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Pathophysiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Heart Failure

A
  • An abnormal clinical symptom involving impaired cardiac pumping and/or filling
  • heart is unable to produce a adequate cardiac output to meet metabolic needs
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2
Q

characteristics of heart failure (4)

A
  • ventricular dysfunction
  • reduced exercise tolerance
  • diminished quality of life
  • shortened life expectancy
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3
Q

Is heart failure a disease?

A

no, it is associated with long-standing hypertension, coronary artery disease, and MI

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4
Q

Identifying people with possible HF

- decreased exercise tolerance due to:

A

Dyspnea

General Fatigue

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5
Q

Identifying people with possible HF:

- people with fluid retention:

A
  • abdominal swelling

- peripheral edema

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6
Q

HF may initially be asymptomatic - when will manifestations be found?

A
  • manifestations of HF may have been found during annual physical exam/screening
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7
Q

Cardinal symptoms of HF

A

shortness of breath, shortness of breath upon exertion, and peripheral edema

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8
Q

Major contributing factors

A
  • HTN

- history of MI or coronary artery disease

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9
Q

Other risk facors

A

smoking
obesity
high serum cholesterol
diabetes

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10
Q

Caused by any interferences with normal mechanisms regulating CO (5)

A
  • preload
  • afterload
  • myocardial contractility
  • heart rate
  • metabolic state of individual
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11
Q

How does it happen?

- abnormal loading conditions

A
  • increased preload (more fluid coming into the heart with venous return) - hypervolemia & septal defects
  • increased afterload (hypertension, atherosclerosis)
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12
Q

Cardiomyopathy

A

ischemic conditions:

- CAD & MI lead to damage of the cardiac muscle

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13
Q

Abnormal ventricular filling

A

stenosis of mitral or tricuspid valve

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14
Q

High CO demands

A
  • sepsis, severe anemia puts pressure on the heart
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15
Q

Preload

A

volume of blood in ventricles at the end of diastole (end diastolic pressure)

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16
Q

Afterload

A

resistance left ventricle must overcome to circulate blood

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17
Q

causes of increased preload:

A
  • hypervolemia
  • regurgitation of cardiac valves
  • the volume of blood going into the heart
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18
Q

Causes increased afterload

A
  • hypertension
  • vasoconstriction
  • blood pressure
  • stiff arteries
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19
Q

Systolic Failure - most common cause of HF

A
  • inability of the heart to pump blood effectively
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20
Q

Hallmark finding of systolic failure

A

decrease in the left ventricular ejection fraction (EF) (LV loses ability to generate enough pressure to eject blood through high-pressure aorta)

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21
Q

Ejection Fraction

A

fraction or % of total volume of blood in the LV that is ejected during each ventricular contraction
- normal value is > 55% of ventricular volume

22
Q

What EF is considered alarming? And what causes this?

A

< 40% requires specialist intervention
- caused by myocardial ischemia (dead muscle tissue around the heart), increased afterload, cardiomyopathy, or mechanical abnormalities

23
Q

Diastolic Failure (HF - PEF) and diagnosing factors

A
  • impaired ability of the ventricles to relax and fill during diastole resulting in decreased stroke volume and CO
  • pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, normal ejection fraction
  • inability of the LV to relax normally, resulting in fluid backing up in the lungs
24
Q

Left sided HF (most common)

A

backup blood into the atrium and pulmonary veins.

manifested as pulmonary edema: SOB, crackles, decreased air entry

25
Q

Right Sided HF

A

causes backward blood flow to the right atrium and venous circulation. Resulting in peripheral edema, weight gain, ascites, JVD, hepatomegaly

26
Q

Manifestation of LHF

A
  • decreased CO, activity intolerance, signs of decreased tissue perfusion
  • pulmonary congestion, impaired gas exchange (cyanosis, signs of hypoxia), pulmonary edema (orthopnea, cough with frothy sputum, paroxysmal nocturnal dyspnea)
27
Q

Compensatory mechanism: ventricular dilation

A
  • enlargement of chambers of heart related to elevated pressure over time.
  • cardiac muscle increases in strength and dilates
  • initially intended to cope with elevated blood volume -> leads to increased cardiac output and maintanence of BP
  • turns into ventricular hypertrophy. Cant keep up
28
Q

Compensatory mechanism:

- increased sympathetic nervous system stimulation

A
  • 1st mechanism triggered. least effective

- increased epinephrine and norepinephriine -> increased HR, myocardial contractility, peripheral vascular constriction

