- Inability of the heart to work effectively - Usually a chronic health problem - Life threatening

Heart Failure Flashcards by Kol Giessel

How is CAD different then HF?

HF= Pump Failure = ventricles aren’t able to pump EFFECTIVELY/enough blood/O2 to meet demands of body

CAD=the build up of atherosclerosis in the arteries that are feeding blood and oxygen to the heart

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HF characteristics

Inability of the heart to work effectively
Usually a chronic health problem
Life threatening

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5 contributing factors to HF

1.High Blood Pressure
2.Heart Problems
-Valve Defects, Rhythm Disorders, Heart Muscle Defects, CAD
3.Lifestyle
-Failure to take preventative medications, Diet (excessive salt/fluid), Alcohol/drug misuse
4.Other Medical Conditions
-Anemia, Kidney disease, obesity, Diabetes, Thyroid Disorder
5.Lung problems
-Poor blood supply to lungs, lung disease, asthma, bronchitis, obstructed airways, high BP in
lungs

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preload vs afterload

PRELOAD= volume of blood in ventricles at end of diastole (diastolic pressure), determines how much heart will stretch

AFTERLOAD = resistance left ventricle must overcome to circulate blood = systemic vascular resistance

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Preload is increased in

Hypervolemia, regurgitation of cardiac valves, heart failure
Hypertension can also cause high preload!

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Afterload is increased in ___ & _____

Increased afterload leads to

-Hypertension, vasoconstriction –> leads to left ventricle hypertrophy/failure

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another name for left sided HF

Congestive HF

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Typical causes of Left sided HF

*HTN
CAD (and Myocardial Infarction) - blockage of main artery to left ventricle
Valvular Disease
Cardiomyopathies

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2 types of left sided HF

systolic and diastolic

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diastolic vs systolic left sided HF

Systolic
-Left ventricle pump failure, failing to contract enough

Diastolic
-Left Ventricle doesn’t relax during diastole

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EF in L sided HF: diastolic vs systolic

Systolic = EF <40%
Diastolic = EF preserved but misleading
—>Does not hold as much blood but percentage of EF is same b/c there was never that much blood in the their to begin with

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most common cause of systolic L sided HF

HTN

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most common cause of diastolic left sided HF?

Aging

Being a woman

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Left sided HF: diastolic vs systolic ventricles?

diastolic- -Stiff ventricle (rigid and thick)

systolic - -Ventricular Dilation (flabby and thin)

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systolic left sided HF

Left ventricle pump failure, failing to contract enough
EF < 40%
Ejection fraction= % of blood pushed out of Left Ventricle during contraction, normal is 50-70%
Ventricular Dilation (flabby and thin)
Most common cause is HTN

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Diastolic left sided HF

Left Ventricle doesn’t relax during diastole
Preserved EF (but can be misleading)
Stiff ventricle (rigid and thick)
Does not hold as much blood but percentage of EF is same b/c there was never that much blood in the their to begin with
*Most common cause is Aging
Females more likely to have

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normal EF

50-70%

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What happens when blood doesn’t have good forward flow

AND

What happens when blood backs up

moving into L atria and back into lungs + decrease O2 to body

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Clinical manifestations of left sided HF

Weakness - lack of O2
Fatigue - lack of O2
Dizziness- lack of O2
Acute Confusion - lack of O2
Oliguria –> kidney not getting enough blood flow/O2
Pulmonary congestion - blood back up/ poor gas exchange
Breathlessness - blood back up + lack of O2

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causes of right sided HF

# 1 =Left ventricular failure –> high pressure area builds up in lungs due to back flow> Right ventricle has to push really hard to get blood through to the lungs > Right side hypertrophies
Right ventricular Myocardial Infarction
Pulmonary HTN (Cor Pulmonale) - Right side has a hard time pushing blood forward, isolated right sided heart failure

(-PE and Cor pulmonale = isolated right sided heart failure)

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what is right sided HF?

Right ventricle cannot empty completely

- ->Increased pressure in venous system —>Peripheral edema, fluid back into spleen/liver

clinical manifestations of right sided HF

(fluid backing up into the system)

Jugular vein distention
Increased abdominal girth (ascites, hepatomegaly)
Dependent edema
Hepatomegaly –>Hepatojugular reflux - press on liver and see immediate jugular vein distention
Ascites –> Measure abdominal girth
*Weight most reliable indicator of fluid gain loss

considerations for taking Daily weights

when to call provider?

Same time everyday

1-2 lbs/ day or 3 lbs/ week = call provider

labs for HF

hyponatremia
HgB and Hematocrit
-BNP brain natriuretic peptide
Urinanlysis
ABG

BNP < 100 =

normal! BNP > 100 = risk for HF

What is BNP

brain natriuretic peptide --> released from overstretched heart muscle , good for diagnosing acute heart failure

Which test will check for EF?

echocardiogram

normal vs left sided diastolic vs left sided systolic HF EF

55-70%= normal <40% = Left Systolic failure Normal EF = Left Diastolic

another name for an invasive pulmonary catheter to monitor HF?

Swann Catheter

Oxygenation management (3)

- Positions in high Fowlers if patient dyspneic - Apply Oxygen - Maintain oxygen sat. above 90%

Benefits of Bipap? (2)

- Reduces Preload b/c increases pressure in thoracic cavity and reduces fluid coming into heart - Opens Alveoli due to increased pressure

how often to auscultate breath sounds when concerned about oxygenation with HF?

every 4-8 hours

3 things to make the heart pump better

Preload reduction Afterload reduction Contractility enhancement

ACE, ARB

reduce afterload

Diuretics

reduce preload, improve contractility

Morphine

reduced pre/after load/anxiety

Beta Blockers

not used acutely, long term management

Digoxin and Nitrates

reduce after/preload

fluid and sodium restrictions for HF

- Fluid Restrictions - <2L /day | - Sodium Restrictions - 2-3 g/day

pulmonary edema onset

rapid!

s/s of pulmonary edema

- Dyspnea & Persistent Cough - Coarse Crackles in bases of lungs - Pink frothy sputum - (Other: Cyanosis, Tachycardia, Anxiety) - High Fowler’s

vital sign that will help guide therapy for pulmonary edema

Non surgical options for managing HF

- CPAP = Continuous Positive Airway Pressure - reduces preload, opens alveoli - Ultrafiltration- removal of fluids - reduces preload - Cardiac Resynchronization Therapy/ Biventricular Pacing : for pump failure - Implantable Cardiac Defibrillator - EV <30% = candidate for it - Gene Therapy

Bi ventricular pacing indicated in HF patients with:

- LEF < 35% - NYHA functional class III or IV - Medication optimized

Surgical managements for HF

- VADS - Heart reduction - Endoventricular circular patch cardioplasty - Acorn cardiac support

Vads are what kind of therapy

-external power source, goes through hole in abdomen Bridge Therapy: temporary until heart transplant or Destination Therapy: final therapy - no transplant

indications of worsening HF

- Rapid weight gain - Decrease in activity or exercise tolerance - Cough/ Congestion - Excessive awakening at night for urination - Dyspnea - Increased edema in feet/ankles/ascites

most important diagnostic indicators for HF

ECHO + BNP

NYHA Class 1

Class I - No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc.

NYHA Class 2

Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.

NYHA Class 3

Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20—100 m).Comfortable only at rest.

NYHA Class 4

Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.