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XIO > Heart failure > Flashcards

Heart failure Flashcards

1
Q

Frank starling

A

More blood (EDV) = more stretching (more preload) = greater contraction (more SV)

Describes the relationship between preload & cardiac performance
Normal systolic contractile performance (SV or CO) is proportional to preload within the normal physiologic range
Contractility is reasonably reflected by EF (percentage of end diastolic volume ejected with each contraction (SV)

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2
Q

Cardiac reserve is the

A

ability of the heart to increase its performance above resting levels in response to stress or need for increase oxygen consumption

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3
Q

cardiac reserve does what? (think sympathetic) and helps with what in HF?

A

Increase in HR
Increase in systolic /diastolic volumes
Increase in tissue extraction of oxygen
This compensatory mechanism helps with decreased blood flow in HF

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4
Q

Heart failure - is it the ventricles or the atria?

A

A clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles to fill or eject blood It is a syndrome of ventricular dysfunction.

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5
Q

Left ventricle fails and causes what symptoms? (just 2) (Levi - the one you forget)

A

shortness of breath and fatigue

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6
Q

Right ventricle fails and causes

A

peripheral and abdominal fluid accumulations

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7
Q

HF is a clinical syndrome characterized by signs and symptoms of (HF is fluid)

A

fluid overload or inadequate tissue perfusion.

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8
Q

HF is a complication that results from problems such as (brad, tjan, and val cause HF)

A

cardiomyopathy, valvular heart disease, endocarditis

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9
Q

HF - gender (HF does not discriminate)

A

equal between men and women

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10
Q

HF more common at what age? (same as always)

A

among 65 +, overweight, and african american

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11
Q

death from HF is dropping, but

A

readmissions are high

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12
Q

The term heart failure indicates myocardial disease, in which there is a problem with the

A

contraction of the heart (systolic failure) or filling of the heart (diastolic failure)

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13
Q

HF - permanent or reversible?

A

Some cases are reversible depending on the cause

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14
Q

HF develops fast or slow?

A

Develops slowly and gradually, as the heart loses the ability to work and pump blood efficiently, d/t a change in normal mechanisms of circulation and cardiac output

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15
Q

Most HF is a chronic,

A

progressive condition managed with lifestyle changes and medications

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16
Q

In the past, HF was often referred to as

A

congestive heart failure (CHF), because many patients experience pulmonary or peripheral congestion with edema.

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17
Q

HF - Heart does not provide tissues with adequate

A

blood for metabolic needs

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18
Q

HF - elevation of pulmonary or systemic venous pressures may result in (pressure on the freeway turns into congestion)

A

organ congestion

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19
Q

HF Causes abnormalities in systolic or diastolic?

A

one or the other or both

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20
Q

Structural defects can also cause HF - ex - and what about thyroid?

A

Congenital defects, valvular disorders, rhythm abnormalities, high metabolic demands (thyrotoxicosis)

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21
Q

HF - collagen

A

thickens

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22
Q

types of HF

A

Heart failure with reduced ejection fraction (HFrEF) or systolic HF
Heart failure with preserved ejection fraction (HFpEF) or diastolic HF
Left ventricular failure
Right ventricular failure

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23
Q

what determines HF? (HF is just CO and EF)

A

Cardiac output
Ejection fraction

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24
Q

HF factors

A

Factors
HR, SV, preload, afterload, contractility

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25
Q

HF Key

A

Recognize and assist compensation (BNP and RAAS system)

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26
Q

HF goal

A

Restore C.O. and gas exchange

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27
Q

HF is determined by just one thing - what is it?

A

ejection fraction, the percentage

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28
Q

HFrEF (HF with reduced ejection fraction) - caused by what? (the lefties reducies)

A

Caused by global LV systolic dysfunction
LV contracts poorly, empties inadequately

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29
Q

HFpEF (HF with preserved ejection fraction) (preserve is not preserving the filling)

A

LV filling is impaired (not necessarily the contraction part)

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30
Q

HFpEF - causes (wizard door)

A

Age related changes, diabetes, obesity, CKD and/ or causes of systemic inflammation

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31
Q

HFpEF goals - (preserve my BP and DM)

A

BP control
DM management

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32
Q

LV failure (what about lymph nodes)

