Heart Failure Flashcards
L sided HF
Ineffective pumping of L ventricle
Decreased perfusion from poor CO
Pulmonary congestion
Caused by:
- HTN
- MI
- CAD
- Valvular diseases
Systolic HF: failure w/ decreased ejection fraction
Diastolic HF: Preserved L ventricle function but can’t rest during diastole–> can’t fill properly
L sided HF manifestations
Nocturnal dyspnea Elevated pulmonary capillary pressure Cough Crackles Wheezes Bloody spit Tachypnea
Confusion/restlessness
Tachycardia
Exertional dyspnea
Fatigue
Cyanosis
R sided HF (cor pulmonale)
Caused by: L side HF, MI, Pulmonary HTN
RV doesn’t empty completely–> inc. volume and pressure in venous system
Peripheral edema occurs Inc abd girth (Ascites) Dependent edema JVD Hepatosplenomegaly
R sided HF manifestations
Orthopnea (SOB when lying down) Dyspnea tachypnea Cyanosis Cool clammy skin Cough w/ bloody spit Crackles, wheezes, rhonchi Tachycardia
ACCF/AHA stages of HF
A: High risk, but no structural heart disease or symptoms of HF
B: Structural heart disease but no symptoms of HF
C: Structural heart disease with prior or current symptoms of HF
D: Refractory HF requiring specialized interventions
NYHA functional classifications
1: No limitation of physical activity. Activity doesn’t cause HF symptoms
2: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity causes symptoms of HF
3: Limitation of physical activity. Comfortable at rest- light activity causes symptoms
4: Any physical activity causes symptoms, or has HF symptoms at rest.
Specific S&S for HF
Atrial fibrillation:
- excess stress of atria (most common)
- Loss of atrial contraction reduces CO by 10-20%
- Inc. risk of stroke
- Treated w/ cardioversion (resetting heart rhythm), anti-dysrhythmics, anticoagulants
HF complications
MI
Fatal dysrhythmias (Ventricular tachycardia)
Severe hepatomegaly (esp RV failure)
Renal insufficiency
LV thrombus formation=stroke
admin anticoagulants if HF + Afib or ejection fraction under 20%
AHA recommends anticoagulation therapy if
HF + afib present
or
EF under 20%
Goals for chronic HF with reduced EF
Symptom management
QOL considerations
Minimize side effects
Monitor response to treatments
CRT (bi-valve pacemaker)
ICD (implanted defibrillator)
Goals for chronic HF with preserved EF
symptom management, treat underlying conditions
Stage D HF non–pharmaceutical interventions
Intra-aortic balloon pump (IABP) for MI
Ventricular assist devices (VAD)
Cardiac resynchronization therapy (CRT) or bi-ventricular pacing
Cardiac transplantation: BEST ROUTE but hard to find
Core measures of HF
- Written discharge instructions:
- Activity
- Diet
- Meds
- Follow up appt
- Recording daily weight
- Symptom management
2: LV function documented before, during, and after discharge
3: If EF under 40% then ACE inhibitors
4. Smoking cessation
Labs to take for HF pt
BNP: under 100ng/L
Electrolytes
BUN
UA
CXR for enlarged heart
Echocardiogram to determine EF%
EKG
Meds to reduce afterload
ACE inhibitors and ARBs
Meds to reduce preload
Diuretics and venous dilators
Loop diuretics (furosemide) Potassium sparing (spironalactone) Venous dilators (Mrophine, nitroglycerine)
Meds to increase contractility (inotropic)
Digoxin (decrease HR and inc. contractility)
Nesiritide, beta blockers
Ventricular assist device functions
Functions as the LV, RV, or both
can be short or long term
Daily weight considerations for HF
1L of fluid =1kg
gain of 3lb over 2 days
or
3-5lb over a week
REPORT TO PROVIDER
Sodium for HF
restricted to under 2.5g/day
