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NURS 2245 Cardiac > Heart Failure PP > Flashcards

Heart Failure PP Flashcards

1
Q

1 cause of heart failure…

A

Systemic HTN

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2
Q

Causes of HF

A

Systemic HTN
MI
Valve disease
Diabetes

Others
Dysrhythmias
Obesity, Lung Disease, Sleep disorder (breathing)
CKD
Anemia, Hyperthyroidism, Infection, Drugs

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3
Q

The Frank-Starling Mechanism

Heart adjusts its force of contraction based on the amount of blood filling the ventricles (preload).

Maybe impaired by these problems (2)

A

Dilated cardiomyopathy or severe heart failure, where excessive stretch weakens the heart’s ability to pump effectively.

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4
Q

Increased preload & Cardiac output Leads to increased HR & BP / Increased Cardiac workload

Leads to…

A

LV dysfunction

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5
Q

Management of HF

MEDS

A

ACE inhibitors
ARBs
beta-blockers
aldosterone antagonists

interventions like device therapy or surgery, aim to slow or reverse these changes.

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6
Q

Description: Enlargement of the ventricular chambers due to increased volume or pressure.

Causes: Chronic volume overload (e.g., valve regurgitation) or heart failure.
Effects:

Initially helps maintain cardiac output.

Over time, leads to reduced contractility and heart failure.

A

Ventricular Dilation

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7
Q

Description: Thickening of the heart muscle (myocardium) in response to increased workload.

Types:
Concentric Hypertrophy: Due to pressure overload (e.g., hypertension).
Eccentric Hypertrophy: Due to volume overload (e.g., valve regurgitation).

Effects:
Can initially improve heart function.

May lead to stiff ventricles, diastolic dysfunction, and increased oxygen demand

A

Muscular Hypertrophy

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8
Q

Signs of HF (4)

A

Ventricular dilation
Muscle Hypertrophy
Apoptosis
Fibrosis

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9
Q

Ischemic heart disease (e.g., myocardial infarction).

Chronic hypertension leading to left ventricular hypertrophy.

Dilated cardiomyopathy.

Valvular diseases (e.g., aortic stenosis).
Arrhythmias.

Causes Low output or High output HF

A

Low output

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10
Q

Ischemic heart disease (e.g., myocardial infarction).

Chronic hypertension leading to left ventricular hypertrophy.

Dilated cardiomyopathy.

Valvular diseases (e.g., aortic stenosis).
Arrhythmias.

Leads to Low or High Output HF

A

Low output HF

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11
Q

Symptoms

Fatigue, weakness.

Cool extremities (due to poor perfusion).

Pulmonary congestion (e.g., dyspnea, orthopnea).

Peripheral edema.

Low or High Output HF

A

Low output HF

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12
Q

Causes:

Severe anemia.

Thyrotoxicosis (hyperthyroidism).

Arteriovenous fistulas or malformations.

Paget’s disease of bone.

Beriberi (thiamine deficiency).

Sepsis (due to profound vasodilation).

Low or high output HF

A

High

The heart pumps an abnormally high volume of blood, but it still fails to meet the metabolic demands of the body due to an underlying systemic condition.

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13
Q

Warm extremities (due to increased blood flow).

Bounding pulses.

Pulmonary congestion and edema (in advanced stages).

Tachycardia and palpitations.

Low or High Output HF

A

High

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14
Q

HF can be acute or chronic

Describe (4) from each…

A

Acute:
MI
Virus
Drugs
Dysrhythmias

Chronic:

HTN
Valve Diseases
DM
Lng Trm Edema

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15
Q

Primary cause of left sided HF

A

Primary Cause: Left ventricle dysfunction (commonly due to hypertension, ischemic heart disease, or valvular disorders).

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16
Q

Symptoms of Left sided heart failure (4)

A

Dyspnea (shortness of breath), especially on exertion or when lying down (orthopnea).

Paroxysmal nocturnal dyspnea (PND).

Fatigue and weakness due to reduced cardiac output
.
Pulmonary congestion causing cough, crackles, and frothy sputum.

