Heat Failure

Question 1

what is heart failure

Answer 1

cardiac pump function impairment causing a reduction in cardiac output resulting in inefficient perfusion and sx d/t fluid accumulation

Question 2

what is inotropic abnormality (negative)

Answer 2

weakened force of muscular contractions resulting in diminished systolic emptying (ejection fraction)

Question 3

causes of HF

Answer 3

MI
valvular
endocarditis
arrhythmias
excess salt intake

Question 4

common PMHx of HF

Answer 4

MI, HTN uncontrolled

Question 5

Vital signs

Answer 5

tachypnea
tachycardia
cyanosis
confusion
dilated pupils
crackles/wheezes
cool skin
pitting edema
ascites
decreased voiding

Question 6

symptoms

Answer 6

SOBOE
orthopnea
dec activity levels
abd bloating
wt gain
fatigue
weakness
nausea and vomiting

Question 7

CXR

Answer 7

fluid accumulationand cardiomegaly

Question 8

why do pts gain weight?

Answer 8

renin-angiotensin-aldosterone system
cardiac output is decreased so kidneys receive less blood
RAA retains fluid and raises BP
pt voids less and gains weight

Question 9

dx tests

Answer 9

CBC, troponin, BUN, creatinine, LFT, B-type Natriuretic peptide/N-type pro-BNP, EKG, Echo

Question 10

natriuretic peptides

Answer 10

small proteins made by the heart continually made in response to ventricular stress in response to volume expansion or pressure overload

Question 11

BNP and NT-proBNP ranges to dx HF

Answer 11

> 100
450 below 50
900 50-70
1800 >75

Question 12

when to order NPs

Answer 12

acutely dyspneic pts

Question 13

elevated NPs are associated with

Answer 13

poor long term prognosis and adverse impact on long-term mortality

Question 14

tx of HF

Answer 14

address the underlying cause

Question 15

pharmacological tx

Answer 15

diuretics
beta blockers
ace inhiitors

Question 16

which tx is recommended for all pts with fluid overload if hemodynamically stable

Answer 16

IV diuretics

Question 17

types of diuretics

Answer 17

hydrochlorothiazide
metolazone (Zaroxolyn)
furosemide (Lasix)

Question 18

adverse effect of diuretics

Answer 18

electrolyte imbalance–chance of hypokalemia

Question 19

initial tx in sx pts with HF

Answer 19

diuretics and ACE inhibitors

Question 20

MOA of ACE inhibitors

Answer 20

inhibit RAA system

Question 21

types of ACE inhibitors

Answer 21

captopril
lisinopril

Question 22

types of beta blockers

Answer 22

metoprolol
carvedilol

Question 23

L sided HF sx

Answer 23

orthopnea
SOBOE
blood tinged sputum
crackles

Question 24

R sided HF sx

Answer 24

pitting edema
distended jugular vein
ascites
weight gain
hepatomegaly