Heart failure Flashcards
What is heart failure?
This is a syndrome where pts experience typical symptoms such as sob, ankle swelling and fatigue as well as signs such as elevated jugular pressure, pulmonary crackles and displaced apex beat which results from an abnormality in the cardiac structure or function
What are the major criteria when diagnosing HF?
Paroxyzmal noctural dyspnoea Neck-vein distension Rales Cardiomegaly Acute pulmonary oedema S3 gallop Increased venous pressure Hepatojugular reflex Loss of weight more than 4.5kg during 5 days
What are the minor criteria when diagnosing HF?
Ankle oedema Night cough Dyspnoea on exertion Hepatomegaly Pleural effusion Tachycardia (more than 120b/min)
How is HF diagnosed?
Either 2 major criteria
OR 1 major criteria with 2 minor criteria
What are the typical symptoms of HF?`
SOB Orthopnoea Paroxysmal nocturnal dyspnoea Reduced exercise tolerance Fatigue, tiredness, increased time to recover after exercise Peripheral oedema
What are the NYHA classifications for HF?
Class 1: no limitation of physical activity.
Class 2: slight limitation of physical activity - SOB, fatigue or palpitations
Class 3: comfortable at rest but ordinary physical activity is limited as it results in SOB, fatigue or palpitations
Class 4: symptoms at rest and during exercise are present
What are the causes of HF?
CAD/ACS -
Idiopathic dilated cardiomyopathy -
Infection, hypoxia and alcohol abuse - all these reduce contractility
valve disease - as this affects the volume/pressure overload
hypovolemia and constrictive pericarditis - causes insufficient volume
drugs - chemotherapy
electrical disorders - vtach which can cause HF
What is the preload?
Volume coming into the ventricles at the end diastolic pressure
When is the preload increased?
Hypervolemia
Regurgitation of cardiac values
What is the afterload?
the resistance the left ventricle must overcome to circulate blood.
this is increased to minimize the symptoms of HF
When is the afterload increased?
hypertension
vasoconstriction
these lead to an increase in the cardiac workload and in the afterload
What are the compensatory mechanisms in HF?
Sympathetic NS
RAAS
What are the counter-regulatory mechanisms?
the chambers of the heart try to release hormones which try to compensate the negative effects of the other hormonal mechanisms.
Natriuretic peptides (ANP and BNP) promote diuresis (increase urine output) and vasodilation.
these have a negative impact long term
What is systolic failure?
the inability of the ventricle to contract normally which leads to a decrease in CO. EF <40%
What is diastolic failure?
inability of the ventricle to relax and fill normally causing increasing filling pressure. EF is >50%
What are the symptoms of LV failure?
Pulmonary edema dyspnoea poor exercise tolerance orthopnea fatigue paroxymal noctural crackles frothy pink sputum
What are the symptoms of RV failure?
systematic venous congestion
peripheral oedema
pulsation in neck (jugular vein distention)
weight gain +1kg/day
Abdomen distension - hepta, spleno, ascites
pitting oedema
What are the nursing interventions for HF?
H - head of bed elevation - high fowler position
O - oxygen therapy
P - push diuretics and morphine
E - end sodium/water - sodium swells.
D- iet limit sodium and fluids (1.5lts/day)
R - isk of falls due to orthostatic hypotension
B - BP/BNP - take and monitor trends
E - elevate head of bed and legs
D - daily weight (Document 1kg/day or 3kg over a week)
S - sex only if you can climb 2 flights of stairs without SOB
S - stockings provide TED stockings but remove daily
What are the nursing assessment for HF?
Vital signs - BP, HR, RR, TEMP
I/O
Right sided: peripheral edema MONITOR, monitor weight gain, check for pitting edema, neck J.V.D and measure the abdomen distension
Left sided: monitor SOB, measure 02 saturations, ask for sleeping difficulties, listen for crackles and collect sputum
What is the difference between acute and chronic HF?
acute: is used exclusively to mean new onset acute or decompensation of chronic cardiac HF characterized by pulmonary and/or peripheral edema
chronic develops or progresses slowly
What are the investigations done to diagnose HF?
ECG
BNP
(if these are normal, an echo is done)
CBC + u+e (as hypovolemia and anaemia can cause HF)
Chest x-ray - cardiomegaly, alveolar shadowing and pleural effusion.
ECHO - indicate the cause (MI or valvular disease) and assess the presence or absence of LV dysfunction
Nuclear imaging
LV angiogram
What is the medical management of HF?
Diuretics - relieve symptoms of HF. - loop (Watch for hypokalemia, renal impairment. - potassium-sparing (if potassium is less than 3.2mmol/L)
ACE-I (if not tolerated ARBs are given) - improves symptoms. SE: hyperkalemia
Beta-blockers - decrease mortality in HF.
Spironolactone - use in pts on optimal drug therapy but still symptomatic. risk of hyperkalemia is minimal.
Digoxin - helps with symptoms
Vasodilators - should be used if intolerant to ACE-I or ARBs.
LMWH - given as a DVT prophylaxis
Opiates - help with dyspnea and anxiety.
