Heart Failure Flashcards
Heart failure definition
Heart’s inability to meet the oxygenation needs of the body as a result of decreased pumping ability or decreased filling ability or both (biventricular failure)
Precipitating factors of heart failure
Anything that decreases supply or increases demand of oxygen
Two types of cardiomyopathy
Dilated/congestive (can’t squeeze, associated with fluid volume overload) = systolic failure
Hypertrophic (thickening of ventricular walls and septum, chambers get smaller) = diastolic failure
Normal stroke volume amount
About 70 mL
APE TM
Aortic valve - 2nd right ICS
Pulmonic valve - 2nd left ICS
Erb’s point - 3rd left ICS
Tricuspid valve - left lower sternal border, 4-5th ICS
Mitral valve (apex) - 5th ICS, left mid clavicular line
List of causes of left ventricular failure:
MI
CAD
HTN
Aortic stenosis
Aortic regurgitation
Mitral stenosis
Mitral regurgitation
Cardiomyopathy
List of causes of right ventricular failure
Left ventricular failure
Pulmonary HTN
Right ventricular infarct
Characteristics of left ventricular failure
- Decreased cardiac output
- Increased LVEDV/P (left ventricular end diastolic volume/pressure)
- Increased left atrial pressure
- Increased pulmonary venous pressure
- *Pulmonary interstitial edema
- Intra-alveolar edema
- **Cardiogenic pulmonary edema
- Eventual increased pulmonary artery pressure
Major complication to be on lookout for with left ventricular failure
Pulmonary interstitial edema
Major problem with cardiogenic pulmonary edema
Can’t suction out because more keeps coming, *pt needs diuretics
Characteristics of right ventricular failure
Pulmonary HTN
Increased RVEDV/P
Increased right atrial pressure
Increased systemic venous pressure
Systemic edema
Compensatory mechanisms for heart failure
- SNS - detects drop in CO & makes heart work harder
- Renin-angiotensin mechanism - makes body hold onto water
- Atrial/B-type natriuretic hormones - encourage diuresis measured through BNP
- Tissue necrosis factor
- Myocardial hypertrophy
- Ventricular dilation
*Assessment cues for left ventricular heart failure
Dyspnea
Orthopnea
Fatigue
Crackles
Cough
Hemoptysis
Cyanosis
Palpitations
Dysrhythmias
Pulsus alternans
S3 heart sounds
Increased PCWP
*Pulmonary edema
Most common dysrhythmia with left ventricular failure
Afib
How to treat PCWP
Diuretics
Symptom of very severe LVF
Hemoptysis (pink frothy sputum)
Most life threatening complication of LVF
*pulmonary edema
Manifestations of pulmonary edema
SOB
Dyspnea at rest
Disorientation
Anxiety
Tachycardia
Crackles
Frothy, blood-tinged sputum
Cold, clammy skin
Cyanosis
*Signs and symptoms or RVF
Increased CVP/RAP
JVD
Hepatojugular reflux
Splenomegaly
Ascites
N/V
Anorexia
Peripheral edema
Weight gain
Nocturia
What should you teach pt about weight gain with RVF
*weigh themselves every day at same time and report weight gain > 2 lbs in 24 hrs
- to prevent this, take diuretics *as prescribed every time
Assessment diagnostics for heart failure
CXR
EKG
Echocardiogram
Lab: BNP (used to confirm, higher = worse HF)
Non-surgical interventions for acute HF
Balance oxygenation and activity:
- intra-aortic balloon pump (IABP)
- left/right ventricular assist device (LVAD)
- fluid and electrolyte balance
- pharmacologic therapy
What is involved in fluid and electrolyte balance?
Sodium restriction
Fluid restriction
Daily weight
Monitoring potassium levels
Strict intake and output
*List of options to treat heart failure
Balloon pump
Behavior modification
Batista procedure
Biventricular pacing
Cardiac rehab
Fluid and electrolyte balance
Heart jacket
Implanted cardoiverter defibrillation
Left/right ventricular assist device
What does self-management education include for a pt with valvular heart disease
- Disease process and possibility of HF
- Drug therapy including: diuretics, vasodilators, beta blockers, calcium channel blockers, antibiotics, and anticoagulants
- The prophylactic use of antibiotics
- A plan of activity to rest and conserve energy
Precautions patients need to adhere to regarding infective endocarditis
Pts with defective or repaired valves are at risk so they need to inform all health care providers or valvular heart disease history
- will require antibiotic administration before all invasive dental procedures
What will patients who have had valve replacements with prosthetic valves require?
Lifetime prophylactic anticoagulation therapy to prevent thrombus formation
What should we teach pts taking anticoagulants?
Nutritional considerations (if taking warfarin) and prevention of bleeding
*Avoid foods high in vitamin K, especially dark leafy veggies
*Use electric razor to avoid skin cuts
*Report any bruising or excessive bleeding to PCP
What should pts who have had valvular surgery avoid?
Avoid invasive dental procedures for 6 months because of potential for endocarditis
What should pts with prosthetic valves avoid?
Any procedure using magnetic resonance unless the newest technology is available
