Heart Failure Flashcards
What happens in heart failure
The heart is unable to pump an adequate amount of blood to meet tissues metabolic needs
How much is pushed out each time systole happens
65-70%
What is normal for cardiac output
Normal 4-8 liters/min
Decreased CO symptoms
Neurological symptoms change in LOC and if it continues chest pain and SOB
Heart failure results in:
Decreased CO Decreased SV Decreased Contractility Increased O2 demand on weakening heart High risk of MI Heart gets stiff
With heart failure what can the heart not handle ?
Increased volume
Increased afterload
Amount of stretch on the ventricles during diastole
Preload
Amount of resistance or workload the left ventricle has to overcome to get blood flow out the aorta to the body and brain
Afterload
In who does heart failure occur earlier in
Males and African Americans
Risk factors for Heart Failure
CAD HTN Diabetes Smoking Obesity Proeinuria High cholesterol
What does protein in the urine signify
That the cells of the kidney shed protein into the urine should be concerned about strain on kidney
Number 1 cause of heart failure
Coronary artery disease
Other causes of heart failure besides CAD
MI Valvular dysfunction Cardiomyopathy HTN Congenital defects
What is uncontrolled hypertension correlated to
Heart failure
Complications of HTN heart
- major risk factor for CAD
- left ventricular hypertrophy
- heart failure
What is a hallmark sign of systolic heart failure
Decreased LV ejection
Ejection fraction with systolic heart failure
<40%
Is diastolic or systolic heart failure most common
Systolic heart failure is most common
Sign of systolic heart failure
Thin walls
Sign of diastolic heart failure
Thick heart walls
Diastolic heart failure deals with _______ filling pressures d/t _____ ventricles
High filling pressure d/t stiff ventricles
Diastolic heart failure deals with venous engorgement which lead to pulmonary congestion. What do those two things mean?
Venous engorgement- blood cannot get into right atrium it back up in venous side
Pulmonary congestion- backs up into lungs, cannot get out to body. Sx: sob, low pulse ox, crackles, neuro Sx
Diastolic heart failure is the result of what?
Left ventricular hypertrophy and chronic HTN
-thick walled
Symptoms of left ventricular heart failure
Dry hacking cough, fatigue, dyspnea, paroxysmal nocturnal dyspnea, Orthopnea, nocturia, activity intolerance
Signs of left ventricular heart failure
Tachypnea, tricuspid or mitral murmur, tachycardia, babasilar crackles, S3 S4, decreasing pulse ox, pulmonary edema, cyanosis
Symptoms of right ventricular heart failure
Weakness, fatigue, RUQ pain, anorexia and GI bloating, nausea
Signs of right ventricular failure
JVD, hepatomegaly, positive hepatojugular reflex, ascites, weight gain, peripheral edema
4 compensatory mechanisms for heart failure
Increased sympathetic stimulation
Ventricular dilation
Hypertrophy
Activation of renin-Angiotension system
Most common type of cardiomyopathy
Dilated
Characteristics of dilated cardiomyopathy
Idiopathic
Ventricular dilation from pressure. Prone to HF, low CO
Characteristics of Hypertrophic cardiomyopathy
Left ventricular enlarges and walls thicken d/t being overworked and strained. Decreased cardiac pump
Characteristics of restrictive cardiomyopathy
Secondary condition. Results from another diagnosis, ventricle restricted and decreased pump ability
What is BNP
B-Natriuretic Peptide
It is a serum blood draw used to determine the severity of heart failure
Increases with worsening HF
Peptide released from heart in response to left ventricular overload
What can a chest x ray show
Size of heart and if there is fluid in the lungs
Complications of HF
Sudden death Dysrhythmias Pulmonary edema Renal failure Pneumonia
Goals of management for heart failure
- prevent of Myocardial damage
- prevent progression of existing function
- prevent exacerbations
- relieve signs/symptoms
- improve quality of life
How do you decrease intravascular volume
By using diuretics to reduce venous return and preload
What position would you want somebody who you are trying to decrease preload to be in
High Fowlers position with legs dangling at bedside. This helps decrease venous return because of pooling of blood in extremities
What should you do before giving a vasodilator? Why?
Measure BP and HR before giving because vasodilation will relax and your BP will drop. This will leave more volume in venous side of heart which is what’s needed
What can you use to decrease preload?
- vasodilator (Nitroglycerine)
- high Fowlers position w/ legs dangling at bedside
What would you use to decrease Afterload
- Nitroglycerin
- Sulfate-IV–> for chest pain and can also decrease preload causing vasodilation which helps afterload
- Nesiritide- IV –> given to increase BNP enzyme
- Nipride- IV –> given for severe HTN, start very slow
In what way would you improve gas and oxygenation in a severe case
BiPAP or mechanical ventilation
What is anxiety many times associated with
Dyspnea
What is a important nursing function with heart failure
Reduce Anxiety! Anxiety can trigger SNS and increase myocardial workload .
What do daily weights assess for
Fluid retention
Why do we care about hemoglobin?
Oxygen carrying component
Benefit of sodium restriction
Improved action of diuretics
How do you know if a activity is too stressful
BP change of more that 20 mmHg or a pulse increase of 20 BPM
What do positive inotropic agents do
Increase for of contractility of heart
Carvedilol (Coreg)
- One of few beta blockers approved for HF
- blocks the negative effects of SNS in the failing heart
- Only to be used with other meds
What kind of Med is Digoxin
Positive Inotropic Agent
What should you do before giving Digoxin
Check pulse first
If a patient is taking Digoxin what should you have them report
Any anorexia, nausea, vomiting
Side effects of Nitroglycerin
Headache
Hypotension
What way can you give NTG
sub lingual tablet Spray Transdermal patch Nitropaste IV
What meds can potentially worsen heart failure
Ca++ channel blockers
NSAIDS
Steroids
How much weight gain in a week can tell you somebody’s heart failure is worsening
3 pounds a week
