Heart Failure Flashcards
- an abnormal clinical syndrome involving impaired cardiac pumping and/or filling.
- characterized by ventricular dysfunction, reduced exercise tolerance, diminished quality of life, and shortened life expectancy.
Heart Failure
Heart Failure
- an abnormal clinical syndrome involving impaired cardiac pumping and/or filling.
- characterized by:
- ventricular dysfunction
- reduced exercise tolerance
- diminished quality of life
- shortened life expectancy.
HF Risk Factors
- Hypertension
- Modifiable risk factor
- Properly treated/managed can decrease incidence by 50%
- Coronary artery disease (CAD)
- Myocardial infarction
- Advancing age
- Diabetes
- Cigarette smoking
- Obesity
- High serum cholesterol
Precipitating Causes for HF?
- Anemia - decreases O2 carrying capacity
- Infection - increases O2 demand
- Hypothyroidism - increases rate of atherosclerosis
- Dysrhythmias - decrease CO, increase workload
- Endocarditis - increase O2 demand, damage vessels
- Pulmonary embolism - increase pressure = pulmonary HTN and decrease CO
- Can be caused by any interference in the normal mechanism regulating CO
Most common form
of HF?
Left-Sided Failure
Effects of Systolic HF?
- Reduced EF
- Inability to pump blood forward
- Decreased LV ejection fraction (EF)
- end result = pulmonary congenstion
Causes of Systolic HF?
- Impaired contractile function
- Increased afterload
- Cardiomyopathy
- Mechanical abnormalities
Effects of Diastolic HF?
- preserved EF
- Impaired ability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume and CO
- Same end result as systolic failure = pulmonary congestion
Causes/Risk factors of Diastolic HF?
- left ventricular hypertrophy from:
- hypertension
- older age
- female gender
- diabetes
- obesity
Seen in disease states such as dilated cardiomyopathy (DCM)
Mixed Heart Failure
- diastolic and systolic
Effects of Mixed HF?
- Poor EFs (<35%)
- High pulmonary pressures
- Biventricular failure
- Both ventricles may be dilated and have poor filling and emptying capacity
Type of HF seen in disease states such as dilated cardiomyopathy (DCM)?
Mixed HF
Right-Sided Heart Failure
- RV fails to pump effectively
- Fluid backs up in venous system
- Fluid moves into tissues and organs
Causes of Right-Sided Heart Failure?
- Left-sided HF is most common cause
- RV infarction
- Pulmonary Embolism
- cor pulmonale (RV dilation and hypertrophy)
Ventricular failure leads to:
- Low blood pressure (BP)
- Low CO
- Poor renal perfusion
- Abrupt or subtle onset
- Compensatory mechanisms mobilized to maintain adequate CO
The main compensatory mechanisms for Heart Failure?
- neurohormonal responses
- renin-angiotensin-aldosterone-system (RAAS)
- SNS
- ventricular dilation
- ventricular hypertrophy (last response)
What are Natriuretic peptides?
- Counterregulatory Mechanisms in HF
- Atrial natriuretic peptide (ANP),
- b-type natriuretic peptide (BNP) release from ventricles
- Released in response to increased blood volume in heart
- Causes: diuresis, vasodilation, and lowered BP
- Counteracts effects of SNS and RAAS
Renal effects of Natriuretic peptides?
- increased glomerular filtration rate and diuresis
- excretion of sodium (natriuresis).
CV effects of Natriuretic peptides?
- vasodilation
- decreased BP.
hormonal effects of Natriuretic peptides?
- inhibition of aldosterone and renin secretion
- interference of ADH release.
Manifestations of Left-Sided HF?
- S3, S4 heart sounds
- Fatigue
- Dyspnea
- Orthopnea
- Dry, hacking cough
- Pulmonary edema
- Nocturia
Manifestations of Right-Sided HF?
- Hepatomegaly
- Splenomegaly
- Congestion of the GI tract
- Jugular vein distention (JVD)
- Peripheral edema
AHA stages of HF?
(A) high risk, no structural heart disease or symptoms
(B) structural heart disease, without S/S
(C) structural heart disease, with S/S
(D) refractory HF requiring specialized interventions
NYHA stages of HF?
I - no limitations of physical activity
II - slight limitation
- comfortable at rest but ordinary PA causes symptoms
III - marked limitations
- comfortable at rest, but less than ordinary PA causes symptoms
IV - unable to cary on any PA without symptoms, or symptoms at rest
Manifestations of Acute decompensated heart failure (ADHF)?
- pulmonary edema, — is an acute, life-threatening situation.
manifestations of HF depend on:
- Age
- type and extent of heart disease.
Common symptoms of Chronic HF?
- fatigue
- cough
- dyspnea
- tachycardia
- edema
- limitations of ADLs
Chronic Heart Failure Manifestations
- Fatigue
- Dyspnea
- Paroyxsmal nocturnal dyspnea
- Tachycardia
- Edema
- Nocturia
- Skin changes
- Behavioral changes
- Chest pain
- Weight changes
Diagnostic Studies for HF?
- H & P
- Chest x-ray
- Electrocardiogram (ECG)
- Stress testing
- Laboratory data
- Echocardiogram
- Cardiac catheterization
Common Labs for HF?
- Cardiac enzymes
- b-type natriuretic peptide [BNP]
- basic metabolic panel, - liver function studies
- complete blood count
BNP normal lab value?
< 100 pg/mL
BNP value indicative of HF?
> 100 pg/mL
Nursing Interventions for HF?
- HIGH FOWLERS POSITION
- Oxygen therapy
- Vital signs and ECG monitoring
- Monitor laboratory
- values (H/H, BNP, MG, K)
- Intake/output
- Daily weights
- Administer medications
- Patient teaching
- Cardiac resynchronization therapy (if uncontrolled Afib occurs)
Psychological Interventions for HF?
Assess and treat
- Depression
- Anxiety
- Social isolation
Drug Therapy: Diuretics
- mobilize fluid,
- reduce pulmonary
- venous pressure
- reduce preload
- risk for electrolyte imbalance
What is the primary drug of choice in chronic HF patients with systolic dysfunction
Angiotensin-converting enzyme (ACE) inhibitors
may be used in patients who are ACE inhibitor intolerant.
Angiotensin II receptor blockers (ARB)
Anticoagulants
are recommended for?
- all patients with EF <20% and /or Afib
Dig toxicity s/s?
Blurred or yellow vision, n/v fatigue
Dietary restriction of sodium, how much?
< 2000 mg
In moderate to severe HF fluid is restricted to>
< 2000 ml daily
Contact primary care provider for a weight gain of?
3 lb over 2 days or 3 to 5 lb over a week
Complication of ADHF and HF?
- Pulmonary edema
- Pleural effusion
- Dysrhythmias -Atrial Fibrillation
- Hepatomegaly
- Renal failure
Treatment for A fib can include:
- Medications
- Long term anticoagulation
- Coumadin (Monitor INR)
- Cardiac resynchronization therapy (CRT)-cardioversion
Promotes thrombus/embolus formation, increasing risk for MI & CVA
Atrial Fibrillation
Treatment of choice for patients with refractory end-stage HF, inoperable CAD, and cardiomyopathy?
Cardiac Transplantation
End of Life supportive therapies?
- Analgesia
- O2
- nutritional support
