Heart Failure

Question 1

What are the typical causes of left sided HF?

Answer 1

htn, CAD, valvular disease

Question 2

s/s of left sided HF

Answer 2

paroxysmal nocturnal dyspnea
orthopnea
crackles
wheezes
restlessness
exertional dyspnea
oliguria

Question 3

what are the subtypes of left sided HF?

Answer 3

systolic and diastolic

Question 4

what is systolic HF?

Answer 4

heart cannot contract forcefully enough during systole to eject adequate amounts of blood into circulation
ejection fraction is less than 35%

Question 5

what is ejection fraction?

Answer 5

percentage of blood ejected from heart during systole

Question 6

what is a normal ejection fraction?

Answer 6

50-70%

Question 7

What types of patients are candidates for an ICD?

Answer 7

pts with an ejection fracture less than 30%

Question 8

What is diastolic HF?

Answer 8

HF with preserved left ventricular function
left ventricle cannot relax causing inadequate filling
ventricle has to work harder

Question 9

What is Right sided HF?

Answer 9

right ventricle cannot empty properly
increased volume and pressure cause edema
i.e. pulmonary hypertension

Question 10

clinical manifestations of right sided HF?

Answer 10

JVD
hepatomegaly
anorexia and GI distress
ascites
dependent edema
polyuria

Question 11

what is high output HF?

Answer 11

cardiac output remains normal or above normal

Question 12

what causes high output HF?

Answer 12

increased metabolic needs
septicemia
high fever
anemia
hyperthyroidism

Question 13

What is BNP what does it test for?

Answer 13

produced and released by the ventricles as they stretch in response to fluid overload
how much fluid you are retaining

Question 14

what is the BNP for no HF?

Answer 14

100 or less

Question 15

BNP for mild HF

Answer 15

100-300

Question 16

BNP for moderate HF

Answer 16

300-700

Question 17

BNP for severe HF

Answer 17

700 or more

Question 18

Risk factors for HF

Answer 18

smoking
obesity
family hx
HTN
drugs
valvular disease
DM
sleep apnea

Question 19

what is pulse alternans?

Answer 19

a weak pulse alternates with a strong pulse despite a regular heart rhythm

Question 20

What is stage A of HF?

Answer 20

people who are high risk

Question 21

What is Stage B HF?

Answer 21

Structural heart disease but no s/s

Question 22

What is stage C of HF?

Answer 22

Heart disease with signs of HF

Question 23

What is stage D of HF?

Answer 23

end stage heart failure
ICD is used until person can get a transplant

Question 24

What does Digoxin do?

Answer 24

Increase contractility
reduces HR
slows conduction thru AV node

Question 25

What are the s/s of Digoxin toxicity?

Answer 25

fatigue dysrhythmias PVCs Anorexia

Question 26

What must you monitor when giving digoxin and why?

Answer 26

potassium bc hypokalemia can cause digoxin toxicity

Question 27

What is dobutamine?

Answer 27

beta blocker that increases contractility and and CO/perfusion

Question 28

difference between metoprolol tartrate and succinate?

Answer 28

Succinate is an XR Tartrate is short acting

Question 29

what is cardiac resynchronized therapy?

Answer 29

uses a permanent pacemaker or combined with an implantable cardioverter/defibrillator stimulates more synchronized ventricular contractions

Question 30

Ventricular Assist Device

Answer 30

directly assist the heart's pumping

Question 31

what is a worse complication of HF?

Answer 31

pulmonary edema

Question 32

s/s of pulmonary edema

Answer 32

crackles ALOC tachycardia reduced urinary output cough with frothy, pink tinged sputum cold, clammy skin

Question 33

Emergency interventions for pulmonary edema?

Answer 33

Position in high fowlers give 100% oxygen establish IV access Give IV NTG lasix 40-80 mg Morphine 2-5 mg

Question 34

How fast can lasix be pushed?

Answer 34

1- 2 minutes to prevent ototoxicity

Question 35

why is morphine administered for pulmonary edema?

Answer 35

to reduce preload and decrease any anxiety and work of breathing

Question 36

what is the patient education for HF? (Remember MAWDS)

Answer 36

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

Question 37

what are the s/s of worsening HF?

Answer 37

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

Question 38

Why do we give patients with HF ACEI?

Answer 38

ACE inhibitors cause arterial dilation and increased stroke volume and helps get rid of extra fluid