Heart Failure Flashcards
Remodeling Stage 1
Index event – MI, HTN, diseased valves
Remodeling Stage 2
Heart becomes larger and rounder. Cell death.
Remodeling Stage 3
Symptomatic Heart Failure
Symptoms of left sided heart failure
Anxiety Fatigue/Weakness/Lethargy Dyspnea/Exertional/PND Pulsus alternans Increased HR Crackles S3 &S4 gallop
Etiology of acute heart failure
AMI, dysrhythmias, pulmonary emboli, thyrotoxicosis, hypertension crisis, papillary muscle rupture, ventricular septal defect
Etiology of chronic heart failure
CAD, hypertension, rheumatic heart disease, congenital heart disease, cor pulmonale, cardiomyopathy, anemia, bacterial endocarditis
Symptoms of right-sided heart failure
Peripheral or dependent edema, hepatomegaly, splenomegaly, ascites, JVD, fatigue, anorexia, nausea, G.I. bloating
Complications of heart failure
Pleural effusion, arrhythmias (A-fib, VT, LV thrombus), ejection fraction less than 20%, CVA, hepatomegaly (impaired function, cirrhosis)
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
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
Therapies for heart failure
Biventricular pacemaker
Cardiomyopathy is
Dilated, hypertrophic, restrictive
______ ______ is an abnormal clinical syndrome involving an current cardiac pumping and/or filling.
Heart failure
_______ and ______ ______ are the primary risk factors for heart failure
CAD
Advancing Age
The major causes of heart failure may be divided into two subgroups: ______ ______ and ______ ______
Primary causes
Precipitating causes
Primary causes of heart failure include
CAD, hypertension including hypertensive crisis, rheumatic heart disease, congenital heart defects, pulmonary hypertension, cardiomyopathy, hyperthyroidism, valvular disorders, myocarditis
Precipitating causes of heart failure often increase the workload of the ______
Ventricles
Heart failure is classified as ______ or ______ failure or dysfunction. It can be isolated or a combination of both.
Systolic
Diastolic
______ failure results from an inability of the heart to pump blood effectively
Systolic
And systolic dysfunction the ______ ______ loses its ability to generate enough pressure and over time becomes ______ and ______
Left ventricle
Dilated
Hypertrophied
The hallmark of systolic dysfunction is a decrease in the left ventricular ______ ______
Ejection fraction
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)
______ failure is the inability of the ventricles to relax and fill during diastole resulting in increased stroke volume and cardiac output
Diastolic
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
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
