Heart Failure

Question 1

HF causes

Answer 1

HTN/CAD
Controling HTN can decrease incidences of HF

DM, age, tobacco use

Congenital defects
Large PE
Valve disorders

Question 2

Left sided HF

Answer 2

Backup into pulmonary BV

S/s:
Cough, dyspnea, cracjles, orthopnea
Weight gain
Pleural effusion
Fatigue

Question 3

Causes of left sided HF

Answer 3

MI
Longstanding HTN

Question 4

Left sided HF
Preserved EF
Vs
Reduced EF

Answer 4

Preserved EF:
Diastolic failure (filling issue, EF normal)
Usually caused by LVH (longstanding HTN)

Reduced EF (contaction issue, EF decreased)
Worse prognosis

EF:55-60%

Question 5

Right sided HF
What happens
S/s
Cause

Answer 5

Fluid backs up into venous system

S/s:
JVD, dependent edema, ascites, hepatomegaly
Weight gain
fatigue

Cause: left sided hf
Or PE, corpulmonale, right sided MI

Question 6

Biventricular failure

Answer 6

LV and RV failure
Symptoms of both

Usually starts with left then progresses causes right sided HF

Question 7

Compensated responses to HF

Answer 7

Decreased CO stimulared the RAAs system/SNS:

Leads to fluid retentions and remodeling (scarring)

Remodeling increases risk for dysrhythmias

Body release BNP to counteract this (increases BNP in HF)

Question 8

Acute decompensated HF

Answer 8

Sudden increase in symptoms and reduced function

Leads to pulmonary edema (life threatening)

Symptoms:
Worseing dyspnea, JVD
Pink/frothy sputum
Neuro changes (due to hypoxia)
Tachypnea
Cool extremities

Question 9

Complications of HF

Answer 9

Pleural effusion: treat with chest tube, dieurtics, thorcetesis

Dysrhythmias: due to remodeling
Afib

Hepatomegaly

Cardiorenal syndrome:
right sided: back up blood flow
Left sided: decreased perfusion

Anemia

Question 10

HF pharm therapys

Answer 10

Diuretics

ACE-I or ARB

Beta-blockers

Digitalis (digoxin)

Question 11

HF diuretics

Answer 11

Loops
thiazides
aldosterone-antagonists (potassium sparing)

Monitor for:
SE
FVD
Hypokalemia
Hypotension
Kidney function

Question 12

HF
ACE-I OR ARB

What it does
SE

Answer 12

Reduce remodeling

This decreases cardiac dysrhythmias

SE: dry cough, hyperkalemia

Question 13

HF

Beta blockers

WHAT IT DOES
SE

Answer 13

Decrease cardiac workload

Se:
Hypotension
Bradycardia

Question 14

HF

Digitalis (digoxin)

Answer 14

Toxicity
nausea
yellow green halos around lights
Decreased HR
Cardiac arrest

Hypokalemia makes it worse

Question 15

Chronotropic

Vs

Inotropic

Answer 15

Chronotropic (decrease HR)

Inotropic (decrease contraction force)

Question 16

HF diagnostic tests

Answer 16

Echocardiogram:
Measures EF and determines if its left or right sided

CXR: check fluid and remodeling

ECG

Stress tests: for CAD

BNP: elevated in exacerbations

Question 17

Echocardiogram
What it is
Tells us
TEE

Answer 17

Ultrasound of the heart
Tells us:
Valve structure
Heart chamber size/motion
EF (normal 50-75%)

Transesophageal echocardiography (TEE):
More precise
Requires consent/sedation

Question 18

HF nursing management

Answer 18

DW
IO
Cardiac monitoring
Assess for signs of FVE, pulmonary edema

Question 19

HF education
Diet
Others
S/s

Answer 19

Diet: avoid excess sodium, <2 grams/day, fluid restriction

DW
Medication compliance (diuretics)
Vaccinations

Symptoms:
Dyspnea, fatigue, cough, swelling

Question 20

HF devices

Answer 20

ICD: primary prevention for high risk pts (implanted defibillator)

Ventricular assist devices (VADs): eternal left ventricles
wont have heart sounds

Question 21

End stage HF tx

Answer 21

Heart transplant:
contraindicated:
Age>70
Life threatening illness
Active infection
Severe pulmonary disease

Hospice/palliative care