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CSB335 > Heart failure > Flashcards

Heart failure Flashcards

1
Q

What is the definition of heart failure?

A

Inability of the heart to pump blood out as rapidly as it enters and congestion of pulmonary or systemic circulation (often referred to as congestive heart failure) leading to reduced output to body tissues

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2
Q

What are the causes of CHF?

A
  • Diffuse coronary artery disease (myocardial ischemia)
  • Myocardial infarction
  • Arrhythmias (tachycardia/bradycardia)
  • Valvular heart disease
  • Acute hypertensive crisis
  • Chronic hypertension
  • Idiopathic causes
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3
Q

True or false: CHF may develop acutely or be a chronic disease

A

True

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4
Q

What should be suspected in acute onset CHF?

A

AMI, dysrhythmia, and hypertensive crisis

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5
Q

What can cause chronic CHF to worsen acutely?

A
  • Respiratory infection
  • Pulmonary embolism
  • Emotional stress
  • Increased salt and water intake
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6
Q

What are the subtypes of CHF?

A

Left sided, right sided, and biventricular

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7
Q

Describe LHF

A

Left ventricle fails as effective pump -> LV cannot eject blood delivered from right heart through pulmonary circulation -> blood backs up into pulmonary circulation -> increased pressure in pulmonary capillaries forces blood serum out of capillaries into interstitial spaces and alveoli -> increased respiratory work and decreased
gas exchange occur

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8
Q

What are the common causes of LHF?

A
  • AMI
  • Chronic hypertension
  • Dysrhythmias
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9
Q

What is cardiac remodelling?

A

Increased muscle mass without the blood flow to continue tissue oxygenation

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10
Q

Is cardiac remodelling reversible?

A

No

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11
Q

What are the signs/symptoms of LHF?

A 
Dyspnea on exertion 
Paroxysmal nocturnal dyspnoea 
Orthopnea 
Fatigue, generalized weakness 
Anxiety, confusion, restlessness 
Persistent cough 
Pink, frothy sputum 
Tachycardia 
Tachypnea 
Noisy, labored breathing 
Rales/wheezing ("cardiac asthma") 
Cyanosis (late) 
Third heart sound
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12
Q

Describe RHF

A

Right ventricle fails as effective pump -> RV cannot eject blood returning through vena cavae -> blood backs up into systemic circulation -> increased pressure in systemic capillaries forces fluid out of capillaries into interstitial spaces -> tissue oedema occurs

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13
Q

What is the most common cause of RHF?

A

LHF

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14
Q

What are other causes of RHF?

A
  • Chronic hypertension
  • COPD
  • Pulmonary embolism
  • RV MI
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15
Q

What are the signs/symptoms of RHF?

A
  • Tachycardia
  • JVD
  • Pedal, pre-tibial, sacral oedema
  • Hepatomegaly
  • Splenomegaly
  • Generalised oedema
  • Fluid accumulation in body cavities (ascites, pleural effusion, pericardial effusion)
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16
Q

What is the classic triad of RHF?

A

JVD, hypotension, and clear lungs.

17
Q

What is the definition of APO?

A

Rapid buildup of fluid in the alveoli and lung interstitium that has extravasated out of the pulmonary circulation. As the fluid accumulates it impairs gas exchange and decreases lung compliance, producing dyspnoea and hypoxia.

18
Q

What are the two primary causes/categories of APO?

A

Cardiogenic and non-cardiogenic

19
Q

What are the management goals for APO?

A

Improve oxygenation and ventilation
Decrease venous return to heart
Decrease cardiac work and 02 demand
Improve cardiac output by reducing afterload and increasing myocardial contractility

20
Q

Describe the management of APO

A
  • Sit pt up, dangle feet (do not lay flat)
  • Initially use a NRB mask
  • Consider positive pressure ventilation
  • CPAP (continuous positive pressure ventilation)
  • Monitor 12 lead ECG
  • Limit fluids unless RVF only (to increase preload)
  • GTN (caution in RVF)
  • Bronchodilators if indicated
21
Q

What is the definition of cardiogenic shock?

A

Diminished cardiac output leading to impaired tissue perfusion; the most extreme form of pump failure

22
Q

What are the signs/symptoms of cardiogenic shock?

A

Confusion/restlessness/anxiety/stupor/coma
Cool and clammy skin
Pallor
Weak/absent extremity pulses
Tachycardia
Slow/absent capillary refill
BP <90 systolic or more than 30mmHg below normal

23
Q

What can make cardiogenic shock difficult to assess?

A

Arrhythmias, hypovolaemia, decreased vascular tone

24
Q

What are the treatment priorities in cardiogenic shock?

A
  • Rate
  • Rhythm
  • BP
25
Q

What are the goals of cardiogenic shock mx?

A

Improve oxygenation and peripheral perfusion, and avoid increasing cardiac workload (myocardial oxygen demand)

26
Q

Describe the mx of cardiogenic shock

A

Keep patient supine unless dyspnoeic (do not elevate lower extremities)
Oxygenate via NRB
Consider assisting ventilations (decrease work of breathing may benefit patients in shock)
Awareness of imminent arrest - CCP back up for intubation and cardiac control
Monitor ECG
Limit fluids unless suspecting RVF

CSB335 (12 decks)

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