Heart Failure Flashcards
Patients who have heart failure have a heart muscle that is unable to _______________- and this can lead to mild/severe complications.
pump efficiently
Main problem with heart failure
the heart cannot pump effectively and efficiently which can lead to a decline in cardiac output and subsequently affect tissue perfusion
Definition of heart failure
the heart is too weak to pump efficiently so it can’t provide proper cardiac output to maintain the body’s metabolic needs.
Results of heart failure on the body
Organs and tissues will suffer from the decreased blood flow, pressure in the heart increases which over works the ventricles, body can become congested with fluids (enter into congestive heart failure) that can cause life-threatening complications.
Causes of heart failure are mainly due to the heart muscle (specifically the ventricles) becoming _______________-
damaged or too stiff.
Causes of heart failure Mnemonic: FAILURE
Faulty heart valves: AV and SL valve problems (due to congenital issues or infection (endocarditis) that causes blood to back flow (regurgitation) or stenosis (narrowing of the valves that increases pressure of blood flow through the valves). This causes the heart to work harder and become weak over time.
Arrhythmias: atrial fibrillation or tachycardia
Infarction (myocardial)…coronary artery disease: part of the heart muscle dies due to a blockage in the coronary arteries…muscle become ischemic and can die (main cause of left ventricular systolic dysfunction)
Lineage (congenital)…family history
Uncontrolled Hypertension: overtime this can lead to stiffening of the heart walls because with untreated HTN the heart has to work harder and this causes the ventricles to become stiff.
Recreational Drug Use (cocaine) or alcohol abuse
Envaders (instead of Invaders): viruses or infections that attack the heart muscle
Causes of heart failure Mnemonic: FAILURE
What is the F
Faulty heart valves that contribute to increased workload of the heart and become weak over time
Causes of heart failure Mnemonic: FAILURE
What is the A ?
Arrhythmias: atrial fibrillation or tachycardia
Causes of heart failure Mnemonic: FAILURE
What is the I?
Infarction (myocardial)…coronary artery disease: part of the heart muscle dies due to a blockage in the coronary arteries…muscle become ischemic and can die (main cause of left ventricular systolic dysfunction)
Causes of heart failure Mnemonic: FAILURE
What is the L?
Lineage (family history)
Causes of heart failure Mnemonic: FAILURE
What is the U? and what can happen over time with this ?
Uncontrolled Hypertension: overtime this can lead to stiffening of the heart walls because with untreated HTN the heart has to work harder and this causes the ventricles to become stiff.
Causes of heart failure Mnemonic: FAILURE
What is the R?
Recreational Drug Use cocaine or alcohol abuse
Causes of heart failure Mnemonic: FAILURE
What is the E?
Envaders (instead of Invaders): viruses or infections that attack the heart muscle
In this type of heart failure, the ________ side of the heart cannot pump blood out of the heart efficiently so blood starts to back up in the lungs
Left sided heart failure
Most common type of heart failure.
Left-sided heart failure is likely to lead to right-sided heart failure.
Left-sided heart failure is likely to lead to _________________________ failure
right sided heart
In left sided heart failure, The left ventricle becomes too weak and doesn’t squeeze blood out properly….the heart failure can be either ______________ or ______________.
SYSTOLIC OR DIASTOLIC
What is left sided systolic heart failure ?
“Left ventricular systolic dysfunction” remember systolic is the contraction or “squeezing” phase of the heart. In systolic dysfunction, there is an issue with the left ventricle being able to eject blood properly out of the ventricle and the organs can’t get all that rich-oxygenated blood it just received from the lungs. Patients will have a low ejection fraction.
What is ejection fraction ?
Ejection fraction is a calculation used to determine the severity of heart failure on the left side. A normal EF is 50% or greater meaning that more than half of the blood that fills inside the ventricles is being pumped out. An EF can be measured with an echocardiogram, heart cath, nuclear stress test. An EF of 40% or less is a diagnosis for heart failure.
Ejection fraction diagnosis criteria for heart failure
40% or less
What is “left ventricular diastolic dysfunction” heart failure ?
In diastolic dysfunction, the ventricle is too stiff to allow for normal filling of blood. Since there isn’t an issue with contraction but filling the ejection fraction is usually normal.
Left-sided heart failure will present with _______________-Signs and Symptoms.
PULMONARY
What is right sided heart failure ?
the right side of the heart cannot pump the “used” blood it received from the body efficiently so it can’t get the blood back to the lungs to get replenished with oxygen. The causes the blood to back up peripherally (legs, hands, feet, abdomen).
Right-sided heart failure causes _____________ of blood in the heart and this increases the pressure in the inferior vena cava (which normally brings “used” blood back to the heart for re-oxygenation). This built-up pressure causes the _______________ veins to become very congested with blood which leads to _______________and swelling peripherally.
congestion; hepatic; hepatomegaly
Right-sided heart failure is usually caused from ________________ failure because of the increased fluid pressure backing up from the left side to the right.
What are some other causes of right sided heart failure ?
left-sided heart failure
This causes the right side of the heart to become overworked.
pulmonary heart disease “cor pulmonale” as a complication from pulmonary hypertension or COPD.
Right-sided heart failure presents with _____________ SIGNS AND SYMPTOMS.
PERIPHERAL
Left sided heart failure signs & symptoms Mnemonic
DROWNING (these patients are literally drowning in their own fluid from the heart’s failure to pump efficiently)
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
Right-Sided Heart Failure:
Remember the mnemonic SWELLING (fluid is backing up in the right side of the heart which causes fluid to back-up in the hepatic veins and peripheral veins)
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.
Tests used to diagnose Heart Failure
BNP
Chest X-ray
Echocardiogram
Heart Cath
Nuclear Stress Test
What is BNP and what is its importance in heart failure ?
What are the different levels associated with the degree of heart failure ?
(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
BNP of >900 would be classified as __________ heart failure
severe
BNP of 400 would be classified as _______ heart failure
mild
BNP of < 100 would be classified as ______ heart failure
NO FAILURE
Heart failure can be acute or chronic and can be triggered/exacerbated with:
high salt intake or fluids
infection
uncontrolled atrial fibrillation
Renal failure
Nursing Interventions for Heart Failure
Assessing, Monitoring, intervening and Educating
What does Assessing entail ?
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+)
Nursing Interventions for Heart Failure
Assessing, Monitoring, intervening and Educating
What does Monitoring Entail ?
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)
What position should we place heart failure clients in ?
High Fowlers with legs elevated to help with breathing and edema
Fluid restriction for heart failure patients
No more than 2 L per day
Educating the heart failure patient entails ………….
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
daily weight for heart failure patients - what weight gains should we watch out for ?
watch for no more than 2-3 lb per day and 5 lbs per week)
Early signs & symptoms of heart failure exacerbation
Shortness of breath
Weight gain
Orthopnea
What are the groups of drugs that heart failure patients use?
Use mnemonic
Always Administers Drugs Before A Ventricle Dies
ACE inhibitors
ARBS
Diuretics
Beta Blockers
Anticoagulants
Vasodilators
Digoxin
ACE inhibitors & heart failure
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)
ARBS and heart failure
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
Diuretics and Heart Failure
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)
Beta Blockers & Heart Failure
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
Anticoagulants & heart failure
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%.
Vasodilators and Heart Failure
(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
Digoxin and heart failure
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
antidote for Digoxin
Digibind
S/s of Digoxin toxicity
nausea, vomiting, diarrhea, weakness, fatigue, anorexia, visual disturbances - blurry vision, photophobia
