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Heart Failure Flashcards

1
Q

2/3 of the heart’s mass lies to the ____ of the sternum. The upper base is beneath the ____ rib

A

2/3 of the heart’s mass lies to the left of the sternum. The upper base is beneath the 2nd rib

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2
Q

Apex is located at the

A

5th Intercostal space, midpoint to the clavicle

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3
Q

Right Atrium receives systemic venous blood via

A

the superior vena cava, inferior vena cava, and coronary sinus

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4
Q

Left Atrium receives oxygen rich blood from the

A

pulmonary circulation via the Pulmonary Veins

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5
Q

These contract as a single unit

A

cardiac muscles

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6
Q

Simultaneous contraction due to depolarizing at the same time

A

cardiac muscles

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7
Q

Heart’s ability to pump =

A

cardiac output (CO)

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8
Q

cardiac output (CO) is

A

the amount of blood pumped in one minute.

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9
Q

CO is determined by

A

measuring the heart rate (HR) and multiplying it by the stroke volume (SV)

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10
Q

The amount of blood pumped out of the ventricle with each contraction

A

The stroke volume (SV)

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11
Q

The amount of myocardial stretch just before systole caused by the pressure created by the volume of blood within the ventricle.

A

Preload

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12
Q

The amount of resistance to the ejection of blood from the ventricle

A

Afterload

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13
Q

Refers to the force of contraction

A

Contractility

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14
Q

High afterload =

A

high cardiac workload

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15
Q

The inability of the heart to pump sufficient blood to meet the oxygen and nutrient needs of the tissues and organs in the body.

A

congestive heart failure (CHF)

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16
Q

Disorders which produce a reduction in myocardial contractility

A

Volume Overload
Pressure Overload
Loss of muscles
Restricted filling

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17
Q

What Are The Symptoms of Heart Failure?

A

FACES

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18
Q

FACES

A

Fatigue
Activities limited
Chest congestion
Edema or ankle swelling
Shortness of breath

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19
Q

Clinical Manifestations Left-sided failure:

A

Pulmonary congestion
Dyspnea, cough
Pulmonary Crackles
Low O2 Saturation
Paroxysmal Nocturnal Dyspnea

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20
Q

Clinical Manifestations Right-sided failure:

A

Congestion of viscera & peripheral tissues
Edema of lower extremities
Hepatomegaly
Distended jugular veins
Ascites
Weakness
Anorexia & Nausea
Weight Gain

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21
Q

The left ventricle can’t contract vigorously, indicating a pumping problem.

A

Systolic Heart Failure

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22
Q

The left ventricle can’t relax or fill fully, indicating a filling problem. Heart failure with preserved ejection fraction

A

Diastolic Heart Failure

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23
Q

Test done to confirm the diagnosis, identify underlying cause, and determine ejection fraction (EF)