A

Due to LV dysfunction
CO decreases and pulmonary venous pressure increases
When pulmonary capillary pressure exceeds oncotic pressure of plasma proteins, fluid leaks from capillaries to interstitial space and alveoli
Pulmonary compliance is decreased, and work of breathing is increased
Lymphatic drainage increases to compensate but cannot meet demands
Pulmonary edema occurs
Pulmonary effusions develop leading to more dyspnea
MV increases (PaCo2 decreases, pH increases leading to respiratory alkalosis)
Interstitial edema worsens and interferes with ventilation and leads to increase CO2 and respiratory failure

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33
Q

RV failure - what about aldosterone? And anemia? (Alden has anemia in the RV)

A

Systemic venous pressure increases
Fluid leaks and causes edema (dependent)
Feet, ankles, abdominal viscera
Organs most affected are the liver, stomach, intestines, peritoneal cavity (ascites)
Causes hepatic dysfunction (increase bilirubin, PT, alkaline phosphatase, GGT) and the damaged liver breaks down less aldosterone which then leads to more fluid accumulation
Anorexia, malabsorption, hypoalbunemia, diarrhea, anemia (chronic GI blood loss), ischemic bowel

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34
Q

HF - hemodynamics - Effects of decreased CO (and what about potassium?)

A

lower BP, decreased oxygen delivery, parasympathetic tone (arterial baroreceptors), renal perfusion, coronary perfusion, potassium excretion

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35
Q

HF - renal system (what happens to sodium and water?) think edema

A

Renal venous congestion, decreased renal blood flow, filtration and reabsorption and GFR leading to sodium and water retention (RAAS, ADH)

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36
Q

HF - neurohormonal - TNF?

A

Maintain a normal balance between vasoconstriction, stimulating and dilation, relating of the myocardium
Norepinephrine, RAAS, aldosterone, vasopressin, BNP
TNF (tumor necrosis factor is produced from a failing heart

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37
Q

HF diagonsis - using what? (cath can find HF)

A

Pulmonary Artery Catheter (Swan-Ganz)

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38
Q

HF diagnosis using an arterial line - which one? (Art can diagnose HF with a radio)

A

Radial artery, continuous BP measurement
Allen’s test & the 5 P’s for pulses (pain, pallor, pulse, paresthesia, paralysis)

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39
Q

HF - BNP: B-type natriuretic peptide (Bumpin 100 to a 1000)

A

BNP: B-type natriuretic peptide (ventricular stretch)
> 100pg/mL = heart failure
> 1000 your patient is REALLY sick

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40
Q

HF diagnosis - CXR - xray - (xray my large, fat heart)

A

Enlarged heart, pulmonary edema

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41
Q

HF diagnosis - ECG measures what? (E for ECG, E for EF)

A

Echocardiogram
EF, pumping action

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42
Q

HF - New York Heart Association Functional Classification (just 1-4)

A

1-4 (4 being the worst)

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43
Q

manifestations of right sided failure

A

Viscera and peripheral congestion
Jugular venous distention (JVD)
Dependent edema
Ascites
Weight gain
Enlarged organs
Hepatomegaly

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44
Q

manifestations of left sided failure - and cough?

A

Pulmonary congestion, crackles
Dyspnea on exertion (DOE), dyspnea
Low O2 sat
Dry, nonproductive cough initially
Blood-tinged frothy sputum

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45
Q

signs of HF in general (OVERLOAD)

A

O orthopnea
V ventricular failure
E enlarged heart
R reported weight gain
L lungs congested
O output decreased
A apprehension
D dependent edema

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46
Q

HF gerontologic - signs (really the same ones)

A

May present with atypical signs and symptoms such as fatigue, weakness, and somnolence

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47
Q

HF and aging - these are all normal parts of aging, but they lower the threshold - left ventricle diastole? (left ventricle got collagen in its old age)

A

Lowers the threshold for HF
Decline in left ventricular diastolic function due to increase of myocardial collagen, myocardial stiffening and prolonged myocardial relaxation

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48
Q

HF management

A

Drug therapy
Nutritional therapy
Fluid restriction
Weight monitoring
Research therapies
Transplantation
LVAD (left ventricular heart device) **THESE ppl will not have a BP, just a mean arterial

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49
Q

drugs that decrease afterload (the As decrease A-afterload)

