Heart Failure Flashcards by Jeremy Schairer

Remodeling Stage 1

Index event – MI, HTN, diseased valves

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Remodeling Stage 2

Heart becomes larger and rounder. Cell death.

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Remodeling Stage 3

Symptomatic Heart Failure

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Symptoms of left sided heart failure

Anxiety
Fatigue/Weakness/Lethargy
Dyspnea/Exertional/PND
Pulsus alternans
Increased HR
Crackles
S3 &S4 gallop

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Etiology of acute heart failure

AMI, dysrhythmias, pulmonary emboli, thyrotoxicosis, hypertension crisis, papillary muscle rupture, ventricular septal defect

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Etiology of chronic heart failure

CAD, hypertension, rheumatic heart disease, congenital heart disease, cor pulmonale, cardiomyopathy, anemia, bacterial endocarditis

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Symptoms of right-sided heart failure

Peripheral or dependent edema, hepatomegaly, splenomegaly, ascites, JVD, fatigue, anorexia, nausea, G.I. bloating

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Complications of heart failure

Pleural effusion, arrhythmias (A-fib, VT, LV thrombus), ejection fraction less than 20%, CVA, hepatomegaly (impaired function, cirrhosis)

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Digibind dose, onset, half-life

38 mg will bind with 0.5 mg of digoxin, onset less than one minute, half-life 15 to 20 hours

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Digoxin toxicity management (1-6)

stop digoxin
place on ECG monitor
draw digoxin level and electrolytes
replace electrolytes if low
Sx support (GI and Cardiac)
give Digibind for severe overdose

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Therapies for heart failure

Biventricular pacemaker

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Cardiomyopathy is

Dilated, hypertrophic, restrictive

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______ ______ is an abnormal clinical syndrome involving an current cardiac pumping and/or filling.

Heart failure

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_______ and ______ ______ are the primary risk factors for heart failure

CAD

Advancing Age

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The major causes of heart failure may be divided into two subgroups: ______ ______ and ______ ______

Primary causes

Precipitating causes

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Primary causes of heart failure include

CAD, hypertension including hypertensive crisis, rheumatic heart disease, congenital heart defects, pulmonary hypertension, cardiomyopathy, hyperthyroidism, valvular disorders, myocarditis

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Precipitating causes of heart failure often increase the workload of the ______

Ventricles

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Heart failure is classified as ______ or ______ failure or dysfunction. It can be isolated or a combination of both.

Systolic

Diastolic

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______ failure results from an inability of the heart to pump blood effectively

Systolic

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And systolic dysfunction the ______ ______ loses its ability to generate enough pressure and over time becomes ______ and ______

Left ventricle

Dilated

Hypertrophied

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The hallmark of systolic dysfunction is a decrease in the left ventricular ______ ______

Ejection fraction

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Causes of systolic failure include

Impaired contractile function (e.g. MI), Increased afterload (e.g. HTN), cardiomyopathy, and mechanical abnormalities (e.g. valvular heart disease)

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______ failure is the inability of the ventricles to relax and fill during diastole resulting in increased stroke volume and cardiac output

Diastolic

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Diastolic failure is characterized by high ______ ______ due to stiff or noncompliant ventricles and results in ______ ______ in both the ______ and ______ vascular systems

Filling pressures

Venous engorgement

Pulmonary

Systemic

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The presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy, and a normal ejection fraction would give you the diagnosis of ______ ______.

Diastolic Failure

Diastolic failure is usually the result of ______ ______ ______ from chronic hypertension (most common), aortic stenosis, or hypertrophic cardiomyopathy

Left ventricular hypertrophy

Diastolic failure usually occurs more frequently in ______ ______, ______ and people who are ______.

Older adults Women Obese

Dilated cardiomyopathy (DCM) in which horse systolic function is further compromised by ______ left ventricular walls that are unable to ______

Dilated Relax

Patients with mixed systolic and diastolic failure usually have extremely low ejection fractions of less than ______, high ______ ______, and ______ ______

35% Pulmonary pressures Biventricular failure

The patient with ventricular failure of any type may have low systemic arterial ______ ______, low cardiac ______, and poor ______ perfusion. Poor exercise tolerance and ventricular dysrhythmias are also common.

Blood pressure Output Renal

The main compensatory mechanisms of heart failure include (4)

Sympathetic nervous system activation, neurohormonal responses, ventricular dilation, ventricular hypertrophy

The _____ compensatory mechanism triggered is the sympathetic nervous system activation, however it is the ______ ______.

First Least effective

Increased SNS activation which results in release of ______ that results in increased heart ______, increased myocardial ______, and peripheral ______ which initially improves cardiac output.

Catecholamines (Epi and Norepi) Rate Contractility Vasoconstriction

Over time SNS activation is detrimental because it increases the myocardium's need for ______ and the ______ of the already failing heart

Oxygen Workload

With SNS activation the vasoconstriction causes an increase in ______ which initially increases cardiac output, but also an increase in venous return to the heart, which is already ______ ______ and actually worsens ______ performance.

Preload Volume Overloaded Ventricular

In the neurohormonal response to her failure as the cardiac output falls, blood flow to the _____ decreases, triggering the ______ cascade.

