Exam 4: heart failure Flashcards
what is heart failure?
- a cardiovascular condition
- heart is unable to pump an adequate amount of blood to meet the metabolic needs of the body’s tissues
how is heart failure characterized?
- left ventricular dysfunction
- reduced exercise tolerance
- diminished quality of life
- shortened life expectancy
what are the 7 risk factors of heart failure?
- CAD
- advancing age
- HTN
- DM
- tobacco use
- obesity
- high cholesterol levels
what is the etiology of heart failure?
any interference with the normal mechanisms regulating cardiac output
what are the 4 mechanisms that regulate cardiac output?
- preload
- afterload
- myocardial contractility
- heart rate
what are the 9 precipitating factors of heart failure?
- anemia
- infection
- thyrotoxicosis
- hypothyroidism
- arrhythmias
- bacterial endocarditis
- pulmonary disease
- nutritional deficiencies
- hypervolemia
what is systolic failure? what is this aka? what does this cause?
- a defect in the ability of the cardiac myofibrils to shorten
- HFeEF
- causes a decrease in the muscles ability to contract (pump)
how is systolic failure characterized? who experiences this more often?
low forward blood volume
men
what are the 4 causes of systolic failure?
- impaired contractile function
- increased afterload
- cardiomyopathy
- mechanical abnormalities
how is diastolic failure characterized? what is it aka? who experiences this more often?
- high filling pressures
- venous engorgement in both pulmonary and systemic systems
- HFpEF (heart failure with preserved ejection fraction
- women
how is mixed failure characterized?
- low blood pressure
- low CO
- poor renal perfusion
what are the 5 compensatory mechanism for heart failure?
- SNS activation
- neurohormonal response
- ventricular remodeling
- dilation/hypertrophy
- natriuretic petides
how does SNS activation compensate for heart failure? when does this happen?
- release of catecholamines
- increase heart rate
- increase myocardial contractility
- peripheral vasoconstriction
- first thing that happens
- works but after awhile, the heart overworks itself and it ends up detrimental
how do neurohormonal responses compensate for heart failure?
- RAAS
- low CO causes a decrease in cerebral perfusion pressure, ADH is released
- arterial vasoconstriction
- increased contractility
- hypertrophy
what effect does a pro-inflammatory cytokines release have on the heart?
- depressed cardiac function
- over time, cardiac wasting, muscle myopathy, and fatigue
what triggers natriuretic peptides to be released? what effect do these have on the heart?
- released in response to atrial volume and ventricular pressure
- promotes venous and arterial vasodilation
- enhances diuresis
- blocks effects of RAAS
- may have inflammatory effects
what does nitrous oxide do for the heart?
relaxes arterial smooth muscle, resulting in vasodilation and decreased afterload
what is left sided heart failure?
increased blood in the left atrium and pulmonary vein
what is right sided heart failure?
back flow of blood into the right atria and venous circulation
s/s of left sided heart failure?
fatigue paroxysmal noturnal dyspnea orthopnea tachycardia restlessness confusion exertional dyspnea cyanosis increased pulmonary capillary wedge pressure pulmonary congestion
s/s of right sided heart failure?
may be secondary distended jugular veins anorexia GI distress weight gain dependent edema fatigue hepatomegaly splenomegaly increased peripheral venous pressure ascites
s/s of pulmonary congestion?
cough crackles wheezing bloody sputum tachypnea
s/s pf acute decompensated HF?
fatigue dyspnea tachycardia edema nocturia skin changes behavior changes chest pains weight changes
how many classes of persons with HF are there?
4
at diagnosis of heart failure, the pt knows that they have what percent chance of being alive in 5 years?
50%
what is HF preferred over CHF?
not everyone has congestion
which two risk factors of heart failure are the best indicators?
CAD
age
what is cardiac output?
CO=SVxHR
what is preload?
volume of blood
what is afterload?
pressure against the pumping blood
what is the eject fraction (EF)?
% of blood in the ventricle ejected with every heart beat
what is a normal EF?
55-60%
what is HFrEF?
heart failure with reduced ejection fraction
systolic failure
what is the hallmark of systolic failure?
decreased left ventricular ejection fraction
who is at highest risk for diastolic failure?
women
diabetics
what is the biggest risk factor for diastolic failure?
hypertension
what is the EF of mixed heart failure?
< 35%
what are the positive compensatory mechanisms?
natriuretic peptides
nitrous oxide release
what kind of a problem is HF?
a neurohormonal problem
does impaired gas exchange and decreased O2 indicate left or right sided heart failure?
left sided
how should the nurse auscultate for crackles?
on each lobe
3 on right, 2 on left
start in the front
which clinical manifestations indicate HF?
a. orthopnea
b. dyspnea
c. paroxysmal nocturnal dyspnea
d. crackles/rales
a, b, c, d
what is orthopnea? as a nurse, what question may you ask a pt?
difficulty breathing when laying down
ask pt how many pillows they sleep with at night
what is the earliest symptom of chronic heart failure? what often comes with it?
fatigue
dyspnea
how many times does one with nocturia urinate during the night?
6-8 times
what skin changes come from heart failure?
dusty skin
absent pulses
brown discoloration
what causes behavior changes r/t heart failure? c/m of these behavior changes?
hypoxemia
confusion, decreased memory, anxiety, depression
what does a heart failure pt’s weight change at the end of life?
pt may lose a lot of weight right before death
what is class 1 HF?
no limitation of physical activity
ordinary physical activity doesn’t cause symptoms of HF
what is class 2 HF?
slight limitation of physical activity
comfortable at rest, but ordinary activity results in symptoms of HF
what is class 3 HF?
marked limitation of physical activity
comfortable at rest, but less than ordinary activity causes symptoms of HF
what is class 4 HF?
unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest
what are the 6 diagnostic studies used for HF?
physical exam chest x-ray ECG BNP echocardiogram cardiac catheterization
which 2 diagnostic tests are most helpful for HF? which is the best?
BNP (best)
echocardiogram
what does an x-ray show us that is helpful for x-ray?
fluid in lungs
size of heart
what number for BNP is diagnostic of HF?
over 100
what race has a higher incidence of HF, develop HF at a younger age, and experience higher mortality rates related to HF?
African Americans
what race may experience more ACE inhibitor related angioedema
African Americans
what medication is approved only for treatment of HF in African Americans?
Isosorbide dinitrate/hydralazine
what race has a high risk (15-50%) for ACE inhibitor related cough
Asians
what is the most common cause of right sided HF
left sided HF
5 complications of heart failure
pleural effusion dysrhythmias left ventricular thrombus hepatomegaly renal failure
what is a normal pulmonary artery wedge pressure (PAWP)
8-12 mmHg
how high can someone with ADHF’s PAWP level be
as high as 30 mmHg