A

ACE, (end in captopril) ARBs

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50
Q

decrease afterload and preload (Arby’s before and after)

A

ARB (valsartan)

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51
Q

vasodilators decrease preload or afterload? (dilate when it’s too late)

A

decrease afterload (hydro and nitro)

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52
Q

diruetics decrease

A

preload

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53
Q

digotoxin does what? (digs for a deeper contraction)

A

increases contractility

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54
Q

HF nursing management

A

provide symptom relieve and education, improve ventilation (RR, O2, position, monitor lungs), energy management (prevent fatigue, monitor activity, encourage activity), hemodynamic regulation (HR, preload, afterload, contractility, electrolytes, fluids, meds, I&O, weights)

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55
Q

ACE inhibitors - monitor for (hyper kalema plays with aces)

A

ACE inhibitors block aldosterone, which increases sodium. hypotension, hyperkalemia, and altered renal function; cough

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56
Q

beta blockers - how long to start working?

A

prescribed in addition to ACE inhibitors; may be several weeks before effects seen; use with caution in patients with asthma

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57
Q

dig - monitor for

A

monitor for digitalis toxicity especially if patient is hypokalemic

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58
Q

IV medications - which one for LV failure?

A

indicated for hospitalized patients admitted for acute decompensated HF
Milrinone: decreases preload and afterload; causes hypotension and increased risk of dysrhythmias
Dobutamine: used for patients with left ventricular dysfunction; increases cardiac contractility and renal perfusion

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59
Q

Ivabradine (Corlanor) – (Ivan blocks and slows down my heart)

A

Ivabradine (Corlanor) – blocks SA node channel and decreases HR.
Goal is HR <70 since there is a 30% > risk of death with a HR >70
Take with food
Increases risk for atrial fibrillation

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60
Q

Sacubitril/ Valsartan (Entresto) - neprilysin

A

Sacubitril/ Valsartan (Entresto) - neprilysin inhibitor sacubitril and the angiotensin receptor blocker valsartan
Used for HF and HFrEF
Relaxes blood vessels, improves blood flow (kidneys), decreases stress on the heart
Monitor for hypotension, hyperkalemia, and changes in renal function
Twice daily dosing

61
Q

ABCDE

A

ACE, ARBS, Aldactone, ARNI
Beta blockers
Cessation of cigarettes, Corlanor (ivabradine)
Digoxin, diuretics, diet
Education, exercise, Entresto

62
Q

chronic HF -more common with what age? (close)

A

The incidence of HF increases with age
Most common in people older than 75 years
Most common reason for hospitalization of people older than 65 years and is the second most common reason for visits to a physician’s office
Approximately 25% of patients discharged after treatment for HF are readmitted to the hospital within 30 days
The cost to the healthcare system in the US is about 32 billion a year
Affects about 6.5 million people in the US with > 950.000 new cases each year.
About 26 million people are affected worldwide.
COPD

63
Q

advanced HF monitoring (tele savalis is advanced)

A

Self monitoring of symptoms
Labs (can do this at home)
Telemonitoring
Arrhythmia monitoring

64
Q

advanced therapy - when all else fails

A

When all else fails – maximum symptos at rest despite optimal therapy:

Mechanical circulatory support - bridge to transplant or destination therapy
ECMO (blood oxygenated outside of body and then put back in)
LVAD – decreases LV filling pressure; LV size; PA pressure; wall size and stress and HF symptoms; increases LV output

65
Q

heart transplant

A

Transplant –survival is about 88% 1 year; 75% at 5 years & 62% at 10 years
3500 listed
320 die waiting
49% wait more than a year
3100/day on the waitlist

66
Q

LVAD patient education - alerts (Vladamir is less than 65, so can’t have CPR)

A

DONT DO CPR. if SV < 65mL/beat
CO (flow rate < 3.5L/min) if it’s low, it’s usually a battery problem

67
Q

cardiomyopathy

A

Abnormal heart muscle that is enlarged, thickened, or stiffened
Impairs ventricular function and leads to decreased CO

68
Q

types of cardiomyopathy

A

dilated, hypertrophic, and restrictive

69
Q

dilated cardiomyopathy

A

Thick/enlarged ventricular walls
Dilation of chambers
Impairs systolic function (pumping)

70
Q

hypertrophic cardiomyopathy (no more filling for hypertrophy, already too much)

