatigue and limb weakness, neck vein swelling, rales (wet, cracling lung noise), pulmonary edema, cyanosis and abn heart sounds, ZR side of ehart failure = liver and spleen enlarge + peripheral edema, L side CHF = pulmonary congestion and more pronounce respiratory difficulties

Question 4

how to diagnose CHF?

Answer 4

diagnose - physical exam, history, imaging w/ ECG, chest x-ray, and echocardiography, catheterization

Question 5

how to treat CHF?

Answer 5

• cant be cure or reversed, only relieve symptoms and reduce stress on heart
• correct underlying causes, meds, restriction of salt and water, modify activities and lifestyle
• meds include diuretics, improve cardiac ouptput, antihypertensivesm antiarrhythmics and meds to slow heart rate
• ACE inhibitors and ARBs to increase blood flow, diuretics, vasodilators, aldosterone antagoniists, digoxin, intake of fluid and sodium is restircted, special pacemakers, defibrillators, or in extreme cases- heart transplant

Question 6

What is shock?

Answer 6

life-threatening condition in which blood pressure drops too low to sustain life.

caused by any condition that reduces the heart’s ability to pump effectively or decrease venous return

low bp means not enough blood supply to cells = dead cells and damage

Question 7

hat are the major types of shock?

Answer 7

cardiogenic (CARDIAC ARRHYTMIAS AND MI)
hypovolemic (Hemorrhage, trauma, surgery, extensive burns)
anaphylactic (allergy)
septic (toxins from bacteria)
neurogenic shock (damage to CNS)

Question 8

What happens when a baby takes its first breath after birth?

Answer 8

newly expanded lungs initiate a switch from placental to pulmonary oxygenation of the blood (placental uses ductus arteriosus)

cord clamping and removal of palcntal circulation increases pressure in left ventricle, decrease in pressure in right and left atrial (= closes the formaen ovale)

Question 9

What is congenital heart disease?

Answer 9

Genetical, environmental, and chromosomal changes that alter the development of the heart

occurs in 8 out of 1000 infants

Question 9

What is congenital heart disease?

Answer 9

Genetical, environmental, and chromosomal changes that alter the development of the heart

occurs in 8 out of 1000 infants

Question 10

disease associated with Congenital heart disease

Answer 10

parents with histroy of congential heart disease
infants w/ chromosomal abnormalities like Down syndrome or Turner’s sundrome
Maternal diabetes, congenital rubella and maternal durg and alc abuse

Question 11

What is tetralogy of Fallot?

Answer 11

one of the most serious congenital heart defects

4 abnormalities:
(1) ventricular septal defect
(2) pulmonary valve stenosis
(3) dextroposition (displacement to right) aorta that crosses the interventricular septum
(4) hypertrophy of the right ventricle

Question 12

What are the maternal risk factors for Tetralogy of Fallot?

Answer 12

history of rubella, poor nutrition, alcohol abuse,
history of diabetes, and maternal age over 40
genetic disorders like down syndrome

Question 13

Symptoms of tetralogy of fallot?

Answer 13

blue babies at birth
s/s of hypoxia: tachycardia, tachypnea, dyspnea and seizures (bone marrow hypoxia causes polycythemia, increased total RBC mass)
difficulty feeding
failure to gain weight
poor development
cyanosis that becomes more pronounced during feeding
crying, or defecation
fainting
sudden death
clubbing of the fingers
squatting during episodes of cyanosis to relieve breathlessness caused by hypoxia

Question 14

how to treat tetralogy of fallot?

Answer 14

surgical repair of the defects to increase blood flow to the lungs, path the ventricular septal defect, open the narrowed pulmonary valve and close any abn connections between the aortal and pulmonary artery

Question 15

What is transposition of the great arteries?

Answer 15

where aorta and pulmonary artery connect to the wrong ventricle

the pulmonary artery is attached to the left ventricle, and the aorta is attached to the right ventricle = blood flow in the lungs and in the body occurs independently

Deoxygenated blood returns to the right heart and is pumped to the aorta, which pumps blood into the systemic circulation

The left heart receives blood from the lungs and then pumps
the blood back to the lungs

etiology is unknown, most likely from chromosomal abnormalities and environmental conditions like maternal infections and mother’s use of certain drugs durigngestation

Question 16

symptoms, diagnosis and treatment of transposition of the great arteries

Answer 16

s/s - cyanosis, SOB, poor feeding, and clubbing of the fingers, tachypnea

diagnose - physical exam, pt history, palpatation of neck vessels and ausculatation for bp and murmurs, chest radiography, blood tests, cardiac catherization, ECG, echocardiographu, prenatal ultrasonography

if diagnosed before birth - prostaglandins to maintain ductus arteriosus and after birth corrective surgery

treatment - close septal defects, reconstruct or replace valve, repair or join blood vessels, meds to strengthen and regulate heartbeat

Question 17

What are septal defects?

Answer 17

Between 2 atrias (artial septal defect [ASD]) or between 2 ventricles (ventricular septal defect [VSD])

Question 18

how to diagnose + treat septal defects?

