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Heart failure Flashcards

1
Q

Heart Failure: What is it?

A

“HF is a pathological condition in which the heart is unable to pump blood in sufficient amounts from ventricles to meet body’s metabolic needs.”

Not a specific disease

Complex clinical syndrome resulting from any functional or structural impairment to the heart, specifically ejection of blood or ventricular filling

The heart is unable to pump blood in sufficient amounts from the ventricles to meet the body’s metabolic needs.

One of the most common causes for hospitalization in Canada

5 000 annual deaths from heart failure

5-year survival rate in those with heart failure is 50%.

Prevention is key.

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2
Q

Four Causes of HF

A

Failure of ventricle to eject blood
Fluid volume overload
Chamber dilation
Elevated intracardiac pressure

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3
Q

Left sided (Left = Lung) HF Symptoms

Systolic VS Diastolic

A

Pulmonary edema
Coughing
Shortness of breath
Dyspnea

Systolic: decreased contractility, decreased blood ejected

Diastolic: elevated filling pressures, muscle unable to relax

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4
Q

Right sided Symptoms

A

Systemic venous congestion
Pedal edema
Jugular venous distension
Ascites
Hepatic congestion

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5
Q

Three Consequences of HF

A

Blood supply to organs is reduced (kidney before heart and brains)

Impaired kidney filtration can lead to acute kidney injury or chronic kidney failure

Pulmonary edema can lead to shortness of breath and peripheral edema

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6
Q

Heart Failure: Causes

A

Myocardial deficiency
-Inadequate contractility
-Inadequate filling

Increased workload
-Pressure overload
-Volume overload

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7
Q

Inadequate contractility

A

Myocardial infarction
Coronary artery disease
Cardiomyopathy (harder for heart to pump blood)
Valvular insufficiency (heart valves fails to close; blood flows in the opposite direction)

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8
Q

Inadequate filling

A

Atrial fibrillation
Infection
Tamponade
Ischemia

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9
Q

Pressure overload

A

Pulmonary hypertension
Systemic hypertension
Outflow obstruction

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10
Q

Volume overload

A

Hypervolemia
Congenital abnormalities
Anemia
Thyroid disease
Infection
Diabetes

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11
Q

The New York Association’s Classification of Heart Failure

A

Class I
No physical activity limitations
Class II
Ordinary physical activity results in fatigue, dyspnea, or other symptoms.
Class III
Marked limitation in physical activity
Class IV
Symptoms at rest or with no physical activity at all

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12
Q

Class I

A

No physical activity limitations

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13
Q

Class II

A

Ordinary physical activity results in fatigue, dyspnea, or other symptoms.

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14
Q

Class III

A

Marked limitation in physical activity

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15
Q

Class IV

A

Symptoms at rest or with no physical activity at all

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16
Q

Drug Therapy for Heart Failure

A

Positive inotropic drugs
Positive chronotropic drugs
Positive dromotropic drugs

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17
Q

Positive inotropic drugs:

A

Positive inotropic drugs: increase the force of myocardial contraction

Positive inotropic drugs
-Phosphodiesterase inhibitors
-Cardiac glycosides
-B-type natriuretic peptides

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18
Q

Positive chronotropic drugs:

A

Positive chronotropic drugs: increase heart rate

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19
Q

Positive dromotropic drugs:

A

Positive dromotropic drugs: accelerate cardiac conduction

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20
Q

Other drugs used in heart failure

A

Angiotensin-converting enzyme inhibitors
Angiotensin receptor blockers
ß-Blockers
Diuretics (furosemide and spironolactone)

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21
Q

Drugs of Choice for Early Treatment of Heart Failure

A

Angiotensin-converting enzyme inhibitors (lisinopril, enalapril maleate, captopril, and others)

Angiotensin II receptor blockers (valsartan and others)

Certain ß-blockers (bisoprolol, extended-release metoprolol tartrate, and carvedilol)

Loop diuretics (furosemide) are used to reduce the symptoms of heart failure secondary to fluid overload.

Aldosterone inhibitors (spironolactone, eplerenone) are added as the heart failure progresses.