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17
Q

Pathophysiology: Blood backs up into the lungs due to poor left ventricular pumping, leading to pulmonary edema

A

Left sided HF

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18
Q

Complications: Pulmonary hypertension, hypoxia, and possible progression to right heart failure.

Problem…

A

Left sided HF

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19
Q

Primary Cause: Right ventricle dysfunction (often secondary to left heart failure, chronic lung diseases, or pulmonary hypertension

A

Right sided HF

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20
Q

Symptoms of Right sided HF (4)

A

Peripheral edema (swelling in legs and feet).

Ascites (abdominal swelling).

Jugular venous distention (JVD).

Hepatosplenomegaly (enlargement of the liver and spleen).

Fatigue due to impaired venous return and decreased cardiac output.

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21
Q

Pathophysiology: Blood backs up into the systemic circulation due to poor right ventricular pumping, leading to venous congestion.

A

Right sided HF

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22
Q

Fluid Congestion:

____ heart failure → Pulmonary congestion.

_____ heart failure → Systemic venous congestion.

Symptoms Location:

____ → Respiratory-focused symptoms (lungs).

____→ Peripheral and abdominal symptoms.

A

Fluid Congestion:
Left heart failure → Pulmonary congestion.
Right heart failure → Systemic venous congestion.
Symptoms Location:
Left → Respiratory-focused symptoms (lungs).
Right → Peripheral and abdominal symptoms.

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23
Q

Cough worse at night
Dyspnea
Crackles or wheezes
Pleural effusion
Pink, forthy sputum
Tachypnea
S3 S4

Which HF

A

Left

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24
Q

Cardiac output with Left sided HF

A

Decrease

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25
Q

Pulmonary congestion

Which HF

A

Left

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26
Q

Pulse with left HF

A

Thready weak

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27
Q

JVD
Enlarge liver & spleen
Anorexia
Nausea
Dependent edema
Swollen hands or feet
Polyuria at night
Weight gain
Increased or decreased BP

A

Right HF

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28
Q

Systemic congestion

Which HF

A

Right

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29
Q

Cor pulmonale is…

A

Specific type of right sided HF Always caused by pulmonary vascular condition (e.g., COPD, pulmonary embolism).

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30
Q

Most important lab test for determining HF

Values

A

BNP

<100 Normal
100 - 300 further investigation
300 mild HF
600 mod HF
900 severe HF

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31
Q

Name Diagnostic for HF…

A

H&P
ECG
2D echo (EF, Ab values, wall changes)
CXR

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32
Q

Describe New York Association Functional Classification
(For HF)

Class 1 - 4

A

1: No symptoms with ordinary activity

Class II
Description: Slight limitation of physical activity.
Symptoms: Comfortable at rest, but ordinary physical activity (e.g., walking up stairs, moderate exertion) results in fatigue, palpitation, dyspnea, or angina.
Functional Status: Mild symptoms with normal daily activities.

Class III
Description: Marked limitation of physical activity.
Symptoms: Comfortable at rest, but less than ordinary activity (e.g., light housework, short walking) causes fatigue, palpitation, dyspnea, or angina.
Functional Status: Significant symptoms even with minimal exertion.

Class IV
Description: Inability to carry on any physical activity without discomfort.
Symptoms: Symptoms of heart failure (e.g., fatigue, dyspnea, angina) are present at rest. Any physical activity increases discomfort.
Functional Status: Severe limitation; often bedridden or unable to perform daily tasks.

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33
Q

Description: No limitation of physical activity.
Symptoms: Ordinary physical activity does not cause fatigue, palpitation, dyspnea (shortness of breath), or angina.
Functional Status: Asymptomatic during normal activities.

A

Class 1

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34
Q

Description: Slight limitation of physical activity.
Symptoms: Comfortable at rest, but ordinary physical activity (e.g., walking up stairs, moderate exertion) results in fatigue, palpitation, dyspnea, or angina.
Functional Status: Mild symptoms with normal daily activities.

