Heart failure Flashcards
1
Q
Causes of cardiac muscle dysfunction
A
- HTN
- CAD
- Cardiac dysrhythmias
- renal insufficiency
- cardiomyopathy
- heart valve abnormality
- pericardial effusion
- pulmonary embolism
- pulmonary HTN
- spinal cord injury
- age-related changes
2
Q
Heart failure
A
- chronic progressive condition
- heart muscle is unable to pump enough blood to meet needs for blood and oxygen
- heart failure usually results in an enlarged heart
3
Q
Heart failure typical path
A
- normal: ventricles fill with blood and then pump out about 70% of the blood
- diastolic dysfunction: the stiff ventricles fill with less blood and then pump out 70% but this is less than normal
- systolic dysfunction: enlarged ventricles fill with blood and then pump out 40-50% of the blood
4
Q
What does dysfunction in the heart eventually cause
What does it impact first and then what happens from there?
A
- first impacts SV and EF
- chronic elevation of pressures will be transmitted up the atria into the vascular system
- the increase pressure leads to transudate of fluid from the vessels to the interstitial spaces of the lungs or peripheral tissue
- leads to edema
5
Q
Classifications of heart failure
A
- right heart failure = peripheral edema
- left heart failure = pulmonary edema
- biventricular
- systolic vs diastolic dysfunction
6
Q
heart failure with reduced ejection fracture
A
- EF<40
- systolic dysfunction
7
Q
heart failure with preserved EF >50%
A
- still denotes lower than normal SV
- diastolic dysfunction
8
Q
Right sided heart failure typical presentation
A
- congestion of peripheral tissues
- dependent edema and ascites (fluid in abdomen)
- GI tract congestion = anorexia, GI distress, weight loss
- liver congestion: signs related to impaired liver function
9
Q
left sided heart failure presentation
A
- decreased CO: activity intolerance and signs of decreased tissue perfusion
- pulmonary congestions: impaired gas exchange (cyanosis and hypoxia) and pulmonary edema (cough with frothy sputum, orthopnea, PND)
10
Q
What does pulmonary edema sound like
A
- crackles
- wet = gurgling
- dry = fire burning
11
Q
what sound is expected with CHF
A
- S3
12
Q
pulse pressure related to CHF
A
- normal = 40 (120-80)
- CHF: systolic decreases and diastolic increases leading to a lower pulse pressure
- indication heart is not functioning
13
Q
Look at Left and right -sided heart failure diagram
A
- look
14
Q
Clinical manifestations of left sided heart failure
A
- fatigue and weakness
- poor tolerance to activity
- progressive dyspnea
- orthopnea and PND
- tachypnea, pallor, cyanosis
- crackles or rales
- adventitious heart sounds (s3)
- hypoxia/hypercapnia
- voice sounds consistent with consolidation/infiltrates
- decrease pulse pressure
- weak pulse
15
Q
clinical manifestations of right sided heart failure
A
- fatigue and weakness/poor tolerance to activity
- dependent peripheral edema/ascites
- weight gain (fluid)
- cold, pale and cyanotic extremities
- JVD
- decreased peripheral and ventilatory muscle strength and endurance
- poor activity/exercise tolerance or physical work capacity
- decreased quality of life/disability
16
Q
Clinical diagnosis of CHF
A
- echocardiography: left ventricular EF, structure of LV, other structural abnormalities
- lab findings: elevated BNP, BUN, hematologic changes (increase RBCs), hypoxia/hypercapnia, changes in liver and electrolyte levels
- radiologic findings: Evaluation of size and shape of cardiac silhouette; presence of interstitial, perivascular, alveolar edema (fluid in lungs)
17
Q
NYHA classification of CHF
A
- class 1: no limitation of physical activity
- class 2: slight limitation of physical activity, comfortable at rest
- class 3: marked limitation of physical activity, comfortable at rest (may have dyspnea at rest)
- class 4: inability to carry any physical activity with discomfort, symptoms present even at rest
18
Q
ACC/AHA stages of CHF
A
- Stage A: high risk for developing CHF, no structural disorder to heart
- stage B: structural disorder or heart, never developed symptoms of CHF
- Stage C; past or current symptoms of CHF, symptoms associated with underlying heart disease
- stage D: end-stage disease, requires specialized treatment strategies
19
Q
describe the CHF cycle
A
- initially may have impaired cardiac function but have CO sufficient for activity
THEN
- As HF progresses may decompensated with less tolerance to activity
- this can become a long term cycle of compensated then uncompensated
20
Q
Ability of pump or accept blood depends on
A
- total blood volume
- body position and gravity
- skeletal muscle pump
- intrathoracic pressure
- atrial contribution to ventricular filling
- venous tone
- intrapericardial pressures
21
Q
associated effects of CHF
On differnet systems
A
- pulmonary: back up of blood and pressures
- biochemical/nutritional: anorexia
- renal: sodium and fluid retention
- MSK: decrease blood flow, muscle atrophy
