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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
Q

Multigated Analysis Scan

A

MUGA Scan

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26
Q

Test that evaluates that function of the right and left ventricles of the heart.

A

Nuclear Stress Test

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27
Q

Provides a more accurate representation of cardiac ejection fraction.

A

MUGA Scan

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28
Q

Advantages of a MUGA Scan:

A

More accurate than Echocardiogram
More accurate than Angiogram
Non-invasive
Less expensive (than angio)

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29
Q

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).

A

Class I

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30
Q

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).

A

Class II

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31
Q

NYHA Functional classification, Level of clinical impairment:

Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.

A

Class III

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32
Q

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.

A

Class IV

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33
Q

Neurohormone secreted from ventricles in response to pressure changes

A

B-Type Natriuretic Peptide (BNP)

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34
Q

Elevated BNP levels are associated with

A

elevated ventricular filling pressures- (HF worsens)

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35
Q

BNP below 100pg/ml=

A

no heart failure

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36
Q

BNP of 100-300pg/ml

A

suggestive of heart failure

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37
Q

BNP above 300pg/ml=

A

mild heart failure

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38
Q

BNP above 600pg/ml=

A

moderate heart failure

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39
Q

BNP above 900pg/ml=

A

severe heart failure

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40
Q

I & O’s nursing implications

A

shows how the kidneys are working or if diuretic is working

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41
Q

Types of referrals for people with CHF

A

Dietitians, home care, social worker, PT

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42
Q

Activity intolerance:

For acute exacerbations

A

Bed rest

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43
Q

Activity intolerance:

Wait 2 hours after eating before

A

doing physical activity

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44
Q

Activity intolerance:

Positioning

A

elevation of HOB to facilitate breathing and rest, support of arms

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45
Q

Type of meds that control volume

46
Q

Type of meds that slow progression of disease

A

ACE inhibitors and beta blockers

47
Q

Number 1 treatment given for HF

48
Q

How do beta blockers work?

A

they help reduce BP, afterload, and HR

49
Q

Treating underlying causes ….

A

slows progression of the disease, i.e. treating hypertension

50
Q

Medication type that reduces fluid

51
Q

Medication that dilates blood vessels

A

ACE inhibitor and vasodilators

52
Q

Medication type that also treats angina

A

Calcium channel blockers

53
Q

Medication type that decreases BP by inhibiting calcium ions and slows cardiac impulse

A

Calcium channel blockers

54
Q

Medication type that slows heart rate

A

Beta blockers

55
Q

Medication type that needs the apical HR to be checked prior to administering

A

Beta blockers

56
Q

Medication type that is dosed in mcg

57
Q

Medication type that increases the heart’s ability to contract (helps with force of contractions)

58
Q

Medication type that dilates coronary arteries for more oxygen and nutrients

A

Vasodilators

59
Q

Medication type that helps reduce angina and MI

A

Vasodilators

60
Q

Medication type that is 1st prescribed after diuretics

A

ACE inhibitors

61
Q

Medication type, also prescribed to treat hypertension, that reduces pre and after load

A

ACE inhibitors

62
Q

Medication type that is cardio tonic, inotropic, and blocks phosphodiesterase causing stronger contraction

A

Phosphodiesterase inhibitors

63
Q

Medication names:

Diuretics

A

HCTZ (Thiazide)
Furosemide (Loop)
Spironolactone

64
Q

Medication names:

ACE inhibitors

A

The “-prils”
Enalapril
Lisinopril
Captopril

65
Q

Medication names:

Calcium Channel Blockers

A

Amlodipine
Diltiazem

66
Q

Medication names:

Cardiac glycosides

67
Q

Medication names:

Beta blockers

A

Toprol
Lopressor

68
Q

Medication names:

Vasodilators

69
Q

Medication names:

Phosphodiesterase inhibitors

A

IN amrinone

70
Q

Medication class:

Decrease in volume
Decrease in venous return
Reduction in BP
Reduce after load & preload
Reduces myocardial work load

71
Q

Thiazide med name:

A

Hydrochlorothiazide (HDTZ)

72
Q

Med that acts on Distal convoluted tubules

A

Thiazide diuretic

73
Q

Med that is Indicated for edema of CHF, liver & kidney diseases, HTN

A

Thiazide diuretic

74
Q

Medication Adverse Effects:

