Heart Failure Flashcards
What is going on during heart failure?
The heart is unable to pump enough blood to perfuse and meet body’s needs for oxygen and nutrients.
In what two ways can the heart be insufficient during heart failure?
- Insufficient filling with blood
- Insufficient ability to pump the blood
What can heart failure lead to?
A drop in cardiac out put
How is preload described?
The degree of stretch of the cardiac muscle fibers at the end of diastole.
*Think VOLUME
How is after load described?
The resistance to ejection of blood from the ventricle.
*Think PRESSURE
What is the equation for Cardiac Output (CO)
CO= Heart Rate (HR) x SV (Stoke Volume)
How is stroke volume described?
The amount of blood pumped per stroke
Cardiac output is described as what?
The amount of blood pumped from the ventricle per minute
The ejection fraction is described as?
Percent of blood ejected by the ventricle during systole
What is the typical range for the ejection fraction to fall into?
55-65%
If the heart experiences a small stretch what will the corresponding contraction be like?
It will also be small
If the heart experiences a large stretch what will the corresponding contraction be like?
It will also be large
What are the three primary compensatory mechanisms?
Frank-Starling mechanism
Neuroendocrine responses
Myocardial hypertrophy
When you think of LEFT sided heart failure what do you associate it with?
LUNGS
When you think of Right sided heart failure what do you associate it with?
The REST of the body
What is the first two things that become starved of oxygen when a patient is experiencing left sided heart failure?
The heart and BRAIN
What occurs from severe left sided heart failure?
Pulmonary edema
If a patient is experiencing systolic heart failure what can the heart not do?
Can’t eject blood
If a patient is experiencing diastolic heart failure what can the heart not do?
Cant fill with blood
Right sided heart failure is described as?
The right ventricle cannot eject sufficient amounts of blood causing the blood to back up in the venous system.
Left sided heart failure is described as?
The left ventricle cannot pump blood effectively to the systemic circulation causing blood to back up in the lungs.
Chronic heart failure is frequently what?
Biventricular
What are the clinical manifestations of left-sided heart failure?
- Fatigue
- Activity intolerance
- Dizziness
- Syncope
- Dyspnea
- Orthopnea
- Rales or wheezes
What are the clinical manifestations of right-sided heart failure?
- Edema in feet, legs, and sacrum
- Anorexia
- Nausea
- Right upper quadrant pain
- Hepatomegaly
- Jugular Vein Distention
- Nocturia
Why would a patient experience right upper quadrant pain if they have right-sided heart failure?
Because blood is backing up in the liver
What are the three causes for heart failure?
Impaired myocardium
Increased cardiac workload
Acute non cardiac conditions
What are the three conditions that can cause an impaired myocardium that leads to heart failure?
Coronary Artery Disease
Myocardial Infarctions
Cardiomyopathies
What are the four conditions that can cause an increased cardiac workload that leads to heart failure?
Hypertension
Valvular disorders
Anemia
Congenital defects
What are the four acute non cardiac conditions that could lead to heart failure?
Hyperthyroidism
Volume overload
Fever
Massive Pulmonary Edema
What types of cardiovascular conditions are risk factors for heart failure?
Coronary Artery Disease
Hypertension
Prior MIs
True or false:
Cardiotoxic drugs do not increase a patients risk for heart failure.
False
Why would diabetes mellitus be a risk factor for heart failure?
Due to the blood viscosity changes causing micro and macro vesicular changes.
Which race and gender is more likely to have heart failure?
African American males
What are the four abdominal complications that a patient could experience when in heart failure?
- Hepatomegaly
- Splenomegaly
- Ascites
- Impaired liver function
When experiencing heart failure: what are the cardiac and pulmonary complications that could develop?
Dysrhythmias
Further decreasing cardiac output
Acute pulmonary edema
What can result from pulmonary edema?
hypoxemia
How do the alveoli cause pulmonary edema?
The alveoli cause third spacing so they do not pop open causing pulmonary edema
What are the 4 main goals of care for heart failure?
- Slow progression
- Reduce cardiac workload
- Improve cardiac function
- Control fluid retention
What is a TEE?
Transesophogeal echocardiogram
Why would you do a thyroid function test when trying to diagnose heart failure?
Hypothyroidism could be the cause
How many pounds can a patient gain in 24-48 hours due to heart failure?
10-15 lbs
Why would you need to monitor I and Os as well as a patients weight daily if they are in heart failure?
Because the patient is experiencing edema throughout their body so you want to reduce the patients weight.
What ways does a patient who is experiencing heart failure need to change their diet?
Sodium-restricted diet
Fluid restriction
In a patient who is experiencing heart failure: how long do they need to wait to exercise and what type of exercise program should they partake in?
- Wait 2 hours after eating before doing physical activity
- Moderate, progressive activity program
Where in the lungs should you listen to initial signs of pulmonary edema and with which part of the stethoscope?
The base of the lungs and with the bell of the stethoscope
Why should you instruct a patient about coronary artery disease when they are diagnosed with heart failure?
It is the most common underlying cause of heart failure
Where do you need to focus on when doing a physical examination on a heart failure patient?
Respiratory
Cardiac (rate, rhythm, peripheral pulses, S3)
Edema or Ascites
Skin
What are the four diagnoses that belong in the heart failure category?
- Decreased Cardiac Output
- Excess Fluid Volume
- Activity Intolerance
- Deficient Knowledge related to low-sodium diet
When a patient is diagnosed with heart failure and discharged to go home: When should they contact their doctor or go back to the hospital?
When they have gained more than 3 pounds in a day or if they have difficulty breathing.
Why would you measure and record a patients abdominal girth when they are diagnosed with heart failure?
To monitor for ascites
