heart failure

Question 1

epidemiology

Answer 1

one of the fastest growing heart conditions in the US
#1 reason for hospitalization of patients age 65 and older
more hospitilizations from heart failure (1.1 mil) than all forms of cancer combined
550,000 new cases per year
prevalence is 5.7 million

Question 2

acute HF admissions rising due to

Answer 2

noncompliance with diet and drugs
inevitable progression of disease
rising incidence of chronic heart failure (population aging, improved survival with acute MI –> revascularization)
Poor application of chronic heart failure management guidelines
incomplete treatment during hospitalization

Question 3

class 1 heart failure severity

Answer 3

less severe

Question 4

class 4 heart failure

Answer 4

most severe

Question 5

definition of heart failure

Answer 5

inability of the heart to pump sufficient blood to meet the needs of tissues for oxygen and nutrients

Question 6

CO math equation

Answer 6

CO= HRxSV

Question 7

preload

Answer 7

amount of blood in the ventricle at the end of the diastole
venous return of blood
compliance of ventricles (hypertrophy fibrotic tissue after MI)

Question 8

after load

Answer 8

amount of resistance to the ejection of blood

Question 9

contractility: EF

Answer 9

percentage of blood volume in the ventricles at the end of the diastole that is ejected during systole, a measure of contractility

Question 10

systolic heart failure

Answer 10

impaired contraction of the heart
more common than diastolic heart failure
low EF
left sided systolic failure

Question 11

diastolic heart failure

Answer 11

impaired filling of the heart
stiffended and noncompliant muscle
normal EF

Question 12

risk factors that precipitates heart failure

Answer 12

CAD
HTN
cardiomyopathy
valvular disorder
renal dysfunction with volume overload
diabetes: high risk
pulmonary hypertension

Question 13

heart failure pathophysiology: ANP and BNP

Answer 13

in reaction to the stretch of heart muscles, body releases
ANP (arterial)
BNP (tells us how much the chambers stretch), most accurate method in identifying CHF, works to lower the systemic blood pressure (lower the afterload)

Question 14

Heart failure pathophysiology ventricular remodeling

Answer 14

heart compensates for the increased workload to increase the thickness of the heart muscle (ventricular hypertrophy)
enlarged myocardial cells become dysfunctional and die early –> leaving the other normal myocardial cells struggling to maintain CO
a vicious cycle

Question 15

goals of treatment

Answer 15

relieve symptoms
improve functional status and quality of life
extend survival

Question 16

left sided heart failure symptoms (general)

Answer 16

lung symptoms

Question 17

right sided heart failure symptoms

Answer 17

body symptoms

Question 18

ace inhibitors

Answer 18

first line defense
relieve s/s and decrease mortality and morbidity

Question 19

ace inhibitors to watch for

Answer 19

angioedema (rare allergic reaction)
dry cough
hyperkalemia

Question 20

angiotensin receptor blockers ARBs sartan

Answer 20

• have many of the same benefits as ACEs –> alternative for those who cant tolerate
• similar side effects effects hyperkalemia hypotension renal dysfunction

Question 21

nitrates

Answer 21

may be another alternative for those who cannot take ACEs
venous dilation –> lowers preload

Question 22

hydralazine

Answer 22

lowers systemic vascular resistance and left ventricular afterload
smooth muscle arterial vasodilator
good for those with poor kidney function

Question 23

beta blockers

Answer 23

reduced the sympathetic nerve stimulation –> tired, erectile dysfunction
-given in addition to ACEs, diuretics, and digitalis
- may prevent the onset of HF
- patient may feel worse at the beginning

Question 24

diuretics loop

Answer 24

loop first furosemide slow push worried about ototoxicity
monitor for potassium

Question 25

thiazide diuretics

Answer 25

monitor potassium excretion

Question 26

spironolactone

Answer 26

potassium sparing

Question 27

diuretic side effect

Answer 27

electrolyte imbalance
symptomatic hypotension
hyperuricemia (gout)
cardirenal syndrome resistant to diuretics

Question 28

digitalis

Answer 28

• does not result in decreased mortality rate
• digoxin increases the force of myocardial and slows conduction through the AV node
• monitor potassium because the effect of digoxin is enhanced in the presence of hypokalemia and digoxin toxicity may occur
• digoxin is obtained if the patients renal function changes or there are symptoms of toxicity

Question 29

digoxin toxicity

Answer 29

first size is vision change (yellow halo)
anorexia, nausea, vomiting, fatigue, depression, and malaise
changes in heart rate or rhythm onset on irregular rhythm
ECG changes sagging ST

Question 30

CHF exacerbation treatment

Answer 30

IV diuretics
fluid restriction
patient may want to dangle legs (help breathe)
oxygen
amioderone
reduce anxiety

Question 31

use of positive inotropes (amioderone)

Answer 31

short term
balancing the good improved cardiac output and stroke volume against the bad increased myocardial oxygen consumptione

Question 32

anxiety reduction method

Answer 32

stay with them
explain their charts with them