heart failure Flashcards
what is hemodynamics
what controls most of it
the fluid dynamics of blood flow.
the sns controls it primarily
in the book this is…affected by?? everything from CO, SV, preload, afterload, contractility, heart rate
how can you nonivasively assess cardiac hemodynamics
• Estimated by measuring jugular venous distention
Invasive assessment of cardiac hemodynamics (done on hemodynamically unstable pt)
• Pulmonary artery catheter
this is usually in a critical care setting
what is heart failure (HF)?
• Inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients
indicates myocardial disease in which there is a problem with the contraction of the heart or filling of it
used to be called CHF
how is HF characterized
it is recognized as a clinical syndrome characterized by S/S of fluid oveload or inadequate tissue perfusion d/t the heart not being able to produce CO sufficient for demands
is HF acute or chronic, reversible?
either.
can be reversed but its usually progressive and lifelong
where are rates of HF high (what populations)
in rural settings
in older adults
etiology of HF
most prevalent
-ischemic heart disease,->hypoxia->acidosis
-hypertension (systemic or pulmonary)->inc afterload->hypertrophy->inc contractility and is compensatory but may dec space for filling
-diabetes melliutus,
metabolic syndrome,
hyperlipidemia,
smoking
also cardiomyopathy inc metabolic rate eg fever iron overload hypoxia severe anemia (HCt less than 25%) acidosis Worsened by:electrlyte imbalances antiarrythmic meds dysrhythmias
why is HF and the compensatory mechanisms surrounded it termed a “vicious cycle”
the heart cant pump sufficient blood to body so the body stim the heart to work harder but it cant respond so the failure becomes worse
how are systolic and diastolic HF develop
diastolic is d/t hypertrophy (cant fill)
systolic is d/t other factors
HF isnt differentiated by systolic or diastolic as their symptoms are too similar. how is it classified instead
R and L sided HF
or R and L ventricular failure
what causes the S3
aka ventricular gallop-caused by lg volume of fluid entering the V at beginning of diastole
what causes S4
aka atrial gallop. when atrium contracts into stiff V eg s in systolic failure post MI
how does L sided HF affect the lungs/breathing
- Pulmonary congestion occurs when the left ventricle cannot pump effectively
- Pulmonary edema is caused by a backup in the pumping system
- Dyspnea or SOB may be precipitated by activity
- May have orthopnea
- May have sudden attacks of dyspnea at night called paroxysmal nocturnal dyspnea
- Cough associated with left ventricular failure is dry and nonproductive initially will later on be wet with frothy sputum indicating pulmonary edema
- O2 saturation will decrease due to failed pumping ability
- Adventitious sounds. Crackles in lung in early LV failure
how does the dec perfusion affect the rest of the body other than the lungs (from L sided HF)
- Decreased blood flow to kidneys causes reduced urine output (Oligura)
- As it progresses GI symptoms will appear due to lack of O2 perfusion.
- Dec perfusion->dizziness , light headedness, restlessness, anxiety( leads to dyspnea->anxiety=another vicious cycle
- Cyanosis may appear, skin is cool
- -tachycardia, -dysrhythmias->Palpitations may be felt
- Patient becomes increasingly fatigued
what will cause RVF according to ppt
RVF
Acute
Inferior MI
Pulmonary embolus
Chronic
Cor pulmonale
LVF
what will cause LVF according to ppt
LVF
Acute
Anterior MI
Hypertensive crisis
Chronic
Hypertension
clinical mnfts of R sided HF in relation to congestion/edema
- Congestion in the peripheral tissues and viscera is evident
- Increased venous pressure leads to JVD and inc hydrostatic P throughout venous system
- Fluid retention in the lower extremities. Dependent edema, pleural effusion, ascites, anorexia and nausea (congestion in gut), weakness, weight gain
- Edema is usually in ankles-. Can be in sacrum if bedbound. Pitting edema is obvious only after retention of at least 4.5kg of fluid. May occur solely in abdomen,
how does R sided HF affect GI tract/appetite etc
- Anorexia, nausea or abdominal pain result from venous engorgement and venous stasis in abd organs. Cachexia is a potential complication.
how is liver affected by R-sided HF
- Enlargement of the liver (dt venous engorgement) may-> secondary liver dysfx-> fluid forced into the abdominal cavity=ascites. Ascites may->GI distress
how is HF usually Diagnosed
what other info can this diagnositc give
other diagnostics used
echocardiogram
-helps identify cause, ejection fraction
also chest xray
angiogram
ECG
labs performed for HF
- BNP- high levels are sign of high cardiac filling P and can aid in dx of HF. THis is important for diagnosing
- electrolytes
- BUn
- creatinine
- TSH
- CBC
- routine urinalysis
- exercise testing may be done to det if CAD and cardiac ischemia are causing it
class notes add:
- RBC, HCt, Hgb
- GFR
goal of mgmt of HF
- elinate the etiologic factors eg a. fib., excess alcohol, HTN, ischemia
- reduce the workload ont he heart by dec after/preload
- optimize all therapeutic regimens
- prevent exacerbations of HF
how would the ejection fraction be if a pt has diastolic heart failure
it could still be high but the volume (CO) would be lower than normal
what is cor pulmonale. which side of the heart does this cause to fail
enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance or high blood pressure in the lungs (pulmonary hypertension).
affects R side
JVD is an indicator of _____ fx
preload on right side. (R V fx)
what can be used as an indicator of LV afterload
MAP
its an approximate indicator
modifiable risk factors for HF
risk factors from in class
ischemic heart disease (such as cardiomyopathy), HTN, DM, metabolic syndrome, hyperlipidemia, smoking
in class: Risk factors: - Hypertension - Diabetes - Smoking - CAD – atherosclerosis
how can pts modify lifestyle for HF
reduce salt, avoid excessive fluid intake, alcohol, smoking, weight reduction, exercise,
what are the general methods of Tx for HF
- Oral + IV drugs, O2, implantation of assistive devices, surgical approaches (incl transplant)
- Lifestyle
what are the general classes of medications used to Tx HF and how do their actions assist the heart
- ACE inhibitors- promote vasodilation and diuresis by decreasing afterload and preload, decrease the secretion of aldosterone
- Angiotensin II Receptor blockers-similar efects ro Ace Inhibitors. (Result in dec BP, dec systemic vascular resistance and improved CO)
- Beta blockers- reduce mortality and morbidity by reducing the adverse effects from the constant stimulation of the sympathetic nervous system
- Diuretics- prescribed to remove excess fluid, and decrease vascular volume and edema
- Vasodilators- decreases resistance
- Digoxin- increases force of myocardial contraction
- Supplemental O2
- End stage or severe require transplants or VADs
common meds for systolic HF
diastolic HF
ACE I
B-Blockers
diuretics
vasodilators
diastolic failure Tx depends ont he cause. after contributing causes eg HTN and ischemic heart disease are Tx the pt may be started on ACE I and diuretics. May use CCB.
what drug is contraindicated in systolic HF but is ok for diastolic HF
calcium channel blockers
what food could have serious interactions w HF pts drugs
grapefruit
