Heart Failure

Question 1

Drugs that improve contractility (positive inotropes)

Answer 1

Epi, NorEpi, isoproterenol, dopamine, dobutamine, digitalis-like drugs, calcium, milrinone

Question 2

Drugs that decrease contractility (negative inotropes)

Answer 2

CCBs, B-blockers

Acidosis acts like a negative inotrope

Question 3

Preload

Answer 3

Amount of stretch @ the end of diastole

Question 4

Afterload

Answer 4

The amount of resistance the heart must overcome to open the aortic valve & push the blood volume out into systemic circulation

Question 5

Ejection fraction

Answer 5

The amount of blood pumped by the L ventricle w/each heart beat

Question 6

How is EF calculated?

Answer 6

Subtracting the amount of blood present in L ventricle @ the end of systole from the amount present @ the end of diastole & calculating % of blood that is ejected

Question 7

Difference b/t systolic and diastolic dysfunction

Answer 7

• Systolic dysfunction = L ventricle becomes weak/flabby, not able to contract forcefully/loses ability to eject blood; HF w/reduced EF
• Diastolic dysfunction = L ventricle stiffens/bulks up, can contract, but no relax afterwards —> decreased filling; HF w/preserved EF

Question 8

L-sided HF S/S

Answer 8

• Pulmonary congestion, crackles
• S3 (“ventricular gallop”)
• Dyspnea on exertion
• Low O2 sat
• Dry, nonproductive cough initially
• Oliguria

Question 9

R-sided HF S/S

Answer 9

• Viscera & peripheral congestion
• JVD
• Dependent edema
• Hepatomegaly
• Ascites
• Weight gain

Question 10

S/S of pulmonary edema

Answer 10

Restlessness, anxiety, dyspnea, cool/clammy skin, cyanosis, weak/rapid pulse, cough, lung congestion (moist, noisy respirations), increased sputum (frothy, blood tinged), decreased LOC

Question 11

What can manifest as pulmonary edema?

Answer 11

Acute decompensated HF (ADHF)

Question 12

Pulmonary edema

Management

Answer 12

• Early recognition: monitor lung sounds & for S/S of decreased activity tolerance, increased fluid retention
• Minimize exertion
• Oxygen via nonrebreather
• Meds: furosemide, nitroglycerin

Question 13

Pulmonary edema

Nursing interventions

Answer 13

• Position pt upright w/legs dangling (best position for circulation)
• Monitor response to RX and I&O

Question 14

What is the hallmark sign of systolic failure?

Answer 14

Decreased EF

Question 15

How is diastolic dysfunction confirmed?

Answer 15

Echocardiogram, cardiac cath

Question 16

Causes of R-sided HF

Answer 16

• Primary = L sided HF
• R ventricular infarction
• PE
• Cor pulmonale (RV dilation & hypertrophy S/T pulmonary disease)

Question 17

What kind of dysrhythmias are HF patients @ risk for?

Answer 17

Ventricular dysrhythmias, atrial fib

Question 18

What are the main compensatory mechanisms to maintain adequate CO?

Answer 18

• Neurohormonal: RAAS & SNS
• Ventricular dilation
• Ventricular hypertrophy

Question 19

What affect to catecholamines have on cardiac fxn?

Answer 19

• Increased HR
• Increased myocardial contractility
• Enhanced peripheral vasoconstriction

Question 20

What does ventricular remodeling occur in response to?

Answer 20

Continuous activation of neuro-hormonal responses (RAAS, SNS)

Question 21

What happens in ventricular remodeling?

Answer 21

Ventricles get large, but less effective in pumping

Question 22

Consequences of ventricular remodeling

Answer 22

Life-threatening dysrhythmias, sudden cardiac death

Question 23

Drugs to prevent/reverse remodeling

Answer 23

ACEs, b-blockers, aldosterone antagonists

Question 24

When are ANP and BNP released?

Answer 24

Released from overdistended cardiac chambers in response to increased blood vol in heart

Question 25

What are the effects of ANP and BNP?

Answer 25

- Causes diuresis, vasodilation, and lowered BP | - Counteracts effects of SNS and RAAS in pts w/HF

Question 26

Diagnostic tests for HF

Answer 26

Echocardiogram, ECG, CXR, 6-min walk test, cardiopulmonary exercise stress test, heart cath, endomyocardial biopsy

Question 27

Labs for HF in initial assessment

Answer 27

Lytes, BUN, creatinine, LFTs, TSH, CBC, BNP, routine UA

Question 28

Which lab study is used to determine degree of HF?

Answer 28

BNP

Question 29

Other causes of increased BNP

Answer 29

PE, renal failure, ACS

Question 30

HF medications | ACEs

Answer 30

Vasodilation, diuresis, decreased afterload Monitor for hypotension, hyperkalemia, altered renal function, cough

Question 31

HF medications | ARBs

Answer 31

Alternative to ACE’s (if pt unable to tolerate)

Question 32

HF medications | Hydralazine and isosorbide

Answer 32

Alternatives to ACEs

Question 33

HF medications | B-blockers

Answer 33

RX’d in addition to ACEs May take several weeks for effects to be seen; use w/caution in pts w/asthma

Question 34

HF meds | Diuretics

Answer 34

Decrease fluid vol Monitor lytes

Question 35

HF medications | Digitalis

Answer 35

Improves contractility Monitor for toxicity

Question 36

HF medications | ADHF - IV meds

Answer 36

Milrinone (decreases preload & afterload —> hypotension, increased risk of dysrhythmias) Dobutamine (L ventricular dysfunction, increases contractility & renal perfusion)

Question 37

Gerontological considerations

Answer 37

- May present w/atypical S/S - fatigue, weakness, somnolence - Admin of diuretics to older men —> bladder distention S/T urethral obstruction from enlarged prostate (close monitoring)

Question 38

What are possible complications of HF?

Answer 38

Hypotension, poor perfusion, cardiogenic shock Dysrhythmias Thromboembolism Pericardial effusion and cardiac tamponade

Question 39

Cardinal signs of cardiac tamponade

Answer 39

Falling systolic BP, narrowing pulse pressure, rising venous pressure, distant heart sounds

Question 40

Pericardiotomy

Answer 40

Under general anesthesia, a portion of the pericardium is excised to permit the exudative pericardial fluid to drain into the lymphatic system