- hematological: abnormal blood cell function and increase blood volume
- pancreatic: impaired insulin and glucose imbalance
- hepatic: hypo fusion and/or venous congestion leading to cirrhosis
- neurochemical: increase sympathetic stimulation
22
Q
HF impact on the heart
A
- stretching of the myocardium with increase ventricular EDV
- contractile state of myocardium declines
23
Q
How can the kidneys contribute to the progression of CHF
A
- sense low arterial blood flow
- intiate a process to retain fluid
- this contributes to CHF
24
Q
Pulmonary edema and its relation heart failure
A
- left ventricle cannot handle overload of blood volume
- pressure increases in the pulmonary vasculature
- fluid moves out of the pulmonary capillaries into the interstitial space of lungs and alveoli
25
Q
Stage 1 of pulmonary edema in relation to left sided heart failure
A
- excessive fluid is present but managed by lymphatic system
- pressures are starting to increase
26
Q
Stage 2 of pulmonary edema in relation to left sided heart failure
A
- characterized by the presence of interstitial edema
- increases in pressure causes the fluid to move into the interstitial space
- dry crackles with lung sounds
27
Q
Stage 3 pulmonary edema in relation to left sided heart failure
A
- characterized by the presence of alveolar edema
- invades the parenchyma
- fluid overload
- compromised gas exchange
- wet crackles with lung sounds
- blood twinged sputum
28
Q
Cardiogenic causes of pulmonary edema
A
- left ventricular failure
- HTN
- cardiomyopathy
29
Q
non-cardiogenic causes of pulmonary edema
A
- smoke or toxin inhalation
- idiopathic pulmonary HTN
- sepsis/pneumonia (increase permeability)
- near drowning (inhaling water)
30
Q
intrapulmonary shunt
A
- hypoxic blood
- O2 goes out of the alveoli normally
- with a fluid filled alveoli there is not as much gas exchange and therefore the it is perfused by not ventilated
31
Q
Medical treatment for pulmonary edema
A
- manage HTN and CAD
- diet, nutrition, fluid management
- sometimes given a set amount of water to drink so they do not increase fluid too mcc
- proper prescription of activity (too high can cause fluid overload)
- medications
- mechanical/surgical intervention
- education and disease self-management is key
32
Q
Management of heart failure
A
- directed at underlying causes or cause - HTN, atherosclerosis, ischemia, valve dysfunction, arrhythmia etc.
33
Q
What are the goals when managing heart failure
A
- improve heart pump
- reduce the workload for the heart
- control sodium intake and water retention
- supplement vitamins, minerals and amino acids
- decrease sodium intake
- fluid restrictions
- eating heart healthy foods with low cholesterol and fat
34
Q
Medication that patients with heart failure may be on
A
- diuretics: lassie, thiazides to eliminate fluids
- vasodilators: nitrates to decrease PVR
- ACE inhibitors: prevent vasoconstriction
- beta blockers: decreases sympathetic stimulation
- positive inotropic drugs: increase contractility
35
Q
Look over management diagrams in lecture slides and understand where each comes into play
A
36
Q
Mechanical/surgical management for CHF
A
- cardiac assistive devices (pacemakers/defibrillators)
- cardiac transplant
- assisted circulation (mechanical circulatory derives - MCD’s)
37
Q
examples of assisted circulation devices
A
- intra-aortic ballon pump (can go home with this)
- extra corporal membrane oxygenation
- ventricular assist device
38
Q
Life vest
A
- external cardiac defibrillator
- these people are waiting for other treatment such as transplant
39
Q
transplantation
A
- if you work with these patients you are working in a specific center
40
Q
Intra-aortic ballon pump
A
- systole: deflation to decrease after load, decrease cardiac work, decrease myocardial oxygen consumption and increase CO
- diastole: inflation: augmentation of diastolic pressure, increase coronary perfusion, allows more blood flow to the heart
- inserted through femoral artery
41
Q
Extra corporal membrane oxygenation (ECMO)
A
- not going home with this
- waiting to get LVAD or transplant
- gives heart and lungs a break
- ECMH manages all the blood
- femoral access - try to avoid this as it limits mobility
- commonly used with premature babies since they don’t have surfactant
42
Q
Ventricular assist devices
A
- can be left or right or biventrcualr
- heart can rest
- blood gets sucked or pumped out of the ventricle
- LVAD = left ventricular assistive device
43
Q
Bridge vs destination therapy with HF
A
- bridge is that the LVAD or ECMO is bridging them to the next step
- destination therapy is the last thing they are doing
44
Q
Education and self management techniques for patients with CHF
A
- assist with patient with taking responsibility for health (monitoring weight and symptoms)
- optimization of medical therapy/consistency with meds
- vigilant management and follow up
- exercise monitoring during and next day/next treatment
- early attention to fluid overload
