Heart Failure Flashcards
What is ejection fraction?
The percentage of blood volume pumped out of LV .70% is perfect. 55-65% is normal. <40% is HF
Primary risk factors for HF
HTN (women)
CAD (men)
Two types of left ventricular HF
Reduced ejection fraction
Preserved ejection fraction
Pathos of pulmonary edema in LV-HF
LV dilates and hypertrophies because of increased pressure of low ejection fraction.
Blood backs up into LA»increased hydrostatic pressure pushes fluid out of these tight arteries and into alveoli
What does Right ventricle HF look like?
Blood/edema backs up into venous system, not lungs. This will present as
peripheral edema, JVD, hepatomegaly, ascites.
What are some compensatory mechanisms in HF?
RAAS
Sympathetic NS
Ventricular dilation
Ventricular atrophy
What does the RAAS system do in response to HF?
The decreased cardiac output signals RAAS to hang onto water, sodium vasoconstrict»raise BP.
This exacerbates HTN, after load, hypertrophy of heart muscle.
What does the sympathetic NS do in HF?
Drops epinephrine/norepi to raise BP and HR.
This puts more demand for O2 on heart muscle.
What is dilation in HF?
Enlargement of heart chambers
At first, dilation does increase CO (cardiac output). However, over time, the overstretched muscle doesn’t pump as efficiently
What is hypertrophy in HF?
Muscle enlargement.
At first, this helps increase CO.
Over time, the increased muscle needs more O2, has poor circulation and is prone to dysrhythmias.
What is ventricular remodeling? Why is it bad?
Change in heart structure in response to damage.
Less effective pump because of change of shape.
Leads to fibrosis and higher death rates.
Prevention is key.
What meds prevent ventricular remodeling?
ACE
Beta blockers
What hormones work against the compensatory mechanisms in HF?
(These are the good guys)
Atrial natriuretic peptide
Brain natriuretic peptide
Vasodilators and antihypertensives
These combat the RAAS and sympathetic NS effects in HF.
What does high BNP mean in HF?
Fluid retention
The higher BNP=higher mortality rate
What is meant by compensated and uncompensated HF?
Compensated: Compensatory mechanisms (RAAS, Sympathetic NS, Dilation, hypertrophy) are working. Adequate CO.
Uncompensated: They quit working. Inadequate CO
What is acute decompensated HF?
Sudden increase in HF symptoms
Most common cause of hospitalization in older patients
Pulmonary edema s/sx
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea (sudden onset of dyspnea in night)
RR >30
Accessory muscle use
Crackles/wheezes
PInk, frothy sputum
Anxious, pale, cyanotic, ashen, pallor, mottled
Tachycardia
S3, S4 sounds
Hypertensive
Hypotensive (late sign)
S/Sx of Right sided HF
Tachycardia (early sign)
Massive generalized edema
Ascites
Weight gain
JVD
Hepatomegaly
Murmurs
S/Sx of Left sided HF
Tachycardia (early sign)
S3, S4
Confusion/Restless
Dry hacking cough
Dyspnea
Orthopnea
Pleural effusion/Crackles
Nocturia
Paroxysmal nocturnal dyspnea
Shallow fast respirations
Frothy pink tinged sputum
What is the most common dysrhythmia in HF?
Complication in this dysrhythmia?
A fib
Thrombus formation in atria
What is pleural effusion?
Fluid in between two layers (pleura) that cover lungs
Major cause of death in HF
Ventricular dysrhythmias
An enlarged, backed up LV is in danger of what?
Thrombus formation
What is cardiac resynchronization therapy? (CRT)
Pacemaker
What is ICD therapy?
Implanted defibrillator
What is pathos for hepatomegaly in HF?
Venous blood backs up into liver
Can lead to fibrosis and cirrhosis
An increase in BNP can be caused by what conditions? (other than HF)
Pulmonary embolism
Renal failure
Acute coronary syndrome
Classes of meds used to treat acute decompensated HF (ADHF)
Diuretics
Vasodilators
Morphine
Positive inotropic meds (like dopamine, dobutamine, norepinephrine, milrinone, digoxin)
Classes of meds used to treat chronic HF
–All these are aimed at stopping the neuro and hormonal compensatory mechanisms–
ACE inhibitors (–pril)
ARBs (angiotensin 2 receptor blockers) (—sartan suffix)
Beta blockers (–lol)
Aldosterone antagonists (spironolactone and eplerenone)
Diuretics
Digoxin (normal dose is 0.125 mg)
How much sodium is allowed in HF patients?
<2 g daily
SE of ACE inhibitors?
Hypotension
Hyperkalemia
Dry cough
Angioedema
Renal insufficiency
SE of ARBs?
—sartan–
Same as ACE (hypotension, hyperkalemia, renal insufficency)
Except-no cough and low incidence of angioedema
What are some positive inotrope meds and what does that mean?
Positive inotrope means increases heart contractility
Digoxin (weak one)
Dopamine
Dobutamine
Norepinephrine
Milrinone
SE of digoxin
Bradycardia
Dizziness
2 loop diuretics
Furosemide
bumetanide (Bumex)
Potassium sparing diuretics
Also called aldosterone antagonists
Spironolactone
eplerenone (Inspra)
What should be done 1 hour after giving carvedilol (Coreg)?
Obtain a standing BP
What is caution when giving spironolactone and digoxin together?
Watch potassium closely
Can easily become hyperkalemic from diuretic
Dig and hyperkalemia are no good. Makes dig not work.
No foods high in potassium while on spironolactone.
Digoxin toxicity signs
Early: Abdominal pain, nausea, vomiting, anorexia
Vision changes, bradycardia, arrhythmias
What is the difference between HF from reduced ejection fraction (HFrEF) and HF from preserved ejection fraction (HFpEF)?
HFrEF=means the LV is not pumping adequately. It is too weak/damaged.
HFpEF=means the ventricles can’t relax and fill. They are too stiff and noncompliant. Usually from HTN
Treatment is the same but the causes are different.
What is the most common cause of Right sided HF?
Left sided HF progresses to both sides
Possible complication of sodium nitroprusside?
Cyanide toxicity
Looks like confusion fatigue, weakness, tinnitus, rash
When is the vasodilator nesiritide usually given?
In ER setting as a bolus to quickly lower BP, decrease dyspnea
Is digoxin given as short acting or long action positive inotrope?
Long acting
Takes some time to reach therapeutic levels so not used in emergency setting
What is ivabradine (Corlanor)?
Works on SA node to decrease HR
Must have normal sinus rhythm and >70 BPM to use
Used when maxed out on beta blockers to decrease HR
FACES acronym is used to teach HF patients what?
S/Sx to watch for
F=Fatigue
A=Activity intolerance
C=Chest congestion/cough
E=Edema
S=SOB
What is intraaortic balloon pump?
Treatment to temporarily assist heart in pumping harder. A balloon inserted into aorta. Inflates and deflates to help heart push
What is a VAD?
Ventricular assist device
A life vest to help left ventricle pump
Used temporarily until heart transplant
