Heart Failure Flashcards
definition of heart failure
Inadequate cardiac output and oxygen delivery, caused by the inability of the heart to pump efficiently or to fill adequately
what is the most common medicare diagnosis and why
HF
age plays a role
what is ejection fraction
percentage of blood in the LV that makes it out of LV with each heartbeat
normal ejection fraction
60-70%
what is preload?
VOLUME of blood entering the heart
what is afterload?
RESISTANCE heart has to overcome to get blood out of the heart
what is contractility
force from heart muscle – how hard the heart can pump
purpose of inotropic medications
increase the contractility of the heart (digoxin, BB)
what is the cardiac output
amount of blood volume pumped per minute
what is stoke volume
amount of blood pumped out of the ventricle with each beat or contraction
how do you calculate cardiac output
CO = SV x HR
what does starling’s law say
-more volume = more stretched heart is the harder it can contract
-Decreased stroke volume and decreased CO begin compensatory mechanisms
compensatory mechanisms for decreased SV and CO
SNS activates
RAAS activates
B-type natriuretic peptide release
Structural changes occur
peptide released when ventricle is filled with too much fluid and stretches – tries to get body to diureis fluid
B-type natriuretic peptide
possible causes of heart failure
Uncontrolled HTN!!!
Recreational drug use
Infections of the heart
Valvular disorders
Arrhythmias (a fib, tachycardia)
Ischemia/Infarction (MI, CAD)
Congenital defects
causes of left sided HF
systemic causes
Coronary artery disease
Hypertension
Cardiomyopathy
Rheumatic heart disease
causes of right sided HF
pulmonary causes
Chronic obstructive pulmonary disease (COPD)
Pulmonary embolus
Right heart failure due to pulmonary issues (termed “cor pulmonale”)
RV infarct
classification of systolic HF
contraction
Majority of patients
Ventricle unable to contract and eject blood
Ejection fraction is decreased
classification of diastolic HF
relaxation
Ventricle is stiff and can’t fill adequately – they cannot relax and let blood in
Usually related to long-standing hypertension or aortic stenosis
clinical manifestations of right sided HF
rest of the body
Swelling, generalized edema
Weight gain
JVD
Hepatomegaly
Ascites
Irregular heat rate
Increased abdominal girth
Nocturia
Anorexia
N/V
Dependent edema
Fatigue
clinical manifestations of left sided HF
back to the lungs
Dyspnea
Rales – crackles
Orthopnea
Fatigue
Cyanosis
Paroxysmal nocturnal dyspnea
Tachycardia
Nagging cough
Pulmonary edema – pink frothy sputum
S3 heart sound
Confusion/restlessness
AHA/ACC HF stages A-D
A – Patient with risk factors but no left ventricular impairment
B – Asymptomatic with LV hypertrophy and/or impaired LV function
C – Current or past symptoms of heart failure
D – Refractory HF eligible for heart transplant, inotropic and/or mechanical support
NYHA Functional Class 1-4
I – No symptoms with physical activity such as dyspnea or chest pain
II – Mild symptoms with ordinary activities
III – Marked limitation with physical activity but comfortable at rest
IV – Severe limitation and distress with physical activity or at rest
normal range for BNP
less than 400
Evaluates the EF and diastolic function
May distinguish systolic from diastolic dysfunction
echocardiography
diagnostic tests for HF
stress test or coronary angiography (Evaluates for active or reversible ischemia)
two view chest x-ray (Evaluates chamber size and pulmonary congestion)
why is an EKG not a useful screening tool
purely the pathway of electricity – not how hard the heart is pumping
nursing assessments for pts with HF
Responsiveness to medications: monitor HR, BP, volume status
I&O, daily weights!!!
Compliance with diet and fluids
Respiratory status
Safety
Monitor vital signs (HR, BP)
S/S of decreased CO
Labs: K+, BUN, creatinine, Dig levels, BNP!!!, troponins
what should the nurse educate the pt on with HF
Low sodium diet
Fluid restriction
Daily weights
Med compliance
Smoking cessation
Know the s/s of exacerbation
Vaccinations – illness –heart stress
Exercise
Limit alcohol intake
medications to treat HF
ACE Inhibitors (-prils)
ARBs (-sartan)
Diuretics
Beta Blockers (-lols)
Vasodilators
Digoxin
devices to treat HF
Pacemakers – stimulate heart to beat
Biventricular pacemakers
ICDs
Ventricular-assist device (VAD)
where is the fluid buildup in pulmonary edema
fluid in interstitial spaces and the alveoli
fluid accumulated around pleural space
pulmonary effusion