A

Ventricles enlarge and ventricular cavities reduce in size therefore filling (diastolic function) is decreased
DIALATED is only one that is systolic

71
Q

restrictive cardiomyopathy (restriction may di)

A

Ventricles become rigid and fibrotic and filling(diastolic function) is reduced

72
Q

cardiomyopathy - causes

A

Idiopathic, HTN, viral infections, post MI

73
Q

cardiomyopathy symptoms

A

Manifestations of decreased CO
Left sided HF symptoms – activity intolerance, weakness, narrow pulse pressure, decreased peripheral pulse strength, pre/syncope, angina, dyspnea, orthopnea, pulmonary congestion, dysrhythmias (PVCs, VT), murmurs, S3 & S4
Right sided HF symptoms – JVD, peripheral edema, atrial dysrhythmias (AF, PACs), orthopnea, PND, nocturia, hepatomegaly, splenomegaly, abdominal distension, anorexia, nausea
Bradycardia in restrictive due to heart blocks, conduction dysfunction

74
Q

cardiomyopathy treatment

A

No cure, treat underlying cause
Treatment palliative (symptom management) or surgical (heart transplant, muscle resection, valve replacement)
Manage heart failure
Maximize CO, maintain gas exchange, modify activity to tolerance
Medications
ACE inhibitors, afterload reducers, inotropes, calcium channel blockers, beta blockers, diuretics
Biventricular pacemaker
ICD

75
Q

transplant - indications

A

End stage HF refractory for medical care; inoperable/decompensated valvular disease; recurrent life-threatening arrhythmias not responsive to maximal interventions

76
Q

all immunosuppressants increase the risk of..and will accelerate what?

A

cancer, esp lymphoma, and will accelerate CAD

77
Q

pulmonary edema - Is it venous or artery pressure? And fluid moves from where to where?

A

Acute LV failure with pulmonary venous HTN and alveolar flooding
When LV pressure increases suddenly, plasma moves from pulmonary capillaries into interstitial spaces and alveoli.

78
Q

causes of pulmonary edema - Cardiogenic

A

Cardiogenic
CAD-leading to coronary ischemia
Cardiomyopathy
Arrhythmia
Valvular disease
HTN-leads to HF with preserved EF

79
Q

causes of pulmonary edema - Noncardiogenic (without cardiac disease) (think non-heart lung issues) (infections, smoke, altitude)

A

Lung infections
ARDS
HAPE (high altitude)
Toxic exposures
Smoke
Renal disease

80
Q

hypoxia =

A

restlessness, anxiety, agitation, etc.

81
Q

pulmonary edema - symptoms (wheezy has a fat lung)

A

Common findings are severe dyspnea, wheezing (cardiac asthma) , sometimes a cough with pink or blood- tinged frothy sputum

82
Q

JVD will be which sided-failure?

A

right

83
Q

pulmonary edema diagnosis (fat lung is bumpin and needs an xray)

A

Assessment findings of severe dyspnea and pulmonary crackles
CXR –assessment of interstitial edema
BNP (brain naturetic peptide) or NT-pro-BNP (N-terminal-pro-BNP)

84
Q

pulmonary edema treatment (fat lung like angina, it’s da bute)

A

Oxygen
IV diuretic
Nitrates (SL then IV 10-20 mcgs/min titrate up to max of 300 mcgs/min if SBP >100 mmHg) in the critical care unit
IV inotropes (dobutamine) in the critical care unit
Morphine
Ventilatory assistance in the critical care unit
Position upright with legs down
Monitor daily weight
Medications

85
Q

pulmonary edema treatment - AMI or other ACS (acute cardiac syndrome) (fat lung needs a stent)

A

Specific additional treatment depends on etiology
AMI or other ACS (acute cardiac syndrome)-thrombolysis or PCA with/out stent

86
Q

pulmonary edema MOSTDAMP

A

M medications
O oxygen
S sit up
T tourniquet to decrease preload
D diuretics
A assess anxiety
M monitor
P positive pressure

87
Q

which sided failure is more common?

