End stage heart failure Flashcards
Why does Manitoba have a high prevalence of HF?
-comorbidities (Diabetes and Hypertension) are more common
How many Canadians are living with HF?
750,000
1 in 3 Canadians are touched by HF
How many Canadians are diagnosed with HF annually?
> 100,000
Why are congestive heart failure rates on the rise?
-more people survive heart attacks and other acute heart conditions
-as people with damaged hearts live longer, they become more susceptible to heart failure
Define heart failure
complex clinical syndrome resulting from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood
–>heart is unable to pump an adequate amount of blood to meet the body’s metabolic demands (inadequate CO)
What are the characteristics of heart failure?
What are the classifications of HF?
How is HF identified?
by assessing left ventricle function usually by echocardiogram
What is cor pulmonal
Describe the NYHA classifications of HF
Class I– no symptoms and no limitation of activity (but low EF on echo)
Class II
Class III
Class IV
Describe NYHA grade IV HF
dyspnea at rest
often have hypotension
clinical features of CHF
typically EF <20%
What are the signs and symptoms of HF?
-shortness of breath (dyspnea)
-swelling of feet and legs (edema)
-chronic lack of energy
-difficulty sleeping at night due to breathing problems (PND)
-swollen or tender abdomen with loss of appetite
-cough with frothy sputum
-increased urination at night (nocturia)
-confusion and/or impaired memory
What is a normal ejection fraction?
50-60%
below 40% is concerning
What is PND?
proximal nocturnal dyspnea
What is the mortality rate for HF?
-absolute mortality ~50% within 5 years of diagnosis
-survival rate for HF approximately equal to malignancy
-survival time decreases with repeated hospitalizations
How does HF present differently from cancer?
-more edema
-predicting death more difficult
-mistaken belief condition more benign than cancer
-no local pressure effects
-less anemia
Which class of diuretics is proven to be effective for HF?
Spironolactone
When would Eplerenone be used?
when Spironolactone is not tolerated
What is a common SE of Spironolactone that makes young men not want to continue it’s use?
boob development (what is the actual word for this???)
Why are opioids prescribed for HF?
-analgesic for angina
-first line therapy for dyspnea
-helps to balance the supply and demand of oxygen in a failing heart
What does ARNI- Angiotensin receptor-neprilysin inhibitor do?
-dilates the vessels for longer to increase oxygen supply
What is a SGLT2i for when prescribed to a HF patient?
“flozins”
-increases urine output
What is Ivabradine used for?
-second line
-used with beta blocker
-helps to lower heart rate when beta blockers by themselves are not effective enough
What are some self-care maintenance activities for HF?
-decrease sodium intake
-no alcohol
-quit smoking
-decrease strenuous activities
-weigh themselves every day
-fluid restriction
Describe the Nuclear Stress Test (MIBI)
What should the nurse be monitoring when the patient is on furosemide?
potassium
