Heart Failure

Question 1

Factors effecting stroke volume

Answer 1

Preload
Contractility
Afterload

Question 2

Heart Failure Characterized by

Answer 2

Ventricular dysfunction
Reduced exercise tolerance
Diminished quality of life
Shortened life expectancy

Question 3

Heart Failure risk factors

Answer 3

Primary risk factors
CAD
Hypertension

Contributing risk factors 
Diabetes
Tobacco use
Obesity
High serum cholesterol

Question 4

Heart failure with reduced ejection fraction
Caused

Vs. Heart failure with preserved ejection fraction

Answer 4

• Heart failure with reduced ejection fraction:
• Impaired contractile function (e.g., MI)
• Increased afterload (e.g., hypertension)
• Cardiomyopathy
• Mechanical abnormalities (e.g., valve disease)
• Heart failure with preserved ejection fraction:
• Left ventricular hypertrophy from chronic hypertension
• Aortic stenosis
• Hypertrophic cardiomyopathy

Question 5

Major causes of HF can be divided into two subgroups:

Answer 5

(1) primary causes, consisting of underlying cardiac diseases, such as coronary artery disease (CAD) and cardiomyopathy
(2) precipitating causes, such as anemia, pulmonary disease, and hypervolemia.

Question 6

Symptoms of Heart Failure

Answer 6

• Fatigue and Anemia
• Edema
• Skin Changes 
-- Dusky, cool, damp to touch 
-- Lower extremities: shiny and swollen, diminished or absent hair growth, pigment changes)
• Behavioral Changes 
-- restlessness
-- confusion
-- decreased attention span or memory
• Angina
• Dyspnea, orthopnea, paroxysmal nocturnal dyspnea 
• Persistent, dry cough, unrelieved with position change or over-the-counter cough suppressants 
• Tachycardia
• Nocturia 
• Weight changes
-- Anorexia, nausea
-- Fluid retention

Question 7

Compensatory Mechanisms

Answer 7

• Compensatory mechanisms are activated to maintain adequate CO
>Venticluar dilation
>Ventricular hypertrophy
>Increased sympathetic nervous system stimulation
>Neurohormonal responses
• Sympathetic nervous system (SNS) activation: first and least effective mechanism
>Release of catecholamines (epinephrine and norepinephrine)

Question 8

Symptoms of Acute Decompensated Heart Failure

Answer 8

• Orthopnea
• Dyspnea, tachypnea
• Use of accessory muscles
• Cyanosis
• Cool and clammy skin

Physical findings
• Cough with frothy, blood-tinged sputum
• Breath sounds: crackles, wheezes, rhonchi 
• Tachycardia
• Hypotension or hypertension

Question 9

Complications: HF

Answer 9

• Pleural effusion
• Dysrhythmias
• Left ventricular thrombus
• HF can lead to severe hepatomegaly.
• Renal insufficiency or failure

Question 10

Diagnose HF

Answer 10

• History and physical examination
• Chest x-ray
• ECG
• Lab studies (e.g., cardiac enzymes, BNP)

Question 11

HF Goals

Answer 11

• Decrease client symptoms.
• Improve LV function.
• Reverse ventricular remodelling.
• Improve quality of life.
• Decrease mortality and morbidity.
• Treat the underlying cause and contributing factors.
• Maximize CO.
• Provide treatment to alleviate symptoms.
• Improve ventricular function.
• Preserve target organ function.

Question 12

ADHF Treatment

Answer 12

• High Fowler’s position
• Supplemental oxygen
• Continuous ECG monitoring
• Ultrafiltration: option for clients with volume overload
• Circulatory assist devices are used to treat clients with deteriorating HF.
• Coexisting psychological disorders should be addressed.
• Decrease intravascular volume (give diaretic)
• Decrease venous return (preload)
• Decrease afterload
• Improve gas exchange and oxygenation
• Improve cardiac function
• Reduce anxiety

Question 13

HF Drugs

Answer 13

• Diuretics are used to mobilize edematous fluid, reduce pulmonary venous pressure, and reduce preload.
• Thiazide diuretics (e.g., hydrochlorothiazide [Hydrodiuril]) are often the first choice in chronic HF because of their convenience, safety, low cost, and effectiveness.
• ACE inhibitors are the primary drugs of choice for blocking the RAAS system in HF clients with systolic dysfunction. They include ramipril (Altace), enalapril (Vasotec), captopril, and benazepril (Lotensin).
• For clients who are unable to tolerate ACE inhibitors, angiotensin receptor blockers (ARBs) are recommended.
• ACE inhibitors – reduce systematic vascular resistance which increases cardiac output so increase perfusion
• Neprilysin inhibitors
• ß-Adrenergic blockers – blocks negative effects of sympathetic nervous system. Needs to increase dose graduakky
• Positive inotropic agents

Question 14

Client education

Answer 14

• Symptom management is controlled with the use of self-management tools (e.g., daily weights).
• Salt must be restricted.
• Energy must be conserved.
• Medications (lifelong)
• Taking pulse rate
• Home BP monitoring
• Signs of hypokalemia and hyperkalemia if taking diuretics that deplete or spare potassium
• Instruct client in energy-conserving and energy-efficient behaviours.