GI upset
CNS complications (lethargy, sedation, fatigue)
Hypovolemia, Hypokalemia (assess K+)
↑levels of Ca & uric acid (gout)

A

Thiazide diuretic

75
Q

Med with Drug to drug interaction:

↑ risk of Digoxin &Lithium Toxicity especially with hypokalemia
↓effectiveness of oral antidiabetics

A

Thiazide diuretic

76
Q

Med that acts on the Loop of Henle

A

Loop diuretics

77
Q

Med that is indicated for Acute CHF, Acute Pulmonary Edema, liver & kidney diseases, HTN

A

Loop diuretics

78
Q

Adverse effects of loop diuretics

A

Hypokalemia
Volume depletion (↓BP??)
Hyperglycemia (with diabetics)
Ototoxicity (???)

79
Q

Contraindications for loop diuretics

A

Allergy, Electrolyte depletion, anuria/renal failure, hepatic coma,pregnancy & lactation

80
Q

How to avoid ototoxicity with loop diuretics

A

IV push slowly

81
Q

Drug to drug interactions for loop diuretics

A

↑ risk of ototoxicity with Aminoglycosides/Cisplatin. ↑ anticoagulation effect with anticoagulants ,decreased effect when used with NSAIDs.

82
Q

aminoglycosides

A

antibiotics (gentamycin)

83
Q

Med that acts on distal tubule & collecting duct

A

potassium sparing diuretics

84
Q

Indications for potassium sparing diuretics

A

edema in CHF, hypokalemia, liver & kidney diseases, HTN, hyperaldosteronism

85
Q

Drug to drug interaction with potassium sparing diuretics:

A

↓ diuretic effect when used with salicylates (aspirin and Pepto bismol)

86
Q

Name of an ACE inhibitor

A

benazepril

87
Q

Major side effect of ACE inhibitors

A

angioedema

88
Q

Ace inhibitors decrease…

A

preload & afterload

89
Q

Med that blocks the enzyme which converts Angiotensin I to II → prevention of vasoconstriction & release of aldosterone

A

ACE inhibitors

90
Q

Vasodilators of choice in treating HF

A

ACE inhibitors

91
Q

Many times swelling SE shows in the

A

lips and face, and can constrict the airway

92
Q

Angioedema is more common in what population?

A

African American men

93
Q

What vital must me assessed before giving cardiac glycosides?

94
Q

Overall effect of cardiac glycosides:

A

↓ in myocardial workload & relief of CHF.

95
Q

Cardiac glycosides onset of action is…

96
Q

Negative chronotropic effect

97
Q

Cardiac glycosides are safe for patients with

A

liver dysfunction

98
Q

Cardiac glycosides are excreted in urine & can cause

A

toxicity in renal diseases

99
Q

What must be monitored when giving cardiac glycosides?

A

Serum potassium

100
Q

Signs and symptoms of digoxin toxicity

A

Nausea, anorexia, confusion, visual disturbance (halos), and bradycardia

101
Q

IHSS

A

Idiopathic hypertrophic subaortic stenosis (a genetic condition)

102
Q

Contraindication for cardiac glycosides:

A

allergy, lethal ventricular arrhythmias, IHSS, acute MI, renal insufficiency

103
Q

Treating CHF acronym

A

UNLOAD FAST

104
Q

UNLOAD FAST

A

Upright position
Nitrates
Lasix
Oxygen
ACE inhibitors
Digoxin

Fluids decrease
Afterload decrease
Sodium restriction
Test

105
Q

A, B, C, D, E’s of Heart Failure Therapy

A

A. Angiotensin converting enzyme inhibitors, anticoagulants
B. Beta blocking drugs
C. Calcium channel blocking drugs
D. Diet, diuretics, digitalis, dobutamine
E. Exercise

106
Q

Acute event that results from HF

A

Pulmonary Edema

107
Q

Abnormal accumulation of fluid in the interstitial spaces or the alveoli

A

Pulmonary Edema

108
Q

Clinical manifestations of Pulmonary edema

A

Increasing restlessness & anxiety from hypoxia
Breathlessness

Extremities become cold & moist

Nail beds become cyanotic

Distended Neck Veins

109
Q

Management of Acute Pulmonary Edema

A

Improve ventricular function and increase respiratory exchange
O2
Medication therapies
Nursing support

110
Q

Med that ↓anxiety & preload in PE

Med/Surg (17 decks)

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