A

Class II

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35
Q

Description: Marked limitation of physical activity.
Symptoms: Comfortable at rest, but less than ordinary activity (e.g., light housework, short walking) causes fatigue, palpitation, dyspnea, or angina.
Functional Status: Significant symptoms even with minimal exertion.

A

Class III

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36
Q

Description: Inability to carry on any physical activity without discomfort.
Symptoms: Symptoms of heart failure (e.g., fatigue, dyspnea, angina) are present at rest. Any physical activity increases discomfort.
Functional Status: Severe limitation; often bedridden or unable to perform daily tasks.

A

Class IV

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37
Q

Nitroglycerin has this affect on preload & afterload

A

Lowers

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38
Q

Pregnant women have this type of precaution with cardiologist…

A

Go to a specialist

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39
Q

Why consider use of ARBS instead of ACE Inhibitors…

A

Less serious SE (Dry Cough & Angioedema)

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40
Q

ARNI (Angiotensin Receptor-Neprilysin Inhibitor) refers to a class of medications used to treat….

A

HF with reduced ejection fraction (HFrEF).

The most commonly used ARNI is sacubitril/valsartan

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41
Q

ARNI

Is a combination of Sacubitril (neprilysin inhibitor) & Valsartan (angiotensin receptor blocker - ARB)

The combination results in reduced stress on the heart and improved cardiac function.

Approved for what problem…

A

Approved for HFrEF (Heart Failure with Reduced Ejection Fraction) to reduce the risk of cardiovascular death and hospitalization for heart failure.

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42
Q

SE For ARNI (6)

A

Hypotension.

Hyperkalemia.

Dizziness.

Angioedema (rare but serious).

Renal impairment.

Cough (less common than with ACE inhibitors).

Basically the same as ACE & ARBS

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43
Q

When to hold K sparing Diuretucs

Uses

Heart failure (e.g., spironolactone in HFrEF).

Hypertension (as an adjunct to other diuretics).

Edema associated with liver cirrhosis or nephrotic syndrome.

Hyperaldosteronism (primary or secondary).

When to hold..

A

K >5
Creatinine >2.5

44
Q

Adult males 0.7–1.3 mg/dL (62–115 µmol/L)

Adult females 0.6–1.1 mg/dL (53–97 µmol/L)

Creatinine levels norms

What do highs and lows means

A

High

Dehydration
CKD
MEDS: ACE / ARBS NSAIDS
HF
High protein diet
Rhabdomyolysis

Low

Liver problem
Preggers
Low muscle mass

45
Q

Diuretics help with remodeling of the heart

T or F

A

T

46
Q

Best medications to reduce afterload (3)

A

ACE
ARB
ARNI
Angiotensin Receptor-Neprilysin Inhibitor

47
Q

Slide

SE For ACE (4)

A

Low BP
Worsening Kidney Function
Hyperkalemia
Chronic Cough
Angioedema

48
Q

How long to be off an ACE befire starting an ARI

A

72 hrs

49
Q

Contradictions to ARNI

(4)

A

Concurrent Use of ACE / ARB
DM
Preggers

50
Q

Valsartan / Sacubitril

Is this type of medication…

Cost 12$ per day

A

ARNI

Angiotensin Receptor-Neprilysin Inhibitor

51
Q

Reduce preload (3)

A

Diet
Diuretics
Venous Vasodilators

52
Q

Traditional HF Diet

  1. Limit sodium to….
  2. Fluid restrictions (class IV patients)
  3. Weight self (How Often)
  4. Weight gain of ___ in 1 day or
    ____ in 1 week = contact HCP
A
  1. 2 G
  2. 2 L/day
  3. Daily weight
  4. 3# in 1 day or 5# in 1 week
53
Q

Therapeutic level of Digoxin

A

0.5 - 2 ng/ml

54
Q

Medication Antidote for Digoxin…

Amount….

A

Digi fab 0.125

55
Q

Last Resort for HF

A

Left Ventricular Assist Device (LVAD)

56
Q

Beta-Blockers have 3 effects

Adrenergic …. Primary
Cholinergic….
Glycopenic ….

