Heart Faliure

Question 1

What is heart faliure?

Answer 1

An acute or chronic condition in which the heart doesnt pump blood as well as it should resulting in congestion (CHF) of blood backing up and being unable to meet demands of the body.

Question 2

What is systolic heart faliure? (HFrEF)

Answer 2

Where the ventricles cant pump hard enough during systole

Question 3

What is diastolic heart faliure? (HFpEF)

Answer 3

Where not enough blood fills into ventricles during the diastole

Question 4

What does RHF stand for?

Answer 4

Right Heart Failure

Question 5

What is Right sided Heart Failure?

Answer 5

In right-sided heart failure, the heart’s right ventricle is too weak to pump enough blood to the lungs. As blood builds up in the veins, fluid gets pushed out into the tissues in the body. Right-sided heart failure symptoms include swelling and shortness of breath. i.e blood builds up in peripheral and organ circulation.

Question 6

What is left sided heart faliure?

Answer 6

Where the left ventricle is unable to pump with enough force, the blood ends up backed up in the lungs causing pulmonary congestion (alveoli are filled with oedema fluid making gas exchange nearly impossible). This means the body is unable to adequately supply body organs leading to low oxygen perfusion and hypoxia.

Question 7

what are some signs and symptoms of heart faliure?

Answer 7

A cluster of different symptoms, elevated BNP (>80), normal-low LVEF from an echocardiogram.

Question 8

What is an echocardiogram?

Answer 8

a test of the action of the heart using ultrasound waves to produce a visual display, for the diagnosis or monitoring of heart disease.

Question 9

What is an LVEF?

Answer 9

Left ventricular ejection fraction (LVEF)
Ejection fraction typically refers to the left side of the heart. It shows how much oxygen-rich blood is pumped out of the left ventricle to most of the body’s organs with each contraction.

Question 10

Which usually occurs first? LHF or RHF?

Answer 10

LHF usually develops first then RHF because the left ventricle pumps blood throughout the body.

Question 11

What are some risk factors/causes of HF?

Answer 11

Ischaemia - MI (Elevated TNI)
Valve disease
Cardiomyopathy
Pericarditis
Fluid overload (renal faliure, IVF)
T2DM
HTN
Smoking

Question 12

What does TNI stand for?

Answer 12

Troponin I

These are proteins that are released when the heart muscle has been damaged, such as occurs with a heart attack

Question 13

What is valve disease?

Answer 13

In heart valve disease, one or more of the valves in your heart doesn’t work properly.

Question 14

What is cardiomyopathy?

Answer 14

Cardiomyopathy is a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body.

Question 15

What is pericarditis?

Answer 15

Pericarditis is swelling and irritation of the thin, saclike tissue surrounding the heart (pericardium). Pericarditis often causes sharp chest pain.

Question 16

what are the clinical manifestations (symptoms) of left sided HF?

Answer 16

Dyspnoea (difficult or laboured breathing)
Orthopnoea (Discomfort when breathing while lying down flat)
Paroxysmal nocturnal dysponea (a sensation of shortness of breath that awakens the patient)
Pulmonary congestion - cough, crackle, wheeze

Question 17

what are the clinical manifestations (symptoms) of right sided HF?

Answer 17

Renal failure
Peripheral Oedema
Ascites (a condition in which fluid collects in spaces within your abdomen)
Enlarged liver and spleen
Distended JVP (bulging jugular vein due to inc pressure of sup vena cava)
Fluid weight gain

Question 18

What is a distended JVD?

Answer 18

Jugular vein distention or JVD is when the increased pressure of the superior vena cava causes the jugular vein to bulge, making it most visible on the right side of a person’s neck

Question 19

What are the signs and symptoms of acute heart failure / exacerbation of CHF?

Answer 19

Elevated BNP
APO
Peripheral Oedema
Type 1 resp failure (ABG)
Exacerbation of symptoms 
Elevated JVP
Audible crackles on chest assessment 
CXR - Consolidation

Question 20

What is a BNP?

Answer 20

Brain natriuretic peptide (BNP) test is a blood test that measures levels of a protein called BNP that is made by your heart and blood vessels. BNP levels are higher than normal when you have heart failure.

Question 21

What is Consolidation (seen in a chest X-ray) ?

Answer 21

Lung consolidation occurs when the air that usually fills the small airways in your lungs is replaced with something else. Depending on the cause, the air may be replaced with: a fluid, such as pus, blood, or water.

Question 22

Why do patients have exacerbations of CHF?

Answer 22

Non compliance with meds
Deterioration of disease process
Fluid overload (Transfusion, IVF, renal failure)
Sepsis

Question 23

What is sepsis?

Answer 23

Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death.

Question 24

What types of nursing management can we apply to a patient with HF?

Answer 24

Fluid balance (acute phase)
Daily weighs
IV frusemide
Ace inhibitor + beta blocker
Daily checks
Fluid restriction
Lying/standing BP's
Oxygen/Airvo 
Monitoring Electrolytes / renal function
If unwell + for escalation consider CCU or ICU for CPAP or blood pressure support

Question 25

What is IV furosemide?

Answer 25

LASIX® (furosemide) is an infusion medication mainly used to reduce fluid buildup caused by certain underlying medical conditions — such as kidney and/or liver disease, as well as heart failure.

Question 26

How do ace inhibitors and beta blockers help with HF?

Answer 26

Beta-blockers treat many of the same conditions as ACE inhibitors, including high blood pressure, chronic heart failure, and stroke. Both types of medications also prevent migraines. Unlike ACE inhibitors, however, beta-blockers can help relieve angina (chest pain).

Question 27

What is Airvo?

Answer 27

a humidifier with integrated flow generator that delivers high flow warmed and humidified respiratory gases to spontaneously breathing patients through a variety of patient interfaces.

Question 28

What is CPAP?

Answer 28

Continuous positive airway pressure is a form of positive airway pressure ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person

Question 29

what is the CCU?

Answer 29

critical care unit

Question 30

What type of education and discharge planning do we consider for a patient with HF?

Answer 30

Use the HF discharge pathway
Use the “managing your HF book/pack”
Medication education
Refer to AD/CRISS - Titration + monitoring
Recommend daily checks (weight, breathing, swelling)
Tell the patient when to reach out for help
And ensure the discharge summary includes a (target weight, plan for titration, current BNP, and community service prescription )

Question 31

What does CRISS stand for?

Answer 31

CRISS = Cardio-Respiratory Integrated Specialist Services

Question 32

What is titration?

Answer 32

Titration is a way to limit potential side effects by taking time to see how your body will react to a drug. In titration, the medication is started at a low dose. Every couple of weeks, the dose is raised (“up-titrated”) until the maximum effective dose (“target dose”) has been achieved or side effects occur.