A

left

88
Q

The nurse is obtaining data on an older adult client. What finding may indicate to the nurse the early symptom of heart failure? (HF can’t exercise early in the morning)

A

Dyspnea on exertion

89
Q

late signs of HF (have fun late with hypo and tachy)

A

hypotension and tachycardia

90
Q

HF left side (the neas)

A

dyspnea, orthopnea, crackles, pink frothy

91
Q

HF right side (right side rocks the body with fluid)

A

JVD, edema, ascities, hepatomeglia, spleenomeglia

92
Q

main cause of HF

A

HTN

93
Q

sleep apnea - right or left sided failure?

A

right

94
Q

HF causes changes in collagen how?

A

Cardiac myocyte function
Collagen turnover

95
Q

HF - what causes left-sided failure? (usually ventricle, that’s all)

A

Left most commonly d/t LV dysfunction

96
Q

HF - right side

A

Right ventricle is thinner and more compliant and accepts blood @ low pressures and ejects against lower vascular resistance.

97
Q

HFrEF - does diastolic increase or decrease? (reduce is opposite)

A

increased diastolic volume and pressure (preload) and decreased EF

98
Q

HfPef - LV end-diastolic pressure is increased when? (di is always under pressure, preserve it)

A

rest and during exertion

99
Q

HfpEF - contractility (contracts and EFs are preserved and normal)

A

Contractility and EF remain normal & end-diastolic volume is normal (in most patients)

100
Q

HfpEF - Diastolic dysfunction results from (preserve the dying bc they’re stiff and can’t relax)

A

impaired ventricular relaxation, increased ventricular stiffness

101
Q

HF results from (MI hypertension, diabetes, and smoking is causing HF)

A

acute MI, and hypertension, diabetes, salt, smoking

102
Q

HfPEF - causes (preserving the endothelium is secondary)

A

endothelial dysfunction, cardiac microvascular dysfunction or secondary myocardial injury

103
Q

HfPEF - goals (preserve spiro for sleep apnea)

A

Aldosterone blockage treatment (controversial-use of spironolactone and eplerenone results in reduced vascular stiffness and diuresis, causing a decrease in BP)
OSA (sleep apnea) treatment

104
Q

HfPEF goals - meds? (preserve the diuretics and statins)

A

CAD treatment
AF treatment (rate & rhythm)
Diuretics
statins

105
Q

anorexia, diahrrea, anemia -right or left side? (anorexia is not right)

A

right

106
Q

HF - hemodynamics

A

Effects of increased sympathetic tone (arterial baroreceptors), HR, sodium and water retention, preload, afterload, cardiac workload, congestion

107
Q

Pulmonary Artery Catheter (Swan-Ganz) does what? (cath measures the pressure)

A

Measures pressures inside the heart
Helps determine the cause of decreased CO

108
Q

what heart sound with left-sided failure? (gallop to the left 3 times)

A

S3 or “ventricular gallop”

109
Q

left side - pee, or no? (olga on the left)

A

Oliguria

110
Q

left side - slow or fast HR?

A

Restlessness
Tachycardia

111
Q

left side - big one - what about lying down and breathing? and nighttime breathing?

A

Orthopnea
Nocturnal dyspnea

112
Q

HF - older adults and renal function - what to watch out for

A

Decreased renal function can make older patients resistant to diuretics and more sensitive to changes in volume

113
Q

HF - older adults - kidney stuff

A

Administration of diuretics to older men requires nursing surveillance for bladder distention caused by urethral obstruction from an enlarged prostate gland; monitor older persons for incontinence, retention, UTI, presyncope/syncope, dehydration, electrolytes
be aware of BPH in men - this could cause kidney failure

114
Q

HF - older adults - normal changes (the left side goes down with age)

A

Modest decline in LV systolic function
Decline in ability to respond to increased work demands (beta adrenergic stimulation)
Response to exercise and stressors decreases

115
Q

HF older adults

A

Hypoxia, infections (PNA), fluid overload, renal failure, non-adherence to drugs regimens or diets (low sodium)

116
Q

LVAD (left ventricular heart device) **THESE ppl will not have a (vlad has no blood pressure)

A

BP, just a mean arterial

117
Q

restrictive cardiomyopathy - causes (amy and radiation restrict brad)

A

d/t amyloidosis, XRT (radiation)

118
Q

cardiomyopathy - causes

A

, thyroid disease, diabetes, peripartum, alcoholism, anabolic steroid use, chemotherapy, XRT, connective tissue disorders

119
Q

pulmonary edema - most cases result from what? (I FFAV my fat lung)

A

½ of all cases worldwide result from acute coronary ischemia followed by heart failure, arrhythmia, acute valvular disorder and acute volume overload due to IV fluids.
Drug or dietary non-adherence is often involved.