A

Echocardiogram

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24
Q

Normal EF=

A

55%-65% of ventricular volume

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25
Multigated Analysis Scan
MUGA Scan
26
Test that evaluates that function of the right and left ventricles of the heart.
Nuclear Stress Test
27
Provides a more accurate representation of cardiac ejection fraction.
MUGA Scan
28
Advantages of a MUGA Scan:
More accurate than Echocardiogram More accurate than Angiogram Non-invasive Less expensive (than angio)
29
NYHA Functional classification, Level of clinical impairment: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
Class I
30
NYHA Functional classification, Level of clinical impairment: Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
Class II
31
NYHA Functional classification, Level of clinical impairment: Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
Class III
32
NYHA Functional classification, Level of clinical impairment: Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.
Class IV
33
Neurohormone secreted from ventricles in response to pressure changes
B-Type Natriuretic Peptide (BNP)
34
Elevated BNP levels are associated with
elevated ventricular filling pressures- (HF worsens)
35
BNP below 100pg/ml=
no heart failure
36
BNP of 100-300pg/ml
suggestive of heart failure
37
BNP above 300pg/ml=
mild heart failure
38
BNP above 600pg/ml=
moderate heart failure
39
BNP above 900pg/ml=
severe heart failure
40
I & O's nursing implications
shows how the kidneys are working or if diuretic is working
41
Types of referrals for people with CHF
Dietitians, home care, social worker, PT
42
Activity intolerance: For acute exacerbations
Bed rest
43
Activity intolerance: Wait 2 hours after eating before
doing physical activity
44
Activity intolerance: Positioning
elevation of HOB to facilitate breathing and rest, support of arms
45
Type of meds that control volume
diuretics
46
Type of meds that slow progression of disease
ACE inhibitors and beta blockers
47
Number 1 treatment given for HF
diuretics
48
How do beta blockers work?
they help reduce BP, afterload, and HR
49
Treating underlying causes ....
slows progression of the disease, i.e. treating hypertension
50
Medication type that reduces fluid
diuretics
51
Medication that dilates blood vessels
ACE inhibitor and vasodilators
52
Medication type that also treats angina
Calcium channel blockers
53
Medication type that decreases BP by inhibiting calcium ions and slows cardiac impulse
Calcium channel blockers
54
Medication type that slows heart rate
Beta blockers
55
Medication type that needs the apical HR to be checked prior to administering
Beta blockers
56
Medication type that is dosed in mcg
Digoxin
57
Medication type that increases the heart's ability to contract (helps with force of contractions)
Digoxin
58
Medication type that dilates coronary arteries for more oxygen and nutrients
Vasodilators
59
Medication type that helps reduce angina and MI
Vasodilators
60
Medication type that is 1st prescribed after diuretics
ACE inhibitors
61
Medication type, also prescribed to treat hypertension, that reduces pre and after load
ACE inhibitors
62
Medication type that is cardio tonic, inotropic, and blocks phosphodiesterase causing stronger contraction
Phosphodiesterase inhibitors
63
Medication names: Diuretics
HCTZ (Thiazide) Furosemide (Loop) Spironolactone
64
Medication names: ACE inhibitors
The "-prils" Enalapril Lisinopril Captopril
65
Medication names: Calcium Channel Blockers
Amlodipine Diltiazem
66
Medication names: Cardiac glycosides
Digoxin
67
Medication names: Beta blockers
Toprol Lopressor
68
Medication names: Vasodilators
Nitrates
69
Medication names: Phosphodiesterase inhibitors
IN amrinone
70
Medication class: Decrease in volume Decrease in venous return Reduction in BP Reduce after load & preload Reduces myocardial work load
Diuretics
71
Thiazide med name:
Hydrochlorothiazide (HDTZ)
72
Med that acts on Distal convoluted tubules
Thiazide diuretic
73
Med that is Indicated for edema of CHF, liver & kidney diseases, HTN
Thiazide diuretic
74
Medication Adverse Effects: GI upset CNS complications (lethargy, sedation, fatigue) Hypovolemia, Hypokalemia (assess K+) ↑levels of Ca & uric acid (gout)
Thiazide diuretic
75
Med with Drug to drug interaction: ↑ risk of Digoxin &Lithium Toxicity especially with hypokalemia ↓effectiveness of oral antidiabetics
Thiazide diuretic
76
Med that acts on the Loop of Henle
Loop diuretics
77
Med that is indicated for Acute CHF, Acute Pulmonary Edema, liver & kidney diseases, HTN
Loop diuretics
78
Adverse effects of loop diuretics
Hypokalemia Volume depletion (↓BP??) Hyperglycemia (with diabetics) Ototoxicity (???)
79
Contraindications for loop diuretics
Allergy, Electrolyte depletion, anuria/renal failure, hepatic coma,pregnancy & lactation
80
How to avoid ototoxicity with loop diuretics
IV push slowly
81
Drug to drug interactions for loop diuretics
↑ risk of ototoxicity with Aminoglycosides/Cisplatin. ↑ anticoagulation effect with anticoagulants ,decreased effect when used with NSAIDs.
82
aminoglycosides
antibiotics (gentamycin)
83
Med that acts on distal tubule & collecting duct
potassium sparing diuretics
84
Indications for potassium sparing diuretics
edema in CHF, hypokalemia, liver & kidney diseases, HTN, hyperaldosteronism
85
Drug to drug interaction with potassium sparing diuretics:
↓ diuretic effect when used with salicylates (aspirin and Pepto bismol)
86
Name of an ACE inhibitor
benazepril
87
Major side effect of ACE inhibitors
angioedema
88
Ace inhibitors decrease...
preload & afterload
89
Med that blocks the enzyme which converts Angiotensin I to II → prevention of vasoconstriction & release of aldosterone
ACE inhibitors
90
Vasodilators of choice in treating HF
ACE inhibitors
91
Many times swelling SE shows in the
lips and face, and can constrict the airway
92
Angioedema is more common in what population?
African American men
93
What vital must me assessed before giving cardiac glycosides?
HR
94
Overall effect of cardiac glycosides:
↓ in myocardial workload & relief of CHF.
95
Cardiac glycosides onset of action is...
rapid
96
Negative chronotropic effect
Slows HR
97
Cardiac glycosides are safe for patients with
liver dysfunction
98
Cardiac glycosides are excreted in urine & can cause
toxicity in renal diseases
99
What must be monitored when giving cardiac glycosides?
Serum potassium
100
Signs and symptoms of digoxin toxicity
Nausea, anorexia, confusion, visual disturbance (halos), and bradycardia
101
IHSS
Idiopathic hypertrophic subaortic stenosis (a genetic condition)
102
Contraindication for cardiac glycosides:
allergy, lethal ventricular arrhythmias, IHSS, acute MI, renal insufficiency
103
Treating CHF acronym
UNLOAD FAST
104
UNLOAD FAST
Upright position Nitrates Lasix Oxygen ACE inhibitors Digoxin Fluids decrease Afterload decrease Sodium restriction Test
105
A, B, C, D, E's of Heart Failure Therapy
A. Angiotensin converting enzyme inhibitors, anticoagulants B. Beta blocking drugs C. Calcium channel blocking drugs D. Diet, diuretics, digitalis, dobutamine E. Exercise
106
Acute event that results from HF
Pulmonary Edema
107
Abnormal accumulation of fluid in the interstitial spaces or the alveoli
Pulmonary Edema
108
Clinical manifestations of Pulmonary edema
Increasing restlessness & anxiety from hypoxia Breathlessness Extremities become cold & moist Nail beds become cyanotic Distended Neck Veins
109
Management of Acute Pulmonary Edema
Improve ventricular function and increase respiratory exchange O2 Medication therapies Nursing support
110
Med that ↓anxiety & preload in PE
Morphine

Med/Surg (17 decks)

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