Heat Failure Flashcards
what is heart failure
cardiac pump function impairment causing a reduction in cardiac output resulting in inefficient perfusion and sx d/t fluid accumulation
what is inotropic abnormality (negative)
weakened force of muscular contractions resulting in diminished systolic emptying (ejection fraction)
causes of HF
MI
valvular
endocarditis
arrhythmias
excess salt intake
common PMHx of HF
MI, HTN uncontrolled
Vital signs
tachypnea
tachycardia
cyanosis
confusion
dilated pupils
crackles/wheezes
cool skin
pitting edema
ascites
decreased voiding
symptoms
SOBOE
orthopnea
dec activity levels
abd bloating
wt gain
fatigue
weakness
nausea and vomiting
CXR
fluid accumulationand cardiomegaly
why do pts gain weight?
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
dx tests
CBC, troponin, BUN, creatinine, LFT, B-type Natriuretic peptide/N-type pro-BNP, EKG, Echo
natriuretic peptides
small proteins made by the heart continually made in response to ventricular stress in response to volume expansion or pressure overload
BNP and NT-proBNP ranges to dx HF
> 100
450 below 50
900 50-70
1800 >75
when to order NPs
acutely dyspneic pts
elevated NPs are associated with
poor long term prognosis and adverse impact on long-term mortality
tx of HF
address the underlying cause
pharmacological tx
diuretics
beta blockers
ace inhiitors
which tx is recommended for all pts with fluid overload if hemodynamically stable
IV diuretics
types of diuretics
hydrochlorothiazide
metolazone (Zaroxolyn)
furosemide (Lasix)
adverse effect of diuretics
electrolyte imbalance–chance of hypokalemia
initial tx in sx pts with HF
diuretics and ACE inhibitors
MOA of ACE inhibitors
inhibit RAA system
types of ACE inhibitors
captopril
lisinopril
types of beta blockers
metoprolol
carvedilol
L sided HF sx
orthopnea
SOBOE
blood tinged sputum
crackles
R sided HF sx
pitting edema
distended jugular vein
ascites
weight gain
hepatomegaly
