Heart Failure

Question 1

Heart Failure

Answer 1

Interference in normal mechanisms regarding CO - preload, after load, cardiac contractility and rate.
2 main causes are hypertension and CAD.
1 in 5 Canadians.
Mortality after dx is 23%.

Question 2

Systolic HF

Answer 2

Reduced ejection fraction.
Most common type.
Left ventricle loses ability to eject blood through aorta (>40% of blood is pumped through).

Question 3

Diastolic HF

Answer 3

Preserved ejection fraction.
Inability of ventricles to relax and fill during diastole. The decreased filling results in decreased stroke volume and CO.
Most often from left ventricular hypertrophy.

Question 4

Left Sided HF

Answer 4

More common.
Blood backs up into lungs. This will cause pulmonary congestion and edema in the lungs (leading to diminished sounds). Could also hear crackles or wheezing.

Question 5

Right Sided HF

Answer 5

Backward flow of blood from atria into systemic circulation. Leads to edema in extremities, jugular venous distention and an enlarged spleen (splenomegaly).
Primary cause of right sided HF is left sided HF.

Question 6

Acute HF

Answer 6

Pulmonary edema! Fluid in lungs can continue to increase causing respiratory acidosis.
Pts are anxious, pale, clammy, cyanotic, severe dyspnea and orthpnea, blood-tinged sputum.
Elevated HR with either an increase or decrease in BP.

Question 7

Acute HF nursing interventions

Answer 7

administer loop diuretics.
decrease venous return by elevating head of bed and dangling feet.
morphine can improve gas exchange.
monitor vital signs.
weight gain - notify physician if you lose/gain 2kg overnight and 2.5 kg over a 5 day period.

Question 8

Complications of HF

Answer 8

Plural effusion - fluid leaking into plural space.
Dysthymia’s - due to enlargement of heart
Left ventricular thrombus -
Hepatomegaly - due to venous system backing up into liver
Renal failure - due to hypo perfusion of kidneys.

Question 9

Diagnosis of HF

Answer 9

Echocardiography - can distinguish difference between preserved ejection fraction and reduced ejection fraction.
Chest X-RAY and BNP levels- can help distinguish pleural effusions from other causes of dyspnea (such as pneumonia)

Question 10

Drug Therapy for Chronic HF

Answer 10

Diuretics
ACE inhibitors
Neprilysin Inhibitors
Beta Adrenergic Blockers
Mineral Corticoid Receptor Antagonists

Question 11

Diuretics

Answer 11

Loop diuretics and Thiazide diuretics help manage edema

Question 12

ACE inhibitors

Answer 12

end in “pril”
first line medication for HF
block conversion of angiotensin to angiotensin II (a substance that narrows blood vessels).
Increase cardiac contractility and reduce preload and after load.
risk for life threatening angioedema (anaphylaxis allergy)

Question 13

Beta Adrenergic Blockers

Answer 13

end in “ol”
treat hypertension, prevent increased HR
avoid in people with asthma as it can cause bronchoconstriction.

Question 14

Digoxin

Answer 14

cardiac glycoside that increases cardiac contractility and CO.
Low potassium levels can increase risk of digoxin toxicity (normal levels are 3.5 - 5 mol/L).
Digoxin toxicity can cause N/V, diarrhea, blurred vision, colour changes (seeing yellow halos).
Check digoxin levels every 6 weeks if on it long term.