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NURS 232 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Describe Heart Failure

A

Abnormal clinical syndrome involving impaired cardiac pumping and/or filling. Heart is unable to produce an adequate CO to meet metabolic needs.

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2
Q

4 characteristics of heart failure

A
  1. Ventricular dysfunction
  2. Reduced exercise tolerance
  3. Diminished QOL
  4. Shortened life expectancy
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3
Q

Formula for cardiac output

A

CO = HR x SV

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4
Q

2 Primary risk factors of heart failure + 4 others

A

1 - Coronary artery disease
2 - HTN (vessels become less elastic)

DM, smoking, obesity, high serum cholesterol

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5
Q

Interferences with what CO regulating mechanisms can cause HF?

A
  1. Preload
  2. Afterload
  3. Myocardial contractility
  4. HR
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6
Q

What is preload?

A

Initial stretching of cardiac myocytes prior to contraction. Volume of blood in ventricles at end of diastole.

Increased in: hypervolemia, regurgitation of cardiac valves

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7
Q

What is afterload?

A

SVR (systemic vascular resistance): resistance L ventricle must overcome to circulate blood.

Increased in: hypertension, vasoconstriction

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8
Q

What is myocardial contractility?

A

Capacity of the heart to have a strong and effective contraction

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9
Q

What is HFrEF?

A

Heart Failure with Reduced Ejection Fraction
- most common form of HF
- caused by impaired contractile function, increased afterload, HTN, cardiomyopathy, mechanical abnormality
- hallmark finding: decrease in the LV EF < 40% - loses ability to generate enough pressure to eject blood forward through high-pressure aorta

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10
Q

What is an ejection fraction? What is a normal value?

A

EF = fraction or % of total amount of blood in LV that is ejected during each ventricular contraction

Normal: >55% of ventricular volume. Pts with < 40% require specialist intervention

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11
Q

What is HFpEF?

A

Heart Failure with Preserved Ejection Fraction:
- HF symptoms with an EF of 50% or greater
- inability of the ventricles to relax and fill during diastole
- results in decreased stroke volume and CO
- caused by L ventricular hypertrophy from HTN, myocardial ischemia, valvular disease, cardiomyopathy

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12
Q

4 Compensatory Mechanisms for HF

A

Body is trying to maintain homeostasis:
1. SNS stimulation increases
2. Neurohormonal responses
3. Ventricular dilation
4. Ventricular hypertrophy

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13
Q

Describe SNS stimulation compensation

A
  • often 1st triggered to increase HR, myocardial contractility
  • good initially, but not over time when they increase the O2 demand in the myocardium
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14
Q

Describe neurohormonal response compensation

A
  • kidneys and posterior pituitary stimulate ADH to retain salt and water which causes an increase in preload
  • RAAS system is associated with water and sodium reabsorption, BP regulation, K secretion
  • good initially, but excessive Na and H20 retention can cause systemic venous congestion and peripheral edema
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15
Q

Describe cardiac decompensation

A
  • compensatory mechanisms can no longer maintain adequate CO
  • insufficient tissue perfusion
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16
Q

Describe Ventricular Remodeling

A
  • hypertrophy of cardiac myocytes
  • eventually leads to an increase of ventricular mass, shape, impaired electrical conduction, and impaired contractility
  • takes up more space, less space for the chamber
    BIGGER BUT LESS EFFECTIVE

not the same as how the heart strengthens in athletes

17
Q

Describe Ventricular Dilation compensation

A
  • Enlargement of chambers of heart due to elevated pressure over time
  • Copes with increased BV in the ventricles
  • Decreases elasticity in the muscle fibers over time which leads to a decreased CO
18
Q

Describe Ventricular hypertrophy compensation

A
  • increase in muscle mass and cardiac wall thickness due to overwork and strain
  • increases CO but requires more O2 for contractions
19
Q

Describe 2 Counterregulatory Mechanisms

A

Myocardium produces hormones in response to stretching due to increased BV in the heart:

  1. ANP - atrial natriuretic peptide released from atria
  2. BNP - beta-type natriuretic peptide released from ventricles

ANP lowers BP and cardiac hypertrophy
BNP reduces ventricular fibrosis

20
Q

What is the most common type of HF?

