EXAM 3: CHF Flashcards
What is CHF
Inability of the heart to provide sufficient blood to meet the O2needs of tissues and organs
dystolic dysfunction
Defect in ventricular filling
systolic dysfunction
Defect in ventricular ejection
Ejection fraction is defined as
amount of blood pumped by the left ventricle with each heartbeatand measures the strength of the heart
Normal EF
60-65
Most common reason for hospital admission in adults for CHF is over the age of…
65 years
American Heart Association (AHA) estimates that more than ______ new cases of HF per year
650,000
Causes of HF include:
Myocardial Disease: Cardiomyopathies
Congenital Heart Defects- VSD, ASD
Constrictive Pericarditis- bag sack around the heart, prevent the heart from doing its job
Valvular Heart Disease: Stenotic Valvular Disease & Aortic insufficiency
Increased Pressure Work- Systemic HTN
Pulmonary HTN, Coarctation of Aorta= most common in Peds
Increase Volume Work- AV Shunt, Excessive IV Fluids**- extra IV fluids, extra blood volume Ex: EJ of 15; 100cc/hour IV; making the EJ work harder than it’s suppose to; keep monitoring for the types of HF.
Increased Perfusion Work
Thyrotoxicosis; excessive releases of T3 and T4
Anemia
Name 2 Natriuretic peptides
Atrial Natriuretic Peptide (ANP)
Brain [Ventricles] Natriuretic Peptide [BNP]
Out of the 2 natriuretic peptides which one can be measured in the hospital?
BNP
Which test confirms that patient is suffering from CHF?
Echocardiogram
counterregulatory mechanisms of NAP
- Increase GFR and diuresis
- Excretion Na+ (naturesis)
- Vasodilation and decreased BP
- Inhibition of aldosterone and renin secretion and interference with ADH release.
What does Nitric Oxide and prostaglandin released from endothelium do?
Relaxes the arterial smooth muscle, resulting in vasodilation and decreased afterload
Complications of HF
- Pleural Effusion- fluid outside the lungs but inside the thoracic cavity; when liver fails
- Dysrhythmias- primary source of impulse SA node (located-RA)
- Left Ventricular Thrombus- left side fails blood accumulated to the lungs
- Hepatomegaly
- Renal Failure
Which diagnostic studies is used for BNP screening test?
Blood Work
Which of the following are screening tests for CHF? Select all that apply
a. Echo b. BNP c. ECG d. CXR
B, C, D
Why are beta blockers used for CHF? (the purpose of it)
lower the BP and slows the HR; have direct effect of dilating the blood vessels; prevents it from getting worse
Which medication should you NOT give for CHF
diltiazem./verapamil
Purpose of atenolol for CHF? purpose of why its given
protects the heart; slows the HR only
Treatment for HF
-Diet
-Lifestyle changes
-Combination Drugs
Vasodilators, Diuretics, Inotropics (Enhances of cardiac contractility)
Indications for heart transplantation
End-stage HF refractory to medical care
Severe, decompensated, inoperable, valvular heart disease
Recurrent life-threatening dysrhythmias not responsive to maximal interventions, including defibrillators
Any other heart abnormalities that severely limit normal function and/or have a mortality risk of more than 50% at 2 yr
Absolute contraindications
Chronologic age over 70 yr or physiologic age over 65 yr
Life-threatening illness (e.g., malignancy/cancer) that will limit survival to <5 year despite therapy
Advanced cerebral or peripheral vascular disease not amenable to correction
Active infection, including HIV infection
Severe pulmonary disease that will likely result in the patient being ventilator dependent after transplant
Relative contraindications for heart transplantation (maybe you will get the heart)
Severe obesity
Psychologic impairment
Active substance abuse (e.g., alcohol, drugs, tobacco)
Uncontrolled diabetes with vascular and neurologic complications
Irreversible liver or kidney dysfunction not explained by HF
Evidence of noncompliance with accepted medical practices
Lack of social support network that can make long-term commitment for patient’s welfare
Unrealistic expectations by the patient or caregiver regarding transplant, its risks, and its benefits
Patho of HF
HF–> decrease SV–> Sympathetic Circulatory Reflexes and vasoconstriction which will Decreased Renal Blood Flow–>decrease in RAAS Salt and H2O retention, increase SV compensated HF–> increase in HR, Cardiac Contractility, ANP, BNP release which will decrease BP
Decompensated HF–> Overfilling of the ventricles and circulation decreased SV and development of peripheral and pulmonary edema; decrease diastolic filling time decreased SV; increased after load
increased pressure work
RSHF
Swelling of hands, legs, liver Weight gain Edema Lethargic Large neck vein (JVD) Increase HR Nocturia Girth (Ascites)
LSHF
Dyspnea Rales= crackles Orthopnea Weakness Nocturnal paroxysmal dyspnea Increase HR Nagging cough Gaining weight
4 properties of cardiac conduction system
automaticity- initiate an impulse spontaneously and continuously
excitability- electrically stimulated
conductivity- transmit an impulse along a membrane in an orderly manner
