Heart Failure Flashcards
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
HF characteristics
- Inability of the heart to work effectively
- Usually a chronic health problem
- Life threatening
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
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
Preload is increased in
- Hypervolemia, regurgitation of cardiac valves, heart failure
- Hypertension can also cause high preload!
Afterload is increased in ___ & _____
Increased afterload leads to
-Hypertension, vasoconstriction –> leads to left ventricle hypertrophy/failure
another name for left sided HF
Congestive HF
Typical causes of Left sided HF
- *HTN
- CAD (and Myocardial Infarction) - blockage of main artery to left ventricle
- Valvular Disease
- Cardiomyopathies
2 types of left sided HF
systolic and diastolic
diastolic vs systolic left sided HF
Systolic
-Left ventricle pump failure, failing to contract enough
Diastolic
-Left Ventricle doesn’t relax during diastole
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
most common cause of systolic L sided HF
HTN
most common cause of diastolic left sided HF?
Aging
Being a woman
Left sided HF: diastolic vs systolic ventricles?
diastolic- -Stiff ventricle (rigid and thick)
systolic - -Ventricular Dilation (flabby and thin)
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
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
normal EF
50-70%
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
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
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)
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
BP
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.