Answer 18

no symptoms but a large atrial septal defect can overload the right ventricle using it to enlarge and weaken

diagnose by the presence of heart murmur on physical exam, large defects need surgery

Question 19

What is patent ductus arteriosus?

Answer 19

at birth ductus arteriosus is supposed to closes bc if the ductus remains open blood intended for body flows from the aorta to the lungs = overloading pulmonary artery but in PDA it doesnt
- circulation of oxygen is compromised bc abn opening is a shunt allowing oxygenated blood to recirculate through lungs
- detected when “machinery” murmur is heard on ausculation and palpitation reveals a thrill
- infant’s growth and devleopment may be slowed, various signs of heart failure may be present
abt 3000 have it in US yrl

Question 20

how to treat PDA?

Answer 20

use anti-inflammatory meds and antiprostaglandin or ibuprofen to close PDA and and antibiotics to prevent endocarditiis

may need transcatheter procedure or surgery to close PDA

Question 21

What is the coarctation of the Aorta?

Answer 21

• narrowed aoritc lumen, causing partial obstruction of flow of blood through aorta
• congential narrowing of the aorta that can occur almost anywhere along the aorta (most commonly near ductus arteriosus)
• can lead to increased left ventricular pressure and workload, resistance to the left ventricle, decreased bp distal to narrowing & heart failure
• often associated w/ Turner syndrome

Question 22

what are the s/s of aortic coarctation and how to diagnose and treat?

Answer 22

s/s r evident shortly after birth or may not surface until adolescnece

s/s - dizziness, SOB, cold legs, L ventricular fialure w/ pulmonary edema, pale and cyanotic w/ weakness, tachycardia, systemic bp is elveated in arms but decreased in lower extremities
Diagnoses - detection of a characteristic murmur imaging w/ CT, echocardiography and ultrasound
Treatment - surgical enlargement of the aorta lumen

Question 23

cardiovascular disease is the leading cause of death in _________________________________

Answer 23

the leading cause of death in men and women 65+

Question 24

Hypertension occurs in ___________ to ________ of people over age 65

Answer 24

1/2 to 2/3

Question 25

what is the most common hospital discharge diagnosis among older adults in US?

Answer 25

heart failure

Question 26

What occurs with age in the heart?

Answer 26

• blood pressure and left ventricular mass increase
• ventricular filling, heart rate and cardiac output, exercise capacity, and reflex responses of heart rate decrease
• Cellular, enzymatic, and molecular changes in the arterial
  vessels lead to arterial dilation, thickening of the arterial intima, and vascular stiffness.
• CV system is less able to respond to increases in workload and stress

Question 27

What is an atrial septal defect?

Answer 27

• abnormal opening between R and L atria
• blood generally shunts from L to R in all ASDs
• small defects = fatigue, SOB, frequent respiratory tract infections
• large defect = cyanosis, dyspnea, and syncope
• classic systolic cardiac murmur can be heard with a stethoscope
• often associated w/ prematurity and PDA
• close w/ surgical repair

Question 28

What is Cor pulmonale + s/s, etiology?

Answer 28

• aka right-sided heart disease
• results in enlargement of R ventricle as a sequela of primary lung disease
• s/s r dyspnea, distended neck veins, edema of extremities, liver is enlarged and tender
• caused by acutre or chronic pulmonary disease and pulmonary hypertension bc it increases pulmoary bp = right ventricles hypertrophy
• chronic hypoxemia = bone marrow produce increased number of RBCs which can increase viscosity of blood

Question 29

how to diagnose and treat cor pulmonale?

Answer 29

diagnose - history of pulmonary disease and hypoxia, pt respiratroy status and cardiac status r assessed for neck vein distention and peripheral edema, chest radiographic studes and EECG reveal pulmonary congestion and R side heart enlargement and ECG frequently show arrhthymias, elevated RBC

treat - reducing hypoxemia, bronchodilators, supplemental oxygen, bed rest, digitalis preparations to strenghten and slow heartbeat, diuretics, antiocoagulants, phlebotomy (surgical puncture of vein to withdraw blood), low-salt diet

Question 30

What is pulmonary edema + s/s and etiology?

Answer 30

• condition of fluid shift into extravascular spaces of lung
• s/s r dyspnea and coughing, orthopnea, increased cardiac and respiratory rates, bloody, frothy sputum, bp falls, skin becomes cold and clammy
• caused by left-sided heart failure, mitral valve disease, pulmonary embolus, systemic hypertension, arrythmias and renal failure, head trauma, drug overdose exposure to high altitudes

Question 31

how to diagnose and treat pulmoanry edema?

Answer 31

diagnose - clinical picture of dyspnea, orthopnea, bloody, frothy sputum, diminshed breath sounds, rales, rhonchi, wheezing, arterial blood gas for reduced oxygen saturation, increased carbon dioxide retention, increased bicarbonate levels, decreased pH of blod, chest radiographs

treat - Fowler position, oxygen therapy, diuretics, IV vasodilators, nitroglycerine or nitroprusside, morphine sulfate to induce venous dilation, beta2-adrenergic drugs to dilate the bronchiles and to control bronchial spasms