A

Adrenergic - Decreased heart rate and contractility.
- Bronchoconstriction (non-selective).
- Vasoconstriction (in certain vascular beds).

Cholinergic - Increased parasympathetic (vagal) tone.
- Bradycardia and AV node conduction delay.

Glycopenic - Impaired glycogenolysis and glucose release.
- Masked symptoms of hypoglycemia in diabetics.

57
Q

Sweating

Shakiness or tremors

Tachycardia (rapid heartbeat)

Anxiety or nervousness

Irritability or mood swings

Palpitations

Hunger

Neuroglycopenic Symptoms (due to insufficient glucose to the brain):

Confusion or disorientation

Difficulty concentrating

Slurred speech

Dizziness or lightheadedness

Weakness or fatigue

Blurred vision

Headache

Loss of coordination

Seizures (in severe cases)

Loss of consciousness or coma (severe hypoglycemia)

Other Symptoms:

Nausea

Cold, clammy skin

Hypo or hyperglycemia

A

Hypoglycemia

Think drunk with Tachycardia

58
Q

Why are BB not a good first choice in black men.

A

They will refuse to take them due to ED

59
Q

Diuretics alone can be given to treat HF

A

F

Never alone

60
Q

Types of meds given to treat HF

A

1.ACE Inhibitors

Examples: Enalapril, Lisinopril, Ramipril

  1. Angiotensin Receptor Blockers (ARBs)

Examples: Losartan, Valsartan, Candesartan

  1. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)

Example: Sacubitril/Valsartan (Entresto)

  1. Beta-Blockers

Examples: Carvedilol, Metoprolol succinate, Bisoprolol

  1. Mineralocorticoid Receptor Antagonists (MRAs)

Examples: Spironolactone, Eplerenone

  1. Diuretics

Examples: Furosemide, Bumetanide, Torsemide
Ivabradine

  1. Hydralazine and Nitrates (Combination Therapy)

Example: Hydralazine/Isosorbide dinitrate (BiDil)
SGLT2 Inhibitors

Examples: Dapagliflozin, Empagliflozin

61
Q

Aldosterone antagonists aka potassium sparring diuretics

Give examples…

Hold…

A

Spironolactone
Eplerenone

Hold
K>5
Creatinine >2.5

62
Q

SE of spironolactone (3)

A

Hyperkalemia
Gynecomastia
Impotence

63
Q

Venodilators

Dilate veins to decrease blood returning to the heart

Tolerance can develop

Examples….

A

Nitroglycerin (Store in Dark colored Glass container)

Isosorbide

64
Q

Neseritide (natrecor)

Type of med…

Action: Causes loss of NA in renal tubules and vasodilation.

Used for….

A

Type : BNP Type venodilator

Used for Acute severe HF

65
Q

Digitalis / Digoxin

Action…

Describe in general…..

Reduces HF symptoms
Increaes exercise tolerance
Improve hemodynamics
Decrease progression of HF

Improves rate of survival….?

A

Improves force of heart contractions while decreasing HR

DOESN’T IMPROVE SURVIVAL RATE

66
Q

SE of Digoxin OD >2ng /ml

A

Anorexia/ Nausea
Mental Status change
Halo around lights
Arrhythmia

67
Q

IV inotropes

Exp.
Milrinone (Primacor)
Dobutamine (Dobutrex)
Dopamine

Used for…
Action…

A

Acute CHF

Increase contractility and dilation peripheral vessels

68
Q

New order for IV furosemide & Digoxin Which lab result is most important to look at….

Why…

A

K

Hypokalemia increase risk of Digoxin toxicity

69
Q

Intra-aortic balloon pump

Used….

Action….

A

Used acute MI/HF to decrease cardiac workload

Increases cardiac output and increases O2 delivery to myocardium

70
Q

Impella is….

