Heart Failure

Question 1

Heart Failure

Answer 1

inability of heart to produce an adequate CO

• CO = SV x HR
• common in over 65 yrs

Question 2

Heart Failure Primary Risk Factors

Answer 2

• CAD
• HTN
• heart disease/defects

Question 3

Contributing Risk Factors

Answer 3

• anemia
• tobacco use
• infection
• dysrhythmias
• diabetes
• obesity

Question 4

Left Sided HF

Answer 4

• pulmonary congestion

- edema

Question 5

Right Sided HF

Answer 5

• jugular venous distention
• hepato/splenomegaly
• ascites
• peripheral edema

Question 6

Systolic HF

Answer 6

decrease in the left ventricular ejection fraction (EF)

-caused by: MI, increased afterload, cardiomyopathy, abnormalities

Question 7

Diastolic HF

Answer 7

• pulmonary problems

- hypertrophy, stenosis, cardiomyopathy

Question 8

Mixed Systolic & Diastolic HF

Answer 8

• DCM, poor ECF, high pulmonary pressures
• biventricular failure
• SNS activation & release of E & NE

Question 9

Counter Regulatory Process

Answer 9

Natriuretic peptides: atrial natriuretic peptide (ANP) and b-type natriuretic peptide (BNP)

Question 10

Clinical Manifestations: Chronic Heart Failure

Answer 10

• fatigue
• limited activity
• chest congestion & cough
• edema
• shortness of breath

Question 11

Diagnostic Studies

Answer 11

• history & physical exam
• chest xray
• ECG
• EF
• stages & classes

Question 12

ACCF/AHA Stages of HF

Answer 12

A: high risk without structural heart disease or symptoms of HF
B: structural heart disease, without sign or symptoms
C: structural heart disease with prior or current symptoms of HF
D: refractory HF

Question 13

NYHA Function Class

Answer 13

I/II: no limitations
III: slight limitation
IV: unable to do physical activity

Question 14

HF Complications

Answer 14

• pleural effusion
• pulmonary edema
• atrial fib
• loss atrial contraction
• high risk of fatal dysrhythmias

Question 15

HF Meds

Answer 15

• same as HTN
• vasodilators: nitrates, hydralazine, & nitroprusside
• anticoagulants
• positive inotropes: dobutamine, digoxin, milrinone

Question 16

Decrease intravascular volume

Answer 16

• Reduces venous return and preload
• Loop diuretics (e.g., furosemide)
• Ultrafiltration or aquapheresis

Question 17

Decrease Venous Return (preload)

Answer 17

• Reduces the amount of volume returned to the LV during diastole
• High-Fowler’s position
• IV nitroglycerin

Question 18

Decrease Afterload

Answer 18

• Improves CO and decreases pulmonary congestion
• IV sodium nitroprusside (Nipride)
• Morphine sulfate
• Nesiritide (Natrecor)

Question 19

Acute Decompensated HF

Answer 19

pulmonary edema

• early: increase in RR & decrease in PaO2
• late: tachypnea, respiratory acidemia

Question 20

Overall goals of therapy for ADHF and chronic HF

Answer 20

• Decrease patient symptoms
• Improve LV function
• Reverse ventricular remodeling
• Improve quality of life
• Decrease mortality and morbidity

Question 21

Improve gas exchange and oxygenation

Answer 21

• Supplemental oxygen •Morphine sulfate

* Noninvasive ventilatory support (BiPAP)

Question 22

Improve Cardia Function

Answer 22

For patients who do not respond to conventional pharmacotherapy •Inotropic therapy
•Digitalis
•B-Adrenergic agonists (e.g., dopamine)
•Phosphodiesterase inhibitors (e.g., milrinone) •Hemodynamic monitoring