Heart Failure Flashcards
What are the typical causes of left sided HF?
htn, CAD, valvular disease
s/s of left sided HF
paroxysmal nocturnal dyspnea
orthopnea
crackles
wheezes
restlessness
exertional dyspnea
oliguria
what are the subtypes of left sided HF?
systolic and diastolic
what is systolic HF?
heart cannot contract forcefully enough during systole to eject adequate amounts of blood into circulation
ejection fraction is less than 35%
what is ejection fraction?
percentage of blood ejected from heart during systole
what is a normal ejection fraction?
50-70%
What types of patients are candidates for an ICD?
pts with an ejection fracture less than 30%
What is diastolic HF?
HF with preserved left ventricular function
left ventricle cannot relax causing inadequate filling
ventricle has to work harder
What is Right sided HF?
right ventricle cannot empty properly
increased volume and pressure cause edema
i.e. pulmonary hypertension
clinical manifestations of right sided HF?
JVD
hepatomegaly
anorexia and GI distress
ascites
dependent edema
polyuria
what is high output HF?
cardiac output remains normal or above normal
what causes high output HF?
increased metabolic needs
septicemia
high fever
anemia
hyperthyroidism
What is BNP what does it test for?
produced and released by the ventricles as they stretch in response to fluid overload
how much fluid you are retaining
what is the BNP for no HF?
100 or less
BNP for mild HF
100-300
BNP for moderate HF
300-700
BNP for severe HF
700 or more
Risk factors for HF
smoking
obesity
family hx
HTN
drugs
valvular disease
DM
sleep apnea
what is pulse alternans?
a weak pulse alternates with a strong pulse despite a regular heart rhythm
What is stage A of HF?
people who are high risk
What is Stage B HF?
Structural heart disease but no s/s
What is stage C of HF?
Heart disease with signs of HF
What is stage D of HF?
end stage heart failure
ICD is used until person can get a transplant
What does Digoxin do?
Increase contractility
reduces HR
slows conduction thru AV node
What are the s/s of Digoxin toxicity?
fatigue
dysrhythmias
PVCs
Anorexia
What must you monitor when giving digoxin and why?
potassium bc hypokalemia can cause digoxin toxicity
What is dobutamine?
beta blocker that increases contractility and and CO/perfusion
difference between metoprolol tartrate and succinate?
Succinate is an XR
Tartrate is short acting
what is cardiac resynchronized therapy?
uses a permanent pacemaker or combined with an implantable cardioverter/defibrillator
stimulates more synchronized ventricular contractions
Ventricular Assist Device
directly assist the heart’s pumping
what is a worse complication of HF?
pulmonary edema
s/s of pulmonary edema
crackles
ALOC
tachycardia
reduced urinary output
cough with frothy, pink tinged sputum
cold, clammy skin
Emergency interventions for pulmonary edema?
Position in high fowlers
give 100% oxygen
establish IV access
Give IV NTG
lasix 40-80 mg
Morphine 2-5 mg
How fast can lasix be pushed?
1- 2 minutes to prevent ototoxicity
why is morphine administered for pulmonary edema?
to reduce preload and decrease any anxiety and work of breathing
what is the patient education for HF?
(Remember MAWDS)
avoid NSAIDS
medication compliance
stay active at your limit dont overdo it
daily weighing at the same time w/ same scale
limit fluid intake to 2L
sodium to 2-3g
what are the s/s of worsening HF?
rapid weight gain 2-3 lbs overnight
decrease in exercise tolerance lasting 2-3 days
cough/ cold symptoms lasting more than 3-5 days
polyuria at night
increased angina or dyspnea
increased edema in feet, ankles, and hands
Why do we give patients with HF ACEI?
ACE inhibitors cause arterial dilation and increased stroke volume and helps get rid of extra fluid
