Congestive Heart Failure

Question 1

What is Heart failure?

Answer 1

-A condition where the heart is not able to pump well enough to meet the bodies needs
-It can involve right, left, or both sides of the heart
-The left side of the heart usually fails first since it has to pump aginist greater resistance than the right ventricle

Question 2

Some common conditions that make Heart failure more likely

Answer 2

-Arrhythmia
-CAD
-Diabetes Mellitus
-Pharmacy and thyrotoxicosis
-Pulmonary embolism (can cause right side heart failure)
-MI

Question 3

Right side heart failure

Answer 3

-When the ability of the RV to contract is inspired (I.e. RV MI, pulmonary embolus)
-Blood pools in the RV and eventually the RA causing pressure and congestion in the vena cavae and systemic circulation

Question 4

Left sided heart failure

Answer 4

-Blood backs into LV due to poor LV function
-As pumping ability is decreased blood is not fully pumped out of the LV
-Blood backs up from the LA to pulmonary veins and can eventually cause pulmonary edema
-Without treatment the blood will back up into RV and cause right sided heart failure as well

Question 5

Common causes of LV failure

Answer 5

-Aortic or mitral valve stenosis or regurgitation
-Hypertension
-LV MI

Question 6

Forward failure

Answer 6

-caused by increased afterload (I.e. in hypertension)
-When afterload increases, the LV can’t eject as much blood as usual, therefore there is decreased flow to the vital organs

Question 7

Backward failure

Answer 7

-Results when the LV fails to empty completely, leftover blood then accumulates in the LV and lungs can lead to right sided heart failure

Question 8

Acute heart failure

Answer 8

-S and S are new
-Typically Na+ and water retention have not occurred yet

Question 9

Chronic heart failure

Answer 9

-S and S have been present for an extended period
-Fluid volume is increased

Question 10

Heart failure primary prevention

Answer 10

-Primary prevention = modifying risk factors such as:
-Salt intake
-Weight
-Lack of exercise
-Smoking
-Stress

Question 11

Heart failure secondary prevention

Answer 11

-Treating CAD
-Preventing MI
-Treating anemia
-Treating infections

Question 12

Heart failure early signs

Answer 12

-Exertional, nocturnal or paroxysmal Dyspnea
-Fatigue
-Hepatomegaly

Question 13

Heart Failure Late signs

Answer 13

-Anorexia
-Chest tightness
-Cyanosis
-Dependent edema
-Diaphoresis
-Dulness over lung bases
-Hemoptysis
-Hypotension
-Inspiratory crackles
-Hepatomegaly
-Narrow pulse pressure
-Nausea
-Oliguria
-Pallor
-Palpitations
-Pitting ankle edema
-S3
-Decreased LOC
-Tachypnea
-Unexplained steady weight gain

Question 14

Goals in management of heart failure

Answer 14

1. Decreasing intravascular volume
   2.Decreasing venous return
2. Decreasing after-load
3. Improving oxygenation and gas exchange
4. Improving cardiac function
5. Reducing anxiety

Question 15

Improving pump preformance

Answer 15

-Cardiac glycosides
-Other positive inotropics

Question 16

Reducing cardiac workload

Answer 16

-Vasodilators
-Anxiety reduction
-Rest
-Wt reduction

Question 17

Controlling salt and water retention

Answer 17

-Diuretics
-Low sodium diets
-Mechanical fluid removal

Question 18

Increasing oxygenation

Answer 18

-Oxygen therapy

Question 19

Collaborative Management; Acute CHF

Answer 19

-Treat underlying cause
-High Fowler’s position
-O2
-Cardiac monitor and O2 sat
-Morphine, lasix, nitroglycerin, inotropic therapy
-Vs q15min-q1h
-Daily weights
-Pt teaching

Question 20

Collaborative Management; Chronic CHF

Answer 20

-Treat underlying cause
-O2 therapy
-Rest
-Daily weights
-Sodium restricted diet
-Pt teaching

Question 21

Diagnostics; Heart failure

Answer 21

-History and Physical Assesment
-Determination of underlying cause
-CXR
-Echocardiography
-ECG
-Cardiac catheterization

Question 22

Complications of heart failure

Answer 22

Most common are;
-Arrhythmias
-Pulmonary edema
-Cardiogenic shock

Question 23

Patient teaching: heart failure

Answer 23

-Key points
-Diet
-Weight loss
-Medications
-Activity levels
-S + S