Heart Failure Flashcards
What is Heart failure?
Inadequate pumping or filling of heart
What are four things that cause heart failure?
- Preload-amount of blood sitting in the heart during diastole
- Afterload-amount of resistance that the left ventricle has to overcome in order to get blood out of heart (Ex: If afterword elevated it is hard for blood to get out ultimately causing heart failure).
- Myocardial contractility-contractility of Myocardial regardless of fluid volume
- Heart rate-(too fast or too slow over time)
What is ejection fraction?
Amount (in %) of blood ejected from the ventricle (Stroke volume) ÷ Amount of blood in the ventricle prior to ejection (End-diastolic volume)
Types of Heart Failure
Left sided-Blood backs up in left atrium/Pulmonary veins.
Manifested by: Pulmonary congestion/edema
Right sided heart failure-blood backs up into the right atrium/venous circulation.
Manifested by: JVD, Hepatomegaly, Ascites, Vascular congestion GI tract, Peripheral edema, scrotal edema
Left sided heart ❤️ failure Signs/Symptoms
Paroxysmal Nocturnal Dyspnea Pulmonary Congestion (Cough, Crackles, Wheeze, Blood-Tinged Sputum, Tachypnea) Restlessness Confusion Orthopneic Exertional Dyspnea Fatigue Cyanosis
Right sided heart ❤️ failure Signs/Symptoms
Fatigue Increase Peripheral Venous Pressure Ascites Enlarged liver & spleen Distended Jugular Veins Anorexia & Compliants of GI distress Swelling in hands and fingers Dependent edema (feet...also in hands)
What is cor pulmonale?
Enlargement of the right side of the heart as a result of Pulmonary hypertension (as is the case sometimes with COPD patients)
Note: Right sided failure that results from left sided failure is NOT the same as “cor pulmonale”.
What is chronic heart failure?
Typically diagnosed in OUTPATIENT setting
Marked by periods of ACUTELY &/OR SLOWLY worsening cardiac function.
Often the consequence of damage caused by other cardiac events or disease, regardless of whether manifested as an acute event.
What is acute decompensated heart failure (ADHF)?
Typically diagnosed in INPATIENT setting
Worsening CHRONIC health failure s/s requiring URGENT therapy
A LIFE-THREATENING condition requiring acute interventions
Typically present with SOA due to excess fluid caused by CARDIAC OVERLOAD.
Do you know the difference between chronic heart failure & acute decompendated heart failure? No/Yes
Yes-Great!
No- Review!
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How do we diagnose heart failure?
History & Physical exam
EKG
BNP & ProBNP (helps distinguish HF from other sources of Dyspnea). Most dyspneic patients w/HF have BNP >400
CxR (may see cardiomegaly & pleural effusion if HF)
Echo (including EF)
What is the correlation with symptoms of heart failure & BNP levels
The higher the BNP levels the more symptomatic the patient.
Collaborative care for CHRONIC heart failure
Treat underlying cause (Ex: HTN, give antihypertensives)
Oxygen therapy (2-6 L/min per NC). Helps relieve dyspnea/fatigue.
Rest-activity periods
Daily weights
Sodium restricted diets
Collaborative care for CHRONIC heart failure (cont)
Drug Therapy ACE ARBS Beta Blockers Diuretics Nitrates Cardiac glycosides (Digoxin)-A positive inotrope thar increases contractility. A negative chronotrope that slows the heart rate. Therefore enhancing cardiac output. Left Ventricular assist device (LVAD) Heart transplant
Why is Spironolactone specific to heart failure
Used for suppression of sodium/water retention to help with offloading of Left ventricle
Associated with decreased hospitalizations & cardiac death
Teach patients this is a potassium sparing diuretic.
Watch carefully for HYPERkalemia and worsening renal failure
