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N420 Flashcards > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Remodeling Stage 1

A

Index event – MI, HTN, diseased valves

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2
Q

Remodeling Stage 2

A

Heart becomes larger and rounder. Cell death.

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3
Q

Remodeling Stage 3

A

Symptomatic Heart Failure

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4
Q

Symptoms of left sided heart failure

A 
Anxiety
Fatigue/Weakness/Lethargy
Dyspnea/Exertional/PND
Pulsus alternans
Increased HR
Crackles
S3 &S4 gallop
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5
Q

Etiology of acute heart failure

A

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

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6
Q

Etiology of chronic heart failure

A

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

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7
Q

Symptoms of right-sided heart failure

A

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

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8
Q

Complications of heart failure

A

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

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9
Q

Digibind dose, onset, half-life

A

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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10
Q

Digoxin toxicity management (1-6)

A
  1. stop digoxin
  2. place on ECG monitor
  3. draw digoxin level and electrolytes
  4. replace electrolytes if low
  5. Sx support (GI and Cardiac)
  6. give Digibind for severe overdose
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11
Q

Therapies for heart failure

A

Biventricular pacemaker

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12
Q

Cardiomyopathy is

A

Dilated, hypertrophic, restrictive

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13
Q

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

A

Heart failure

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14
Q

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

A

CAD

Advancing Age

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15
Q

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

A

Primary causes

Precipitating causes

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16
Q

Primary causes of heart failure include

A

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

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17
Q

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

A

Ventricles

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18
Q

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

A

Systolic

Diastolic

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19
Q

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

A

Systolic

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20
Q

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

A

Left ventricle

Dilated

Hypertrophied

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21
Q

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

A

Ejection fraction

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22
Q

Causes of systolic failure include

A

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

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23
Q

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

A

Diastolic

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24
Q

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

A

Filling pressures

Venous engorgement

Pulmonary

Systemic

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25
Q

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

A

Diastolic Failure

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26
Q

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

A

Left ventricular hypertrophy

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27
Q

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

A

Older adults

Women

Obese

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28
Q

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

A

Dilated

Relax

29
Q

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

A

35%

Pulmonary pressures

Biventricular failure

30
Q

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.

A

Blood pressure

Output

Renal

31
Q

The main compensatory mechanisms of heart failure include (4)

A

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

32
Q

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

A

First

Least effective

33
Q

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

A

Catecholamines (Epi and Norepi)

Rate

Contractility

Vasoconstriction

34
Q

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

A

Oxygen

Workload

35
Q

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.

A

Preload

Volume Overloaded

Ventricular

36
Q

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

A

Kidneys

Renin-Angiotensin-Aldosterone System

37
Q

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

A

Cerebral

Antidiuretic

38
Q

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

A

Endothelian (A potent vasoconstrictor produced by vascular endothelial cells)

39
Q

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

A

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

40
Q

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

A

Dysrhythmias

Sudden (SCD)

41
Q

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.

A

Dilation

42
Q

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

A

Elastic

Overstretched

43
Q

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

A

Hypertrophy

Dilation

44
Q

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 _______

A

Contractility

Circulation

Dysrhythmias

45
Q

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

A

Counterregulatory

Vasodilation

Thus reducing preload and afterload

46
Q

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

A

Diuresis

Inhibiting

47
Q

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

A

Granules

Stretch

Depletion

48
Q

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

A

Cardiac output

Tissue perfusion

49
Q

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

A

Biventricular

50
Q

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

A

Left atrium

Pulmonary veins

51
Q

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

A

Fluid extravasation

52
Q

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

A

Jugular

Hepatomegaly

Splenomegaly

Peripheral

53
Q

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

A

Left sided failure

54
Q

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

A

Right ventricular

Right sided failure

55
Q

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

A

Pulmonary edema

Serosanguineous

56
Q

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

A

Coronary artery disease

57
Q

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

A

Respiratory

Partial pressure

58
Q

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

A

Lymphatic

Interstitial

Tachypnea

59
Q

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.

A

Red blood cells

Airways

60
Q

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

A

Chronic

61
Q

Possible evidence in low perfusion include

A 
Narrow pulse pressure
Sleepy / Obtunded
Low serum sodium
Cool extremities
Hypotension w ACE inhibitor
Renal Dysfunction
62
Q

Signs and Symptoms of congestion

A 
Orthopnea / PND
JVD
Hepatomegaly
Edema
Crackles
Elevated est. PAsys
Valsalva square wave
63
Q

What is the MOA Digibind?

A

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

64
Q

What is the SE of Digibind?

A

Re-emergence of A-Fib or CHF

Hypokalemia

65
Q

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

A

Congestive heart failure

Tachyarrhythmias

66
Q

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

A

Hypokalemic

67
Q

Main SE for Digoxin are

A

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

68
Q

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

A

0.125 - 0.25 mg

36 - 48 hours

0.25 - 0.5 mg Q4h x 2-3 doses

N420 Flashcards (21 decks)

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