heart failure Flashcards
goals of pharmacologic therapy for patients with acute and chronic heart failure?
The goals of pharmacologic therapy for patients with acute and chronic heart failure include preload/afterload reduction, inhibiting neurohormonal activation, and improving LVEF.
Preload and afterload reduction is accomplished through use of diuretics, vasodilators, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or combination ACEI/ARB therapy.
Neurohormonal activation inhibition through the use of ACEI/ARBs, beta-blockers, and aldosterone agonists show long-term survival benefits.
risk factors for developing heart failure include
FAILURE: Faulty heart valves (eg mitral stenosis) Arrhythmias Infarction Lineage Uncontrolled hypertension Recreational drug usage Evaders (Option E with influenza)
Right sided heart failure vs Left sided heart failure
Left-sided systolic dysfunction is where the left side of the heart is unable to CONTRACT efficiently which causes blood to back-up into the lungs…leading to pulmonary edema.
Signs and symptoms: dyspnea, orthopnea, paroxysmal nocturnal dyspnea, weight gain, persistent cough, crackles
Right sided heart failure can build up pressure in the hepatic veins and cause them to become congested with fluid which leads to peripheral edema
Left-sided heart failure can lead to right-sided heart failure, if left untreated.
Normal EF?
normal EF is >60% in a healthy heart.
left-sided DIASTOLIC dysfunction heart failure ?
the issue is with the ability of the ventricle to FILL properly…therefore a patient usually has a normal ejection fraction
BNP?
BNP (b-type natriuretic peptide) is a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure.
<100 no failure, 100-300 present, >300 pg/mL mild, >600 pg/mL >moderate, 900 pg/mL severe
Diagnosing heart failure?
Echocardiogram
Brain natriuretic peptide blood test
Nuclear stress test
Left ventricular diastolic dysfunction
The ventricle is unable to properly fill with blood because it is too stiff. Therefore, blood backs up into the lungs causing the patient to experience shortness of breath.
Dietary restrictions in heart failure
Patients with heart failure should limit sodium intake to 2 to 3 grams per day, avoid canned vegetable/fish, and avoid sandwich meats and cheeses because of their high sodium content. Frozen meals are high in sodium, therefore the patient is correct in saying they should limit their consumption of them.
What can exacerbate heart failure
Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias.
Exercise or no exercise in heart failure?
exercise is important for heart failure patients to help strengthen the heart muscle
Weight gain in heart failure?
heart failure patients should notify their doctor if they gain 2-3 pounds in a day or 5 pounds in a week
Early vs late signs of heart failure
Shortness of breath, orthopnea, and edema are EARLY signs and symptoms. Frothy-blood tinged sputum is a late sign.
ACE inhibitors
These drugs are used as first-line treatment of heart failure. They work by allowing more blood to flow to the heart which decreases the work load of the heart and allows the kidneys to secrete sodium. However, some patients can develop a nagging cough with these types of drugs.
EKG changes that presents with tall peaked T-waves and flat p-waves
Losartan and Spironolactone can both cause an increased potassium level (hyperkalemia). Losartan is an ARB and Spironolactone is a potassium-sparing diuretic. Therefore, the EKG changes are a sign of a high potassium level (normal potassium level is 3.5-5.1).
