Heart Failure Flashcards
Heart Failure/CHF
Cardiovascular condition in which the heart is unable to pump an adequate amount of blood to meet the metabolic needs of the body
heart failure is a complication of
an MI
common causes of HF
•MI, arrhythmias, CAD, RHD, cardiomyopathy, anemia, endocarditis, pulmonary emboli, hypertensive crisis, congenital defects, Diabetes, smoking, substance abuse, family history.
types of HF
Left sided
right sided
high output
left sided heart failure
can be acute or chronic
Subtypes: Systolic ventricular dysfunction
and Diastolic heart failure.
systolic ventricular dysfunction
•Results when heart cannot contract forcefully enough during systole to eject adequate amounts of blood into the circulation.
- Ejection fraction drops to below 40 % with ventricular dilation. Tissue perfusion decreases and fluid accumulates in the pulmonary vessels.
- Called forward failure. Cardiac output is decreased and fluid backs up into pulmonary system.
what is another name for systolic ventricular dysfunction
foward failure
diastolic Heart Failure
- Left ventricle cannot relax adequately during diastole. Prevents ventricle from filling with sufficient blood to maintain adequate cardiac output.
- Ventricle becomes less compliant over time because more pressure is needed to move the same amount of blood as compared to a healthy heart.
diastolic heart failure backs up in
lungs
right sided heart failure
•May be caused by left ventricular failure, right ventricular MI, pulmonary hypertension
The right ventricle cannot empty completely so increased volume and pressure develop in the venous system. Peripheral edema results
right sided failure you get more
peripheral edema
high output heart failure
- Cardiac output can remain normal or above normal
- Caused by increased metabolic demands or hyperkinetic conditions like septicemia and hyperthyroidism
- Not as common
long term use of NSAIDS
cause fluid and sodium retention
which can cause HF
pioglitazone (actos)
used for diabetics causes fluid and sodium retention leading to HF
left sided HF symptoms
*RESPIRATORY SYMPTOMS*
- Fatique, weakness, oliguria during the day, nocturia at night, angina, confusion, restlessness, dizziness, tachycardia, palpitations, pallor, weak peripheral pulses, cool extremities,
- Decreased PaO2, Hacking cough worse at night, dyspnea, breathlessness, crackles or wheezes in the lungs, frothy pink tinged sputum, tachypnea, murmurs
Right sided HF symptoms
*THINK VEINS*
•Jugular neck vein distention
•Enlarged liver and spleen
•Dependent edema in legs and sacrum
•Distended abdomen, anorexia & nausea
•Swollen hands & fingers
•Polyuria at night
•Weight gain
•Increased BP (excess volume) or decreased BP from failure.
diagnostic assessments for HF
BNP (Best TEST)
- B-Type natriuretic peptide ( BNP ) is used for diagnosing Heart Failure
- Electrolyte imbalances may result from HF
- BUN & creatinine to check effect of HF on kidneys
- Urinalysis shows proteinuria
- Hgb & Hct to identify HF caused by anemia
- Microalbuminuria is an early indicator of decreased compliance of heart
B-Type natriuretic peptide (BNP)
secreted from the ventricles or lower chambers of the heart in response to changes in pressure that occur when heart failure develops and worsens.
trying to compensate for failure. tries to regulates BP and fluid balance.
more diagnostic tests for HF
- Arterial blood gases often show hypoxia. Respiratory alkalosis may occur because of hyperventilation. Respiratory acidosis may occur because of carbon dioxide retention
- Chest Xrays help diagnose LVF
- Echocardiogram considered best tool for diagnosing HF. Also determines ejection fraction.
- Radionuclide imaging helps dx HF
- Electrocardiogram can show ventricular hypertrophy, arrhythmias, and any degree of myocardial ischemia or injury
- Pulmonary artery catheters allow assessment of cardiac function and volume in acutely ill patients.
medical treatment for HF
- Medications
- Continuous positive airway pressure (CPAP)- improves sleep apnea in HF and improves cardiac output
- Cardiac resynchronization therapy (CRT)- is biventricular pacing that stimulates more synchronized contraction and improves ejection fraction. Can be used with ICD.
more medical treatment for HF
- Heart transplant for end stage HF
- Ventricular assist devices (VADs)- mechanical pump is implanted to work with patient’s own heart. Can be used short term while waiting for transplant or long term to increase quality of life.
- Heart reduction surgery (partial left ventriculectomy PLV )-removes a section of the weakened heart in left lateral ventricle to reduce size and wall tension.
more heart failure treatments
- Endoventricular circular patch cardioplasty-portions of the septum and left ventricular wall are removed and a synthetic circular patch is grafted into opening, Makes more normal shape for left ventricle and improves ejection fraction.
- Acorn cardiac support device- polyester mesh jacket placed over ventricles to prevent them from overstretching. Reduces hypertrophy and improves ejection fraction.
and yet more heart failure treatments
- Myosplint- recently approved. Electrical stimulation of several tension pads on the outside of the ventricle changes it to more normal shape and improves function.
- Gene Therapy-Investigative. For those not candidates for heart transplant. Replaces damaged genes with normal ones by injecting growth factor into the ventricle. Improves exercise tolerance and regrowth of cardiac cells.
commonly used drugs for systolic HF
- Angiotensin-converting enzyme (ACE) inhibitors or angiotensin- receptor blockers (ARBs)
- Diuretics- loops, thiazides, and potassium sparing
- Human B-type natriuretic peptides
- Nitrates
- Inotropics
- Beta-adrenergic blockers