Describe…

A

LVAD

Pumps blood for LV to aorta 2.5 - 5 L/M

Short term upto 10 days but patients often need it longer

71
Q

SE of BB

A

Hypotension
Bradycardia
Fluid Retention
Fatigue
Impotence
Mask hypoglycemia in Diabetics

72
Q

PT goal for Congestive HF when ready…

A

200 - 400 ft walk

73
Q

Evaluation of LVS function…

A

Echo or Cath

74
Q

Prescribed at discharge fir LVSD left ventricle systolic dysfunction

A

ACE / ARB
BB

Smoking cessation

75
Q

Most common cause of Mitral Stenosis

A

Rheumatic fever

76
Q

Describe affects of Mitral Stenosis

A

Pulmonary congestion

Right sided HF

Preload decrease

CO Falls

77
Q

Stenosis restricts blood flow through the valve due to narrowing, while regurgitation causes blood to flow backward due to improper valve closure.

Stenosis leads to increased pressure before the valve (in the chamber receiving blood), whereas regurgitation increases volume in the chamber behind the valve.

T or F

A

T

78
Q

Chordae tendinae contract & shorten

Valve leaflets…

LA - LV Blood flow impaired

LA dilates, PAP increases, RV hypertrophic & CO DECREASES

This problem….

A

Fuse & become stiff

Mitral stenosis

79
Q

Calcification/ muscle weakness prevent valve closure.

Blood flows back to LA during systole

Decreased CO

LA dilation
Pulmonary Congestion
RV failure

This problem…

A

Mitral regurgitation

80
Q

Pulmonary congestion
AFIB
R HF
Anxiety
Atypical chest pain
Murmur
S3

S/S For..m

A

Mitral regurgitation

81
Q

Valve leaflets enlarge and prolapse into LA during systole

This problem…

A

Mitral valve prolapse

82
Q

Aortic stenosis

Starts when the aorta closes and blood backs up all the way to the Pulmonary Artery. Happens during Systole

Leads to this type of HF….

A

Right sided

83
Q

Aortic stenosis

Backflow of blood from Aorta to ventricles during diastole

LV dilates then hypertrophies

This outcome…

A

LV failure

84
Q

Diagnostic testing for valvular disease
…

A

X ray
Echocardiography
Exercise tolerance test
Cardiac Catheterization
ECG

85
Q

Prosthetic valve

Mech: _____

Bio _____

IRN #

A

Mechanical 2.5 - 3.5

Bio 2 - 3

86
Q

TAVR

Define…

A

TAVR is a minimally invasive surgical procedure used to treat severe aortic stenosis (narrowing of the aortic valve)

Especially in patients who are not candidates for traditional open-heart surgery.

87
Q

New aortic valve is implanted through a catheter, typically inserted via the femoral artery (in the groin) or sometimes through other arteries or the chest.

The catheter delivers the new valve, which is expanded within the existing, narrowed valve to replace it.

Name of procedure…

Who its for…

A

TAVR

Transcatheter aortic valve replacement

Patients with severe aortic stenosis who are at high risk for complications from traditional valve surgery

88
Q

Endocardial injury - vegative lesions - valve destruction

SS

Recurrent fever

Micro emboli
Petechiae
Splinter Hemorrhage
Organ Infarction

Diagnostic

Murmur
Echo
Blood culture

Name problem…

A

Endocarditis

89
Q

Endocarditis

Endocardial injury - Vegative lesions - valve destruction

SS

Recurrent fever

Micro emboli
Petechiae
Splinter Hemorrhage
Organ Infarction

Diagnostic

Murmur
Echo
Blood culture

Treatment….

A

Antibiotics

90
Q

Inflammation of the pericardial layers of heart.

SS

Pericardial Rub / pain
Fever
Cardiac Tamponade

Causes:

Infection
Cancer
Cardiac Surgery
Connective tissue disease

Name problem and treatment….

A

Pericarditis

Colchicine: Reduces symptoms and recurrence.

Steroids
Antibiotics
NSAIDS

91
Q

Pt has Pericarditis

SS

Pericardial Rub / pain
Fever
Cardiac Tamponade

Pt was given

Colchiche
Steroid
Antibiotics

What is the treatment for Cardiac Tamponade….

