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Acute Test #2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

where can you best auscultate murmurs

A

mid clavicular line 5th ICS at apex

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2
Q

cardiac output

A
  • CO = stroke volume x HR

- 4-6L/min

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3
Q

heart failure

A
  • inadequate cardiac output
  • myocardium unable to pump enough blood to meet O2 requirements
  • impaired cardiac pumping/filling
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4
Q

mortality rate of HF

A
  • 33% in first year of dx
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5
Q

preload

A
  • volume of blood in ventricles at end of diastole (filling)
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6
Q

afterload

A
  • resistance left ventricle must overcome to circulate blood

- increased after load = increased cardiac workload

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7
Q

what causes increased preload

A
  • hypervolemia
  • regurgitation of cardiac valve
  • HF
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8
Q

what causes increased after load

A
  • HTN

- vasoconstriction

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9
Q

causes of HF (8)

A
  • HTN
  • congenital heart defects
  • structural defects
  • arrhythmia, previous MI, anemia, pulmonary disease, liver failure, renal failure, hypervolemia
  • ineffective endocarditis, cardiomyopathies
  • stress
  • obesity
  • smoking
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10
Q

what is backflow

A
  • 100cc comes in RA then RV
  • compromised heart only giving half a squeeze pumping out 70cc
  • have 30cc remaining in RV
  • but another 100cc is coming into RA then RV
  • heart will try to grow and stretch to increase space for fluid resulting in backflow and symptoms
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11
Q

how can previous MI lead to HF

A
  • necrotic/scar tissue = improper electrical current and contraction
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12
Q

4 compensatory mechanisms

A

1) frank starlings law (dilation)
2) ventricular hypertrophy
3) sympathetic nervous system activation
4) neurohormonal response

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13
Q

frank starlings law

A
  • ventricles stretch to accommodate contraction issues

- after time elasticity is lost = improper recoil and boggy heart

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14
Q

ventricular hypertrophy

A
  • increasing size/strength of heart muscle to increase force of contraction
  • over time muscle gets too big = smaller ventricle space = decreased CO
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15
Q

sympathetic nervous system

A
  • decreased CO = tells heart to pump harder and faster
  • fight or flight response (E and NE) = increasing HR = increased O2 demands
  • lead to ventricular hypertrophy
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16
Q

neurohormonal response

A
  • decreased CO = decreased O2 to kidney = renin-angiotensin-aldosterone system
  • activation of angiotensin II = vasoconstriction increasing BP
  • aldosterone = retain Na = retain H2O = increased volume
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17
Q

decompensated HF

A
  • when compensatory mechanisms are no longer working/useful
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18
Q

ventricular remodelling

A
  • when heart starts to reshape to accommodate extra fluid and ineffective pumping
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19
Q

right sided HF

A
  • blood starts backing up out of RA into vena cavas

- systemic S&S

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20
Q

right sided HF symptoms

A
  • dependent edema
  • bilateral pitting edema
  • ascites (edema around abdomen)
  • weight gain
  • distended jugular vein
  • fatigue
  • enlarged liver & spleen
  • anorexia/GI complaints
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21
Q

symptoms of ascites

A
  • N&V
  • GI distress
  • decrease appetite
  • all from pressure on abdomen
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22
Q

other term for rt sided HF

A

cor pulmonale

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23
Q

jugular venous pressure (JVP)

A
  • to assess rt sided HF
  • pt at 45 degrees
  • looking for pulsation in internal jugular and measure up
  • <2 is ok
  • > 3 = rt sided HF
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24
Q

left sided HF

A
  • blood backs up into Lt and Rt pulmonary veins

- respiratory symptoms

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25
Q

left sided HF symptoms (11)

A
  • pulmonary congestion
  • tripod
  • confusion/altered LOC (less blood/O2 to brain)
  • exertion dyspnea
  • cyanosis
  • tachycardia (brain telling heart not enough blood so pump faster/harder)
  • orthopnea
  • paroxysmal nocturnal dyspnea
  • chest discomfort (less blood to coronary arteries)
  • nocturia
  • increased pulmonary capillary wedge pressure
26
Q

cardinal sign of left sided HF

A
  • orthopnea

- difficulty breathing why lying down

27
Q

symptoms of pulmonary congestion

A
  • bilateral crackles
  • bilateral wheezes
  • cough
  • blood-tinged sputum
  • tachypnea
28
Q

ejection fraction

A
  • % of blood pumped out of LV during contraction
  • amount of blood pumped out/amount of blood in chamber
  • decreased EF = decreased CO
29
Q

ejection fraction numbers

A
  • 50-70% = normal (anything less = compromised LV)
  • 41-49% = borderline
  • <40% = reduced
30
Q

diagnostic tests for HF

A
  • S&S + pt hx
  • CXR (to see boggy heart)
  • Echo
  • EF
  • BNP
  • ABGs (blood saturation with O2)
  • liver and kidney function tests
31
Q

echocardiogram

A
  • measures myocardial thickness
  • view BF to determine backflow
  • view valves to see if they are shutting properly
32
Q

valves and ventricular remodelling

A
  • valves can’t grow and stretch so when heart does they pull apart and then cant close properly
33
Q