contractility- respond mechanically to an impulse
ECG has 12 recording leads
Bipolar positive and negative
leads I, II, and III
ECG has 12 recording leads
Unipolar positive
leads aVR, aVL, and aVF
ECG has 12 recording leads
Precordial Unipolar leads (V1 through V6)
V1: 4th intercostal space at the right sternal border
V2: 4th intercostal space at the left sternal border
V3: midway between V2 and V4
V4: 5th intercostal space, left midclavicular line
V5: 5th intercostal space, left anterior axillary line
V6: 5th intercostal space, midaxillary
Description of the P wave
0.06-0.12 sec
PR interval
0.12-0.20
T wave
0.16 sec; ventricular repolarization; should be upright
ST segment
represents the time between ventricular depolarization
diastole repolarization
sinus bradycardia causes
- may be a normal sinus rhythm in aerobically trained athletes and in some people during sleep
- Carotid sinus massage, Valsalva maneuver, hypothermia, increased intraocular pressure, vagal stimulation, and certain drugs (e.g., β-blockers, calcium channel blockers)
- Common disease states associated with sinus bradycardia are hypothyroidism, increased intracranial pressure, and inferior myocardial infarction (MI)
sinus bradycardia tx
- IV atropine
- If its ineffective then give dobutamine or epinephrine to speed the HR
- permanent pacemaker therapy is needed
sinus tachycardia causes
-Physiologic and psychologic stressors such as exercise, fever, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemia, myocardial ischemia, heart failure (HF), hyperthyroidism, anxiety, and fear
sinus tachycardia tx
- first treat underlying cause such as fever, pain, anxiety
- clinically stable patients= vagal maneuvers
- In addition, IV βB, adenosine, CCB such as (e.g., diltiazem [Cardizem]) can be given to reduce HR and decrease myocardial O2 consumption?
- In clinically unstable patients, synchronized cardioversion is used
Causes of PAC
-can result from emotional stress or physical fatigue or from the use of caffeine, tobacco, or alcohol
hypoxia
-electrolyte imbalances and disease states such as hyperthyroidism chronic obstructive pulmonary disease (COPD) and heart disease, including CAD and valvular disease
PAC tx
- treat underlying cause such as caffeine or sympathomimetic drugs may be needed
- β-Blockers may be used to decrease PACs
PSVT/ SVT tx
- vagal stimulation
1) IV adenosine (drug of choice)
2) BB, CCB, amiodarone
3) synchronized cardioversion if the pt becomes hemodynamically unstable
Atrial flutter tx
- radiofrequency catheter ablation (tx of choice)
- BB, CCB, amiodarone
Emergency- electrical cardioversion
PSVT HR and rhythm
- HR is 150 to 220 beats/minute and rhythm is regular or slightly irregular
- P wave is often hidden in the preceding T wave
- PR interval may be shortened or normal
- QRS complex is usually normal
Manifestations of PSVT
Hypotension
Palpitations
Dyspnea
Angina
prolonged episode of PSVT
decrease CO, decrease SV
recurring, regular, sawtooth-shaped flutter waves that originate from a single ectopic focus in the right atrium or, less commonly, the left atrium
atrial flutter
Atrial flutter is associated with
CAD, Hypertension, Mitral valve disorders
Cor pulmonale, Cardiomyopathy
Pulmonary embolus
Chronic lung disease
hyperthyroidism
Use of drugs such as digoxin, quinidine, and epinephrine
atrial flutter rate
rate is 200 to 350 beats/minute
Atrial flutter rhythm
-regular and ventricular rhythm is usually regular
Prevention of HF
Reduce signs and symptoms
Reduce fluid overload
Improve exercise tolerance
Prolong life
RSHF management
- 2 pillows
LSHF management
- sticking head out the window, windows open
- sitting upright
- left lateral position
If artifact occurs
check the connections in the equipment and make sure they’re all placed together
The dysrhythmia may be paroxysmal (i.e., beginning and ending spontaneously) or persistent (lasting more than 7 days)
A Fib.
Atrial fibrillation usually occurs in a patient with
CAD valvular heart disease cardiomyopathy hypertensive heart disease HF Pericarditis It often develops acutely with thyrotoxicosis, alcohol intoxication, caffeine use, electrolyte disturbances, stress, and heart surgery
In A fib, When the ventricular rate is between 60 and 100 beats/minute
atrial fibrillation with a controlled ventricular response
priority for patients with atrial fibrillation
Ventricular rate control
The goals of treatment of atrial fibrillation include
- a decrease in ventricular response (to less than 100 beats/minute)
- prevention of stroke
- conversion to sinus rhythm, if possible
Atrial fibrillation longer than 48 hours tx
anticoagulation therapy with warfarin is needed for 3 to 4 weeks before the cardioversion and for several weeks after successful cardioversion.
Medication Alternatives to warfarin are available for anticoagulation therapy in patients with nonvalvular atrial fibrillation
dabigatran (Pradaxa)
apixaban (Eliquis)
rivaroxaban (Xarelto)