120
Q

pulmonary edema - how do pts act?

A

Patients usually present with restlessness and anxiety with a sense of suffocation

121
Q

pulmonary edema - pt appearance?

A

Patients appear pale, cyanotic and have marked diaphoresis; some froth at the mouth

122
Q

pulmonary edema - how is the pulse? and lung sounds?

A

Pulse is rapid and weak, BP is variable
Upon auscultation there are fine pulmonary crackles in both lung fields either widely dispersed or dependent.

123
Q

pulmonary edema - heart sounds (galloping into edema)

A

Heart sounds include a summation gallop (merge of S3 & S4)
Signs of right ventricular failure may be present (JVD, peripheral edema)

124
Q

pulmonary edema - does COPD seem like it?

A

COPD exacerbation can mimic pulmonary edema. The BNP will be normal in COPD patients without pulmonary edema)

125
Q

tests to identify pulmonary edema (fat eats the bun, it’s the abcs)

A

ECG, cardiac markers and other tests to identify etiology (cardiac echo)
ABGs, BUN/Cr, electrolytes, pulse oximetery

126
Q

HfRef Causes defects in (reduced energy zaps my electricity and contractility)

A

Causes defects in energy utilization, supply, electrophysiolgic function and contractility (intracellular calcium & cAMP production)

127
Q

common causes of LVF (mei and brad flew left through the vents and failed)

A

LV failure often leads to RV failure
Common causes are AMI, myocarditis, dilated cardiomyopathy

128
Q

1st treatment for pt with confirmed MI (angie comes first with MI)

A

PCI (percutaneous coronary intervention) angioplasty

129
Q

HF older adults - causes (old man corner)

A

hyperthyroidism, anemia, HTN, myocardial ischemia

130
Q

pulmonary edema - ½ of all cases worldwide result from - but what type?

A

acute coronary ischemia

131
Q

HF older adults - causes

A

LVAD (left ventricular heart device) use of NSAIDs

132
Q

is HF a problem with the ventricles or atria?

A

VENTRICLES

133
Q

pulmonary edema treatment - diet?

A

Low sodium diet, fluid restrictions
Prevent when possible, by checking lung sounds, daily weight, avoid FVE

134
Q

pulmonary edema - treatment - Severe HTN

A

Severe HTN- IV vasodilator

135
Q

pulmonary edema treatment - SVT, VT

A

SVT, VT –cardioversion

136
Q

pulmonary edema treatment - AF with rapid ventricular response

A

Cardioversion or IB beta blocker, digoxin or calcium channel blocker (CAUTION)

137
Q

pulmonary edema treatment - patients with decompensated HF or shock (da bute decomensates)

A

IV dobutamine or IABP for SBP <100 mmHg

138
Q

HfpEF diastolic dysfunction (preserve the dying w/ valves, peri and amy)

A

Valvular disease (aortic stenosis, MVP/MVR), constrictive pericarditis or amiloid infiltration of the myocardium

139
Q

HfpEF diastolic dysfunction (preserve the dying for ischemia and hypertrophy)

A

Acute myocardial ischemia
Hypertrophic cardiomyopathy

140
Q

HFrEF - causes (MI, Mei, and Brad cause the ref to lose)

A

AMI, myocarditis, dilated cardiomyopathy

141
Q

HFpEF happens when (the preserved are stiff)

A

ventricles can’t relax due to stiffness from anything that causes stiffness

142
Q

which cardiomyopathy for HFrEF?

A

dilated

143
Q

which cardiomyopathy for HFpEF? (the stiff one)

A

hypertrophic

144
Q

which HF is apnea?

A

preserved - the stiff one

145
Q

decompensated HF meds

A

mili and da bute

146
Q

brad’s left side symptoms

A

decreased pulse

147
Q

too old for transplant?

A

70, or 65 physical age

148
Q

normal digoxin levels (dig, give me high 5 at 2)

A

0.5 to 1.9 nanograms per milliliter of blood

149
Q

pumonary edema - what sounds?

A

fine crackles in BOTH lungs

XIO (372 decks)

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