Heart failure long answer Q's

Question 1

Definition of CHF

Answer 1

Heart is unable to pump forcefully/fast enough to empty its chambers, resulting in back up of blood into the systemic and/or pulmonary circuit.

In heart failure, cardiac reserve is used at rest.

Question 2

Causes of HF

Answer 2

-	Increased Pre-load (volume): 
     o	Disorders that require ventricles to expel more blood per minute e.g.
     o	Thyrotoxixosis
     o	Anaemia
     o	Mitral or Aortic 
        regurgitation
-Increased Afterload 
    (Pressure)
     o	Disorders that increase 
    resistance to outflow from 
     ventricles
     o	Systemic HTN
     o	Aortic Stenosis
-Weakened Myocardial Contractility 
     o	MI

Question 3

LVF Pathophysiology

Answer 3

“Left ventricle is damaged (Via MI or chronic HTN)
“Right side of heart continues to function normally
“Left side too weak/stretched to pump blood out of ventricles into body
“Blood backs up into Left atrium and pulmonary veins
“ Pulmonary Vessel pressure
“Serum forced out of pulmonary capillaries into alveoli
“Serum mixes with air, creating foam in lungs
“Oxygenation, causing SOB and Orthopnoea
“RR to compensate
“Fluid leaks from bronchioles into interstitial space of lungs, Interstitial pressure
“Interstitial pressure causes bronchioconstriction
“Air passing through narrowed bronchioles causes wheeze
“Air bubbling through fluid-filled alveoli causes crackles/pulmonary oedema
“Narrowed airways and heavy fluid-filled lungs cause WOB,
“WOB puts greater strain on heart
“Dyspnoea and Hypoxia cause panic,
“Panic stimulates sympathetic NS:
o Releases Adrenaline - HR and contractility, working heart harder and O2 demand
o Causes peripheral vasoconstriction:
“Increases afterload
“Weakened heart struggles to push blood through smaller vessels
“Presents as pallor, BP, pale, cold diaphoretic skin
“Hypoxia causes pt to become agitated, confused or disorientated, and ultimately if untreated causes cardiac arrest.

Question 4

RVF Definition

Answer 4

Impairs ability to move deoxygenated blood from systemic circulation to pulmonary circulation

Question 5

RVF Causes

Answer 5

oConditions limiting blood flow into lungs or compromising pumping effectiveness of right ventricle:
      "	LVF
      "	Pulmonary hypertension:
              "	Due to:
              "	Chronic pulmonary 
                disease
              "	Severe pneumonia
              "	PE
              "	Aortic/mitral stenosis
oTricuspid/pulmonic regurgitation/stenosis
oRight ventricular infarction
oCardiomyopathy
oCongential defects

Question 6

RVF Pathophysiology

Answer 6

"Blood -> pulmonary circulation -> L heart
" - CO
"Back-up into venous system
"+ Venous pressure
     o	Blood backs up to 
        hepatic veins = 
        hepatomegaly, rq pain
    o	Severe cases - hepatic 
       cells die   Liver function
     o	Congested portal 
      system splenomegaly & 
       ascites
     o	 JVP on standing
"+RA pressure
"+RV end-diastolic pressure
"Poor circulation - Peripheral 
  oedema
"Congested GI tract 
"-nutrient absorption
"-Anorexia and GI pain

Question 7

CHF signs and symptoms

Answer 7

Breathing:
    o	SOB/DIB on exertion
    o	Orthopnoea
    o	Paroxysmal nocturnal 
        dyspnoea
    o	Cheyne-stokes
    o	Pulmonary Oedema (LV)
    o	Crackles/wheezes o/a
    o	Cyanosis
    o	Frothy, pink sputum
Circulation
    o	 HR
    o	HTN/hypoTN
    o	Pale
    o	Diaphoresis
    o	Cold
    o	Pedal/presacral oedema
    o	Distended neck veins
    o	S3 gallop O/a
    o	AF/VT/VF
Neuro
    o	Fatigue
    o	Confusion
    o	Anxiety
    o	Restlessness
    o	Insomnia
    o	Dizziness
GI/GU
    o	Oliguria
    o	Nocturia ( kidney 
       perfusion when supine)
     o	Ascites (RV)
    o	Malnutrition/wasting

Question 8

Acute management of HF

Answer 8

ABC, time critical = transfer immediately

If pt SOB/Noisy/Tripoding/ sats - Sit up & O¬2

If pulmonary congestion, normal temp, not dehydrated 
    o	GTN - sublingual tablet (2/3/5mg) /spray
    o	Furosemide - 40mg IV 
        over 2 min, anuria 
        contraindicated, when 
        transfer prolonged 
    o	CPAP
If wheezy, 5mg/2.5 ml neb SBL

Extreme caution with fluids

Only give morphine with ACS