Heart Failure Flashcards
What is HF a long term effect of?
Coronary heart disease and MI.
What is heart failure?
Inability of the ventricles to fill during preload and the inability of the heart to pump out blood during after load.
What are the risk factors for HF?
HTN diabetes Smoking Obesity High cholesterol
What causes impaired myocardial function?
Coronary heart disease
Cardiomyopathies
Rheumatic fever
Infective endocarditis
What causes an increased cardiac workload?
Hypertension
Valve disorders
Anemia
Congenital heart defects
What is the frank starling mechanism?
The SNS is stimulated and releases NE which increases the HR and contractility. NE also causes arterial and venous vasoconstriction which increase ventricular filling and myocardial stretch)
*comoensatory mechanism may fail if the heart is over stretched and can no longer contract effectively.
What does activation of the RAAS do?
The decreased renal perfusion causes kidneys to release renin.
Produces vasoconstriction and release of ADH.
Cause vasoconstriction and salt and water retention which causes an increased filling and increased contraction
** but eventually they will over stretch and fail
What does myocardial hypertrophy do?
The ventricles remodel and dilate to accommodate. The additional stretch causes more effective contractions but in the long run the walls of the heart thing out and degenerate.
When does decompensation occur?
When these mechanisms can no longer maintain adequate CO and inadequate tissue perfusion results.
What is systolic heart failure?
Impaired contraction
What causes systolic HF?
Cardiomyopathies
Ischemia
Infarction
Inflammation
What are he signs and symptoms of systolic HF?
Weakness, fatigue, and activity intolerance
What is diastolic HF?
Impaired ability of the ventricle to relax and fill
What is the cause of diastolic HF?
Ventricular hypertrophy
Impaired relaxation of cardiac muscle
What are the signs and symptoms of diastolic HF?
SOB, tachypnea, and respiratory crackles if the left ventricle is affected.
What is left sided HF caused by?
CAD and HTN
What are the signs and symptoms of left sided HF?
Fatigue and activity intolerance are early CM.
SOB, cough (pink frothy sputum), orthopnea, cyanosis, and inspiratory crackles and wheezes.
What are the clinical manifestations of HF?
Edema
Paroxysmal nocturnal dyspnea (when supine)
Nocturia
Weight changes (5lbs in a week)
What are the CM of decompensation HF?
Pulmonary edema (tachycardia, hypotension, ventricular gallop,hypoxemia) Cyanosis and clammy cold skin
*all of these are cardiogenic
What test will be order for HF?
BNP between 100-300 indicates HF. JUST TESTS FOR SEVERITY.
What causes right sided HF?
Pulmonary diseases
What are the signs and symptoms of right sided HF?
Edema in the feet, legs, and sacrum
GI congestion (anorexia and nausea)
JVD
upper right quadrant pain from liver engorgment or splenomegaly
What do diuretics do?
They prompt sodium and water excretion.
watch for significant electrolyte and fluid loss.
What do ACEI do?
Interrupt the conversion of angiotensin I to angiotensin II.
Decreasing cardiac work and increasing CO.
They reduce the progression and manifestations of heart failure.
What should we tell patient who are taking ACEI?
They will experience a dry cough
What are ARBS?
They block the receptor.
They slow the progression of HF and reduce its manifestations.
What do vasodilators do?
Relax smooth muscle in the vessels, causing dilation.
What do intotropic agents do?
Digitalis works to slow and strengthen contractions,
What do sympathomimetic agents do?
Raise everything up, produce a fight or flight response.
What are respiratory manifestations of pulmonary edema?
Tachycardia Paroxysmal nocturnal dyspnea Labored respirations Cough productive of frothy pink sputum Dyspnea Crackles, wheezes Orthopnea
What are cardiovascular clinical manifestations of pulmonary edema?
Tachycardia Cool, clammy skin Hypotension Hypoxemia Cyanosis Ventricular gallop
What are neurological clinical manifestations of pulmonary edema?
Restlessness,feeling of impending doom, anxiety
What does an ECCHO look for?
Left ventricular function
What does an ECG look for?
Dysthymias, myocardial ischemia, or infarction
What does a chest X-ray look for?
Pulmonary congestion
What do thyroid function tests look for?
Hyperthyroidism or hypothyroidism because they can both be a contributing factor to HF