A

Left-sided:
- Backup of blood into the L atrium and pulmonary veins
- L manifested as puLmonary edema
- Respiratory congestion, dyspnea, hemoptysis, orthopnea (SOB when supine)
- CV pallor, third heart sound
- Oliguria (low urinary output), nocturia

21
Q

What is Right-sided HF?

A
  • Backward BF to the R atrium and venous circulation
  • R manifested as peRipheral edema (seen in legs, feet, JVD)
  • Ascites
  • Enlargement of the liver
  • Palpable enlargement of the spleen
  • GI tract congestion
22
Q

2 Clinical Manifestations of HF

A
  1. Acute Decompensated Heart Failure (ADHF)
  2. Chronic HF
23
Q

7 symptoms of ADHF

A

Acute Decompensated (compensatory mechanisms fail) Heart Failure:
1. acutely SOB (rapid RR and HR)
2. wheezing/coughing with frothy blood-tinged sputum
3. pale, cyanotic, clammy skin, cold
4. highly anxious
5. altered LOC

24
Q

Describe Ascites in relationship to HF

A

It is not acute, but can occur in chronic HF who happens to have an acute decompensated heart failure

25
Q

Describe nocturia in relationship to HF

A

PTs with HF compensate by shunting blood to the core, but at night there is less demand on the heart when the body relaxes causing fluid to go back into the vascular spaces and thus, to the kidneys.

26
Q

Goals of ADHF therapy (4Ds)

A

Improve L ventricular function:
- Diuretics to reduce venous return
- Dangle feet and/or High fowlers to reduce venous return
- Devices to improve gas exchange (BIPAP)
- Distress resolving (morphine can lower anxiety by reducing perception of SOB)

27
Q

3 Supportive Devices for Chronic HF

A
  1. Cardiac resynchronization therapy - uses a pacemaker to restore normal HR
  2. Implantable cardioverter-defibrillator - preventative tool that gives a jolt when heart goes into ventricular fibrillation
  3. Mechanical circulatory support
28
Q

6 Common medications for HF

A
  1. Diuretics - ↓ preload by ↓ intravascular volume
  2. ACE inhibitors - 1st line, vasodilators, ↓ SVR cough
  3. B-Adrenergic blockers - ↓ HR+BP which ↓ O2 demand
  4. Neprilysin inhibitors - combination of meds that protect ANP and BNP production
  5. Digitalis - ↓ HR, ↓ SVR, ↑ ventricular contractility, ↑ CO
29
Q

What are inotropic drugs?

A

Mostly for management of ADHF, improve cardiac contractility and ↑ CO

30
Q

What is taken first thing in the morning and trended with VS for HF pts?

A

Daily weight

31
Q

What weight gain levels are reported?

A

Gains of 2 kg/24h or 2.5kg/1week

32
Q

What is Na restricted to for pts with HF?

A

2.0g/day

33
Q

What is Na restricted to for pts with HF and HTN?

A

1.5g/day

34
Q

What are fluids restricted to for pts with HF?

A

1.5-2L/day and 50% should be water

35
Q

5 nursing diagnoses for HF

A
  1. Inadequate CO
  2. Reduced gas exchange
  3. Excess fluid volume (watch for hypokalemia, weight)
  4. Anxiety
  5. Activity intolerance
36
Q

An emergency complication of HF

A

Digitalis toxicity: Life-threatening condition. The most common symptoms: NVD & irregular pulse

37
Q

Describe salt restriction significance in pts with HF

A

The body needs Na, but too much causes your body to hold on to fluid. This fluid build-up makes your heart work harder, causes swelling in your feet, legs, or belly, and potentially in lungs (SOB)

38
Q

What is an atrial kick?

A

The last part of atrial contraction. This is lost in atrial fibrillation.

NURS 232 (11 decks)

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