Heart Failure Flashcards

Question

Right-sided heart failure presents with _____________ SIGNS AND SYMPTOMS.

Answer 1

PERIPHERAL

Answer 2

Difficulty breathing Rales (crackles) Orthopnea (cannot tolerate lying down…must sit-up to breath, especially while sleeping) Weakness (extremely tired and fatigued due to shortness of breath and heart can’t compensate for increased activity) Nocturnal Paroxysmal dyspnea (awaking during sleep with extreme dyspnea) Increased heart rate (due to fluid overload and the heart is trying to get the blood to organs but it can’t because of muscle failure) Nagging cough (can be frothy or blood-tinged sputum from fluid overload in the lungs…very bad sign) Gaining weight from the body retaining fluid…2 to 3 lb in a day or 5 lbs in a week

Answer 3

Swelling of legs, hands, liver, abdomen Weight gain Edema (pitting) Large neck veins (jugular venous distention) Lethargic (weak and very tired) Irregular heart rate (atrial fibrillation) Nocturia (frequent urination at night) lying down elevates the legs and allows the extra fluid to enter into the vascular system which allows the kidneys to eliminate the extra fluid. Girth of abdomen increased (from swelling of the liver and building up fluid in the abdomen)…can’t breathe well and this causes nausea and anorexia.

Answer 4

BNP Chest X-ray Echocardiogram Heart Cath Nuclear Stress Test

Answer 5

(b-type natriuretic peptide) blood test: a biomarker released by the ventricles when there is excessive pressure in the heart due to heart failure. ``` <100 pg/mL no failure 100-300 pg/mL present 300 pg/mL mild 600 pg/mL moderate 900 pg/mL severe ```

Answer 6

NO FAILURE

Answer 7

high salt intake or fluids infection uncontrolled atrial fibrillation Renal failure

Answer 8

Assess patient for worsening symptoms (right-sided failure…peripheral swelling vs left-sided failure…pulmonary edema) Patient responsiveness to medication treatment: watch heart rate (Digoxin) respiratory status blood pressure (vasodilators cause hypotension) diuretics (strict intake and output, daily weights, monitor electrolyte levels, especially K+)

Answer 9

Fluid status (may be ordered a Foley catheter, if on diuretics) Cardiac diet (low in salt and fats) Fluid restriction (no more than 2 L per day) Lab values: watching BNP, kidney function BUN & creatinine, troponins levels, electrolytes (especially potassium…if on Lasix: waste potassium and low potassium increases risk of digoxin toxicity) Edema in leg: Keep legs elevated and patient in high Fowler’s to help with breathing Safety (at risk for falls due to fluid status changes, swelling in legs and feet, and orthostatic hypotension)

Answer 10

High Fowlers with legs elevated to help with breathing and edema

Answer 11

No more than 2 L per day

Answer 12

Early signs and symptoms heart failure exacerbation Shortness of breath Weight gain Orthopnea Low salt (allowed 2-3 G sodium per day) and fluid restriction (no more than 2 L per day) Vaccination to prevent illness, such as annual flu and to be up-to-date with pneumonia vaccine Exercise aerobic (as tolerated) Daily weights (watch for no more than 2-3 lb per day and 5 lbs per week) Compliance with medications Smoking cessation Limiting alcohol

Answer 13

watch for no more than 2-3 lb per day and 5 lbs per week)

Answer 14

Shortness of breath Weight gain Orthopnea

Answer 15

ACE inhibitors ARBS Diuretics Beta Blockers Anticoagulants Vasodilators Digoxin

Answer 16

first line of treatment for heart failure with beta blockers end in “pril” Lisinopril, Ramipril, Enalapril, Captopril works by allowing more blood to get to the heart muscle which allows it to work easier. Also, blocks the conversion of Angiotensin I or Angiotensin II (this causes vasodilation, lowers blood pressure, allows kidneys to secrete sodium because it decreases aldosterone) side effects: dry, nagging cough and can increase potassium (inhibiting angiotensin II which decreases aldosterone in the body which causes the body to retain more potassium and excrete sodium)

Answer 17

end in “sartan” like Losartan, Valsartan used in place of ACE inhibitors if patient can’t tolerate them blocks angiotensin II receptors which causes vasodilation. This lowers blood pressure and helps the kidneys to excrete sodium and water (due to the affects that blocking angiotensin II has on the kidneys…decreases aldosterone). side effects: increases potassium levels….NO dry nagging cough

Answer 18

used along with ACE inhibitors or ARBs to decrease water and sodium retention which will decrease edema in the body and lungs. This allows the heart to pump easier. Patients will urinate a lot! Loop diuretics (most common) like Lasix or Furosemide (watch potassium level because they will waste potassium) Potassium-sparing diuretics like “Aldactone” (can cause hyperkalemia, especially if taking with ACE or ARBs)

Answer 19

blocks norepinephrine and epinephrine effects on the heart muscle given in stable heart failure with ACE inhibitors end in “lol” like Metoprolol, Carvedilol and Bisoprolol not for acute heart failure because the negative inotropic effect on the heart. The negative inotropic effect causes decrease myocardial contractility (slows heart) and decreases cardiac work load. used in stable heart failure in people with ventricular systolic dysfunction (there is a contraction problem with the left ventricle) and to treat diastolic heart failure (remember there is a problem with the heart filling in diastolic dysfunction). It will help the heart rest so the stiff ventricle can fill properly and the volume of blood pumped out increases. side effects: check pulse (bradycardia), no grape juice; mask hypoglycemic signs in diabetics, respiratory issues in asthmatics and patients with COPD

Answer 20

not used in all patients with heart failure Typically, used in patients with heart failure who are in a-fib because they are at risk for blood clot formation or certain scenarios of left ventricular systolic heart failure when there is a low ejection fraction of <35%.

Answer 21

(arterial dilator) Hydralazine…prescribed with a nitrate like Isordil (venous dilator) sometimes used in place of an ACE or ARB, if patient can’t tolerate them this causes vasodilation in the arteries and veins to help decrease the amount of blood and fluid going back which helps decrease the work load on the heart side effects: low blood pressure, orthostatic hypotension

Answer 22

Positive inotropic effect that increases the heart’s ability to contract stronger and it has a negative chronotropic action that causes the heart to beat slower So, the heart slows down and contracts stronger which allows the heart to pump more blood. treatment for patients with left ventricular systolic dysfunction (however, not usually the first line of treatment due to side effects and toxicity risks)…used alongside ACE/beta blockers, and diuretics toxicity issues: monitor patient potassium level (hypokalemia <3.5 mEq/L) because hypokalemia increases digoxin toxicity S & S of toxicity: nausea, vomiting, visual changes yellowish green halos normal Digoxin range 0.5 to 2 ng/mL not for patients with a second or third degree heart block check apical pulse before giving….>60 bpm antidote: Digibind

Answer 23

nausea, vomiting, diarrhea, weakness, fatigue, anorexia, visual disturbances - blurry vision, photophobia