Only after these drugs are used is digoxin added.

dobutamine: positive inotropic drug

hydralazine/isosorbide dinitrate recommended specifically for use in Black patients

22
Q

dobutamine

A

positive inotropic drug; increase froce of contraction

adrenergic; sympathomimetic

23
Q

Angiotensin-Converting Enzyme Inhibitors

A

Prevent sodium and water resorption by inhibiting aldosterone secretion

Diuresis results, which decreases preload, or the left ventricular end volume, and the work of the heart

Examples: lisinopril, enalapril maleate, fosinopril sodium, quinapril hydrochloride, captopril, ramipril, trandolapril, and perindopril erbumine.

24
Q

lisinopril (Prinivil®, Zestril®)

Uses
AEs

A

Uses: hypertension, heart failure, and acute myocardial infarction

Hyperkalemia (due to aldosterone inhibition; increased NA+ excretion; more K+ retained)

Dry cough

Decreased renal function

25
Angiotensin II Receptor Blockers function
Potent vasodilators; decrease systemic vascular resistance (afterload) Used alone or in combination with other drugs such as diuretics in the treatment of hypertension or heart failure Examples: valsartan (Diovan®), candesartan cilexetil, eprosartan mesylate, irbesartan, telmisartan, olmesartan medoximil, and losartan potassium
26
valsartan (Diovan®) similarities and difference with ACE inhibitors
Valsartan shares many of the same adverse effects as lisinopril. Angiotensin II receptor blockers are not as likely to cause the cough associated with the angiotensin-converting enzyme inhibitors. Angiotensin II receptor blockers are not as likely to cause hyperkalemia.
27
β-Blockers
Cardioprotective quality of ß-blockers: prevent catecholamine-mediated actions on the heart by reducing or blocking sympathetic nervous system stimulation to the heart and the heart’s conduction system NE normally stimulate SNS metoprolol carvedilol
28
Aldosterone Antagonists
spironolactone and eplerenone Useful in severe stages of heart failure Action: activation of the renin-angiotensin-aldosterone system causes increased levels of aldosterone, which causes retention of sodium and water, leading to edema that can worsen heart failure.
29
spironolactone
potassium-sparing diuretic and aldosterone antagonist shown to reduce the symptoms of heart failure eplerenone (Inspra®): selective aldosterone blocker, blocking aldosterone at its receptors in the kidney, heart, blood vessels, and brain
30
ACE cause ARBs are ACE and ARBs also effective in slowing ____ & _____ Β Blockers stop
ACE cause diuresis which decreases blood volume and blood return to heart (preload) * ACE inhibitors decrease BV and preload (workload) ARBs are potent vasodilators, decrease systemic vascular resistance (afterload) * Vasodilator; decrease afterload ACE and ARBs also effective in slowing ventricular remodeling and hypertrophy Β Blockers stop catecholamine mediated actions on the heart
31
dobutamine hydrochloride drug class structurally similar to?
β1-selective vasoactive adrenergic drug; increae HR, FOC, and renin release Structurally similar to dopamine
32
hydralazine/isosorbide dinitrate
Drug approved specifically for individuals who are Black.
33
Phosphodiesterase Inhibitors action and 1 drug
One drug in this category available in Canada: milrinone. Work by inhibiting the enzyme phosphodiesterase Result in: -Intracellular increase in cyclic adenosine monophosphate -Positive inotropic response (increased contractility) -Vasodilation -Increase in calcium for myocardial muscle contraction. Inodilators (inotropics and dilators)
34
Phosphodiesterase Inhibitors: Indication
Short-term management of heart failure for patients in the Critical Care Unit. The 2012 Canadian Cardiovascular Society Heart Failure Management Guidelines advise against long-term infusions of milrinone.
35
Milrinone AEs Interactions What must not be given IV with this?
Only available phosphodiesterase inhibitor Available only in injectable form Adverse effects: cardiac dysrhythmias, hypotension, angina, hypokalemia, tremor, and thrombocytopenia Interactions: diuretics (additive hypotensive effects) and digoxin (additive inotropic effects) Furosemide must not be injected into intravenous lines with milrinone.