BNP

A
  • b type peptide
  • hormone released when heart is working really hard
  • quick to check if Lt HF or lung issue
34
Q

BNP values

A
  • <100ng/L = HF improbable
  • 100-500ng/L = HF probable
  • > 500ng/L = HF very probable
35
Q

liver function test

A
  • Rt sided because of backflow
  • de O2 blood sitting in liver = atrophy and necrotic tissue
  • prevents liver from excreting toxins
  • albumin made in liver for oncotic pressure, low albumin = fluid seeping out into interstitial spaces
36
Q

kidney function test

A
  • Lt sided because of lack of forward flow
  • kidneys don’t do well without blood/O2
  • worried about kidney failure
  • BUN, creatinine
37
Q

complications of HF

A
  • pleural effusion
  • dysrhythmias
  • LV thrombus
  • hepatomegaly
  • renal failure (decreased BF)
38
Q

pleural effusion complication

A
  • fluis in visceral pleura
  • blood backs up and moves into lower pressure system
  • fluid surrounding lungs preventing full expansion
  • increased pressure in lungs
39
Q

dysrhythmia complication

A
  • heart stretches = altered electrical conduction

- a fib is common

40
Q

LV thrombus

A
  • clot in LV
  • from stagnant blood
  • can pump out and get stuck = stroke, PE, MI
41
Q

hepatomegaly

A
  • Rt HF
  • non-efficient drainage of BF
  • accumulation of de O2 blood
  • atrophy, necrosis of liver
42
Q

pharmacological management of HF (10)

A
  • ACE inhibitors
  • ARBs
  • angiotensin-receptor neprilysin inhibitors
  • beta blockers
  • diuretics
  • opioid
  • vasodilators
  • inotropes
  • antidysrhythmic agents
  • anticoagulants
43
Q

ACE inhibitors

A
  • lower BP

- capoten, vasotec, altace, zestril

44
Q

ARBs

A
  • lower BP, dont effect HR

- atacand, cozaar, diovan

45
Q

angiotensin receptor neprilysin inhibitors

A
  • lower BP, dont affect HR

- sacubitil/valsartan

46
Q

beta blockers

A
  • decrease BP, HR, CO

- metoprolol, coreg

47
Q

diuretics

A
  • to decrease BV
  • aldosterone antagonist (K sparing) - aldactone
  • loop diuretic (K wasting) - furosemide
  • thiazide (K wasting) - hydrochlorothiazide
48
Q

opioids

A
  • vasodilation
  • helps with oxygenation
  • morphine
49
Q

vasodilators

A
  • decrease vascular resistance

- nitrates, nitroprusside

50
Q

inotropes

A
  • increase contractility of the heart without increasing O2 demands
  • cardiac glycoside - digoxin
  • beta adrenergic agonist - dopamine
  • phosphodiesterase inhibitors - milrione
51
Q

goals for treating HF (8)

A
  • improve myocardial function
  • reduce circulating BV
  • reduce venous return
  • reduce afterload
  • reduce myocardium demands
  • improve cardiac function
  • improve gas exchange and oxygenation
  • decrease anxiety
52
Q

digoxin

A
  • cardiac glycoside that increases contractility
  • apical pulse for 60 secs as it decreases HR
  • 1.8-2.3 therapeutic range
  • risk of toxicity increases with hypokalemia
  • digoxin binds to K+ so if there is none then digoxin is free floating
53
Q

digoxin toxicity symptoms

A
  • see yellow
  • flu like symptoms
  • decreased HR
  • blurred vision
54
Q

nursing management of HF

A
  • hemodynamic monitoring
  • daily weights
  • ins/outs
  • diet (Na restrictive, H2O follows Na)
  • lab values
  • respiratory, cardio, integument, abdominal, neurological assessments
55
Q

daily weights

A
  • morning before breakfast

- >2kg over 2-5 days means peripheral edema and they are retaining too much fluid

56
Q

chronic HF

A
  • chronic progressive state
  • medically managed at home
  • Telehealth home monitor
  • at home monitoring
57
Q

biventricular pacing

A
  • boggy heart and electric conduction affected

- pacemaker implanted to send current to make heart contract

58
Q

implantable cardio-defibrillators

A

implanted defibrillator

59
Q

intra-aortic balloon pump (IABP)

A
  • balloon inserted in aorta
  • balloon inflates when heart is at rest to increase pressure and fill ventricle more
  • push blood into coronary arteries
  • balloon deflates on contraction
  • can increase CO by 40%
60
Q

ventricular assistive device (VADs)

A
  • LVAD inserted in LV
  • external pump takes blood from LV and forces it into aorta
  • bypasses LV
61
Q

artificial heart

A
  • cut off ventricles and put in 2 artificial pumps that take over for ventricles

Acute Test #2 (4 decks)

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