Heart Failure

Question 1

L sided HF

Answer 1

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

Question 2

L sided HF manifestations

Answer 2

Nocturnal dyspnea
Elevated pulmonary capillary pressure
Cough
Crackles
Wheezes
Bloody spit
Tachypnea

Confusion/restlessness

Tachycardia

Exertional dyspnea

Fatigue

Cyanosis

Question 3

R sided HF (cor pulmonale)

Answer 3

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

Question 4

R sided HF manifestations

Answer 4

Orthopnea (SOB when lying down)
Dyspnea
tachypnea
Cyanosis
Cool clammy skin
Cough w/ bloody spit
Crackles, wheezes, rhonchi
Tachycardia

Question 5

ACCF/AHA stages of HF

Answer 5

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

Question 6

NYHA functional classifications

Answer 6

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.

Question 7

Specific S&S for HF

Answer 7

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

Question 8

HF complications

Answer 8

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%

Question 9

AHA recommends anticoagulation therapy if

Answer 9

HF + afib present

or

EF under 20%

Question 10

Goals for chronic HF with reduced EF

Answer 10

Symptom management

QOL considerations

Minimize side effects

Monitor response to treatments

CRT (bi-valve pacemaker)
ICD (implanted defibrillator)

Question 11

Goals for chronic HF with preserved EF

Answer 11

symptom management, treat underlying conditions

Question 12

Stage D HF non–pharmaceutical interventions

Answer 12

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

Question 13

Core measures of HF

Answer 13

1. 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

Question 14

Labs to take for HF pt

Answer 14

BNP: under 100ng/L

Electrolytes

BUN

UA

CXR for enlarged heart

Echocardiogram to determine EF%

EKG

Question 15

Meds to reduce afterload

Answer 15

ACE inhibitors and ARBs

Question 16

Meds to reduce preload

Answer 16

Diuretics and venous dilators

Loop diuretics (furosemide)
Potassium sparing (spironalactone)
Venous dilators (Mrophine, nitroglycerine)

Question 17

Meds to increase contractility (inotropic)

Answer 17

Digoxin (decrease HR and inc. contractility)

Nesiritide, beta blockers

Question 18

Ventricular assist device functions

Answer 18

Functions as the LV, RV, or both

can be short or long term

Question 19

Daily weight considerations for HF

Answer 19

1L of fluid =1kg

gain of 3lb over 2 days

or

3-5lb over a week

REPORT TO PROVIDER

Question 20

Sodium for HF

Answer 20

restricted to under 2.5g/day