36
Cardiac Glycosides is used in?
No longer used as first-line treatment Digoxin is the prototype. Used in heart failure and to control ventricular response to atrial fibrillation
37
Cardiac Glycosides: Mechanism of Action
Increase myocardial contractility Change electrical conduction properties of the heart -Decrease rate of electrical conduction -Prolong the refractory period * Area between sinoatrial node and atrioventricular node
38
Cardiac Glycosides Positive inotropic effect
Increased force and velocity of myocardial contraction (without an increase in oxygen consumption)
39
Cardiac Glycosides Negative chronotropic effect
Reduced heart rate
40
Cardiac Glycosides Negative dromotropic effect
Decreased automaticity at sinoatrial node Decreased atrioventricular node conduction
41
Cardiac Glycosides: Drug Effects
Increased stroke volume (amount of blood pumped by ventricles) Reduction in heart size during diastole Decrease in venous blood pressure and vein engorgement Increase in coronary circulation Decrease in exertional and paroxysmal nocturnal dyspnea, cough, and cyanosis Promotion of tissue perfusion and diuresis Improved symptom control, quality of life, and exercise tolerance, with no apparent reduction in mortality
42
digoxin (Lanoxin®) Drug levels? What increases its toxicity? What must be monitored?
Very narrow therapeutic window Drug levels must be monitored. 0.8 to 2 ng/mL Low potassium levels increase its toxicity. Electrolyte levels must be monitored.
43
digoxin (Lanoxin) AE
Cardiovascular: dysrhythmias, including bradycardia or tachycardia Central nervous system: headaches, fatigue, malaise, confusion, convulsions Eyes: coloured vision (seeing green, yellow, purple), halo vision Gastrointestinal: anorexia, nausea, vomiting, diarrhea MOST ADVERSE EFFECTS SIGNS AND SYMPTOMS OF TOXICITY
44
Digoxin Toxicity treatment
digoxin immune Fab therapy -Hyperkalemia (serum potassium greater than 5 mmol/L) in a digitalis-toxic patient -Life-threatening cardiac dysrhythmias -Life-threatening digoxin overdose
45
Digoxin Large amounts of ____ negatively affect absorption of oral digoxin NHP that increase digoxin levels: Serum digoxin, _____ levels important Apical pulse between _____bpm
Large amounts of bran negatively affect absorption of oral digoxin NHP that increase digoxin levels: ginseng, hawthorn, licorice; St John’s Wort may reduce digoxin level Serum digoxin, potassium levels important Apical pulse between 60-100 bpm
46
Conditions That Predispose to Digoxin Toxicity
Hypokalemia Use of cardiac pacemaker Atrioventricular block Hypercalcemia Dysrhythmias Hypothyroid, respiratory, or renal disease Advanced age Ventricular fibrillation
47
Heart Failure Drugs: Nursing Implications
Assess history, drug allergies, and contraindications. Assess clinical parameters, including -blood pressure -Both radial and apical pulse for 1 full minute -Heart sounds, breath sounds Assess clinical parameters -Weight, input, and output measures -Electrocardiogram -Serum labs: potassium, sodium, magnesium, calcium, renal, and liver function studies Before giving any dose, count apical pulse for 1 full minute. For an apical pulse less than 60 or greater than 100 beats/min -Hold dose. -Notify prescriber.
48
Hold dose and notify prescriber if the patient experiences signs or symptoms of toxicity.
Anorexia, nausea, vomiting, diarrhea Visual disturbances (blurred vision, seeing green or yellow halos around objects)
49
Heart Failure Drugs: Nursing Implications
Check dosage forms carefully and follow instructions for administering. Avoid giving digoxin with high-fibre foods (fibre binds with digitalis). Patients should immediately report a weight gain of 1 kg or more in 24 hours or 2 kg or more in 1 week.
50
milrinone NC
Use an infusion pump. Monitor input and output, heart rate and rhythm, blood pressure, daily weights, respirations, and so on
51
Monitor for therapeutic effects.
Monitor for therapeutic effects. Increased urinary output Decreased edema, shortness of breath, dyspnea, crackles, fatigue Resolution of paroxysmal nocturnal dyspnea Improved peripheral pulses, skin colour, temperature Monitor for adverse effects.

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