29
Q

Compensatory mechanism: Neurohormonal responses

A
  • renal system is particularly sensitive to reduction in BF and renal perfusion.
  • activates renin-angiotensin-aldosterone mechanism
30
Q

Renin-Angiotensin-Aldosterone mechansim

A
  • renin-angiotensin secretion causes vasoconstriction. and release of aldosterone which causes retention of salt & water which increases preload
  • bad because it eventually leads to venous congestion and peripheral edema.
31
Q

Cardiac decompensation

A

compensatory mechanisms no longer maintaining adequate CO and insufficient tissue perfusion results

32
Q

Ventricular Remodeling

A
  • hypertrophy of cardiac myocytes (large cells)
  • increased ventricular mass - impairs contractility
  • bigger, less effective pump
33
Q

Left Ventricular Failure Manifestations:

- respiratory

A
  • pulmonary congestion
  • dyspnea
  • bilateral crackles
  • frothy productive cough
  • hemopytsis
  • orthopnea
  • acute pulmonary edema
34
Q

LVF manifestations

- cardiovascular

A
  • pallor and cool skin
  • hypotension
  • third heart sound
  • enlarged ventricle (PMI shift to left)
35
Q

LVF manifestations - urinary

A
  • decreased output -> oliguria
  • nocturia is common
  • increased BUN
36
Q

Right Ventricular Failure manifestations

A
  • cyanosis and cool skin
  • weight gain
  • ascites
  • liver enlargement
  • dependent edema
  • JVD
37
Q

General S & S of heart failure

A
  • tachycardia - trying to increase CO
  • reduced exercise tolerance
  • fatigue
  • anorexia and cachexia
  • behaviour changes
38
Q

Acute Decompensated Heart Failure (ADHF)

A
  • compensatory mechanisms fail

- manifests as pulmonary edema, often life threatening

39
Q

Symptoms of ADHF (8)

A
  1. crackles
  2. severe dyspnea
  3. fatigue
  4. shortness of breath
  5. pink frothy sputum
  6. increased inspiratory rate
  7. cyanotic
  8. cool and clammy skin
40
Q

Goal of therapy:

A

improve left ventricular function

41
Q

How to improve LV function:

A
  • decrease intravascular volume (lasix diuretic via IV push to help the kidneys get rid of fluid)
  • decrease venous return - preload (high fowlers, dangling legs)
  • improve gas exchange and oxygenation
  • improve cardiac unction
  • reduce anxiety (morphine - deal with SOB)
42
Q

Medication Therapy (GOAL)

A
  • identify type of HF
  • correction of sodium and water retention overload
  • reduction of cardiac workload
  • improve myocardial blood supply
43
Q

Diuretics

A
  • lasix
  • reduces preload by reducing intravascular fluid.
  • gets rid of potassium - be careful
44
Q

ACE (angiotensin converting enzyme) inhibitors

A
  • inhibit angiotensin converting enzyme and by doing this lower BP
  • 1st line therapy
  • vasodilator - decreased systemic vascular resistance. increased cardiac output.
  • ramipril
45
Q

B-Adrenergic blockers

A
  • used with ACE inhibitors to block negative effects of sympathetic nervous systems on the failing heart.
  • beta blockers reduce cardiac oxygen demand by reducing HR and BP
  • metoprolol
  • hold if BP is < 100
46
Q

Vasodilators: nitrates

A
  • reduces afterload by dilating peripheral blood vessels
  • increase myocardial blood supply by dilating cardiac BV
  • first-line med management of chest pain
  • dangerous in RHF because of drop in preload
47
Q

Digitalis

A

digoxin
increases cardiac ouptu
- if below 90 hold drug
assess apical rate of heart

48
Q

Nursing Diagnosis

A
  • decreased cardiac output (physical assessment - VS, heart sounds, lung sounds, LOC, edema, cap refill, fluid balance, lab values - pharmacological management, adequate rest, strict I&O)
  • impaired gas exchange (O2, incentive spirometry and deep breathing, semi-fowlers, diuretics)
  • ineffective tissue perfusion (ROM, massage)
  • Excess fluid volume (diuretics, watch for hypokalemia, ensure sodium restriction, strict I & O, monitor weight)
  • anxiety (Stress management)
  • activity intolerance (treatment of infection or other disease processes, promote sleep, prioritize activities)
49
Q

Emergency toxicity

A
  • Digitalis toxicity

- bradycarida, tachycardia, irregular pulse/arrhythmias

50
Q

Nursing Interventions for Pulmonary Edema

A
  • patency of IV saline lock

- in case they need IV meds

Pathophysiology (8 decks)

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