A

Pericardiocentesis.

Needle drains fluid from around the heart

92
Q

Rheumatic Carditis is Inflammation of all layers of the heart

SS

Heart murmurs (due to valve inflammation and damage).

Tachycardia

Signs of heart failure (dyspnea, fatigue, peripheral edema).

Systemic:

Fever

Joint pain and swelling (migratory polyarthritis)

Skin manifestations (erythema marginatum, subcutaneous nodules)

Chorea (involuntary, jerky movements)

Treatment….

A

Antibiotics min 10 days

93
Q

Rheumatic Carditis is Inflammation of…

Give antibiotics min 10 days

Diagnostic…

A

All heart layers

Echocardiogram

Lab

Elevated CRP

94
Q

Fluid accumulation in pericardium

Sudden decrease in cardiac output

Name problem…

Solution….

A

Cardiac Tamponade

Solution: Pericardiocentesis

95
Q

Muscles fibers of heart are damaged causing them to be Hard, Thick, Rigid.

Causes: Etoh, infection, inflammation, poor nutrient, drugs, genetic, Unknown

Name problem…

A

Cardiomyopathy

96
Q

Types of Cardiomyopathy

Dilated

____ wall thickness, _____ ventricle

A

Normal wall thickness, enlarged ventricle

97
Q

Types of Cardiomyopathy

Hypertrophic

______, ________ muscle walls, _____ filling

A

Thick and stiff muscle walls, impaired filling

98
Q

Types of Cardiomyopathy

Restrictive - rarest

_____ tissue replaces muscle tissue

A

Scar tissue replaces regular muscle tissue

99
Q

Types of Cardiomyopathy

Arrhythmogenic Right Ventricular

______ & _______ tissue replaces muscle

A

Fatty & Fibrous tissue replaces muscle

100
Q

Manifestions of Cardiomyopathy include (4)

A

Dyspnea
Fatigue
Palpation
Dysrhythmias

101
Q

Hypertropic Cardiomyopathy can have chest pain at rest unrelieved by Nitroglycerin.

What can be the outcome…

A

Sudden Death

102
Q

Cardiomyopathy

Dilated & Restrictive

Treatment…

A

Same as HF

Medications:

ACE inhibitors/ARBs: Reduce afterload and prevent heart remodeling.

Beta-blockers: Decrease heart rate and improve ventricular function.

Diuretics: Relieve fluid overload (edema, pulmonary congestion).

Aldosterone antagonists: (e.g., spironolactone) to manage fluid retention and reduce cardiac fibrosis.

Anticoagulants: Prevent
thromboembolism if atrial fibrillation or reduced ejection fraction is present

Digoxin: Improves contractility in select cases.

Devices/Interventions:

Implantable Cardioverter-Defibrillator (ICD): Prevent sudden cardiac death in those with a high risk of arrhythmias.

Cardiac Resynchronization Therapy (CRT): For patients with dyssynchronous ventricular contraction.

Heart transplantation: For refractory cases.

103
Q

Cardiomyopathy

Obstructive

Treatment….

A

BB
CCB

Activity Restrictions

104
Q

Cardiomyopathy

Arrhythmogenic

Treatment…

A

Unclear

BB
CCB
Ablation
ICD

105
Q

Ivabradine is a heart rate-lowering medication used primarily to manage specific types of heart failure and angina.

Used for…

Used in patients..

A

Increasing EF

EF <35

Used in patients

Are in sinus rhythm.

Have a resting heart rate ≥70 beats per minute.

Are already on maximally tolerated beta-blockers or have a contraindication to beta-blockers.

106
Q

Heart stretches & doesn’t come back describes in general this heart condition…

A

Cardiomyopathy

107
Q

Prosthetic valve IRN values

Mech….

Biological….

A

Mechanical 2.5 - 3.5

Biological 2 - 3

NURS 2245 Cardiac (8 decks)

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