Kidneys Renin-Angiotensin-Aldosterone System

Also in the neurohormonal response low CO causes a decrease in ______ perfusion pressure which causes the posterior pituitary gland to secrete _______ hormone which increases blood volume and a person who is already volume overloaded

Cerebral Antidiuretic

The production of ______ is stimulated by ADH which results in further arterial vasoconstriction and an increase in cardiac contractility and hypertrophy

Endothelian (A potent vasoconstrictor produced by vascular endothelial cells)

Locally, ______ ______ are released by a cardiac myelocytes in response to various forms of cardiac injury which further depress cardiac function by causing cardiac hypertrophy, contractile dysfunction, and myocyte cell death

Proinflammatory cytokines (over time a systemic inflammatory response is mounted and accounts for the cardiac and skeletal muscle myopathy and fatigue)

Ventricular remodeling leads to increased ventricular mass, increased wall tension, increased oxygen consumption, and impaired contractility making it a risk factor for life-threatening ______ and ______ cardiac death

Dysrhythmias Sudden (SCD)

Another compensatory mechanism is ______ which is an enlargement of the chambers of the heart. It occurs when pressures in the heart chambers (usually LV) are elevated overtime.

Dilation

Initially dilation leads to increased CO and the maintenance of arterial BP and perfusion, but is inadequate because the ______ elements of the muscle fibers are ______ and can no longer contract effectively

Elastic Overstretched

______ is a compensatory mechanism that is an increase in muscle mass and cardiac wall thickness that usually follows persistent or chronic ______

Hypertrophy Dilation

Hypertrophy leads to an increase in CO and perfusion but over time leads to poor ______, requires more oxygen, has poor coronary artery ______, and is prone to _______

Contractility Circulation Dysrhythmias

Natriuretic peptides (ANP & BNP) are ______ mechanism hormones produced by the heart muscle that promotes venous and arterial ______

Counterregulatory Vasodilation Thus reducing preload and afterload

Natriuretic peptides enhance ______ by increasing glomerular filtration rates thus ______ the development of cardiac hypertrophy

Diuresis Inhibiting

ANP is stored within the ______ of the atria and ventricles so even a slight muscle ______ can cause a release, but prolonged distention leads to ______ of these factors

Granules Stretch Depletion

Cardiac compensation occurs when compensatory mechanisms succeeded in producing adequate ______ ______ needed to maintain adequate ______ ______

Cardiac output Tissue perfusion

HF is usually manifested by ______ failure because of the prolonged strain, both sides of the heart will eventually fail.

Biventricular

Left HF causes blood to back up into the ______ ______ and into the ______ ______

Left atrium Pulmonary veins

Pulmonary pressure caused by left heart failure causes ______ ______, which manifests as pulmonary congestion and edema

Fluid extravasation

Right-sided failure causes a backup of log into the right atrium and venous circulation which manifests as ______ vein distention, ______, ______, vascular congestion of the G.I. tract, and ______ edema

Jugular Hepatomegaly Splenomegaly Peripheral

The primary cause of Racite failure is ______ ______ ______. Chronic pulmonary hypertension results and right-sided hypertrophy and failure

Left sided failure

Cor Pulmonale ( _____ ______ dilation and hypertrophy caused by pulmonary disease) can also cause ______ ______ ______

Right ventricular Right sided failure

Acute decompensated heart failure (ADHF) manifests as ______ ______ in which the lung alveolie become filled with ______ fluid.

Pulmonary edema Serosanguineous

Most common cause of pulmonary edema is a cute left ventricular failure secondary to ______ ______ ______

Coronary artery disease

In ADHF the early stages clinically associated with a mild increase in ______ rate and a decrease in ______ ______ of oxygen in arterial blood.

Respiratory Partial pressure

In ADHF if pulmonary venous pressure continues to increase and there is more fluid than the ______ system can remove then ______ edema occurs at this point and ______ develops and the patient becomes symptomatic

Lymphatic Interstitial Tachypnea

In ADHF if pulmonary pressure increases further the alveoli lining cells are disrupted and fluid containing ______ ______ ______ moves into the alveoli. If it becomes worse the alveoli and ______ are flooded with fluid.

Red blood cells Airways

______ HF is characterized as a progressive worsening ventricular function in chronic neurohormonal activation that result in ventricular remodeling

Chronic

Possible evidence in low perfusion include

``` Narrow pulse pressure Sleepy / Obtunded Low serum sodium Cool extremities Hypotension w ACE inhibitor Renal Dysfunction ```

Signs and Symptoms of congestion

``` Orthopnea / PND JVD Hepatomegaly Edema Crackles Elevated est. PAsys Valsalva square wave ```

What is the MOA Digibind?

Antibody recognizes Digoxin as an antigen and forms and antibody antigen complex which binds and removes Digoxin

What is the SE of Digibind?

Re-emergence of A-Fib or CHF Hypokalemia

Digoxin given IV or PO is used for the treatment of ______ ______ ______ and ______

Congestive heart failure Tachyarrhythmias

Digoxin has a narrow therapeutic range that is increased if the patient is ______.

Hypokalemic

Main SE for Digoxin are

Fatigue, arrhythmias, bradycardia, heart block, anorexia, nausea, vomiting, visual disturbances (green/yellow halo around objects)

What is the daily dose, half-life, loading dose of digoxin?

0.125 - 0.25 mg 36 - 48 hours 0.25 - 0.5 mg Q4h x 2-3 doses