LVAD and HF Flashcards
What is the purpose of an LVAD?
- To correct a left ventricular problem
Where does an LVAD pump blood too?
From the left ventricle of the heart, to the aorta and around the body.
What is the LVAD powered by?
External batteries.
What is the average blood pressure of someone fitted with an LVAD?
60-90 systolic
What are the major health risk to LVAD fitted patients?
- Stroke
- DVT
- Infection
- PE
What does an LVAD rescue pack include?
- Spare batteries
- Spare controller
- Power lead
- LVAD contact card
What alteration in the circulation section of medical patient assessment needs to be made for an LVAD patient?
- Auscultion over the heart to listen for humming and alarms.
What is a mean BP?
The average BP between the systolic and the diastolic.
Define “Atrophy”.
The wastage of muscle.
Define “Hypertrophy”.
The growth of muscle.
What is the impact of left ventricular hypertrophy?
- Increased muscle mass reduces the chamber size, due to the limited space in the thoracic cavity.
- Reduced capacity, reduces the stroke volume from the left ventricle.
How is stroke volume calculated?
SV = Preload + contractility - afterload
How is cardiac output calculated?
CO = Stroke volume x heart rate
Define “Heart failure”.
A Clinical syndrome characterised by several signs and symptoms, where the left ventricle isn’t pumping blood properly.
What are the common causes or heart failure?
- Coronary heart disease
- MI near or in/near/around left ventricle
- Reduced valve effectiveness
- Rhythmic changes
What is the result of valve stenosis?
- Causes the valve to not fully open/close
Where does heart failure occur?
- Right and left ventricles
What might mask Right ventricular heart failure?
- Left ventricular heart failure.
Define “Remodelling”
Where tissue regrow into a slightly different shape, altering the function/ ability to complete a function.
What would increase to maintain cardiac output, in cases of acute heart failure?
- Heart rate, as stroke volume reduced.
What occurs when there is a reduced volume in the left ventricle.
Back flow into the left atrium and pulmonary vein. Leading to increased hydrostatic pressure, and fluid returning back into the alveoli.
What are the backward effects of heart failure?
- Reduced left ventricular emptying
- Increased pressure in the left atrium
- Volume and pressure increase in the pulmonary veins and capillaries
- Fluid leaks into the alveoli
What are the forward effects of heat failure?
- Reduced cardiac output
- Reduced perfusion at the tissues
- Reduced blood flow at the kidneys
- Increased reabsorption of sodium and water
What are the signs and symptoms of heart failure?
- Dyspnoea
- Orthopnoea
- Tachycardia
- cough
- Fatigue
- Dizziness
- Cyanosis
- Crackles/ wheeze
Define “Orthopnoea”.
Difficulty in breathing caused by patient positioning.
Why do Heart failure patients suffer from orthopnoea?
- When laid flat surface area of the lungs reduce.
- Fluid subsequently covers a great area of the capillary bed.
Define “Proximal Nocturnal Dyspnoea”.
Difficulty in breathing that occurs at night.
What are the common causes of right heart failure?
- COPD
- PE
- LHF
- Heart valve disease
In right ventricular heart failure, where does oedema occur?
- in the major organs.
What may occur in right ventricular heart failure?
- Pitting oedema in the lower limbs
- Difficulty in breathing due to acieties
- Distended jugular veins
- Enlargement of the organs.
What is given to reduced major organ enlargement caused by right heart failure.
Steriods
What are the potential triggers for exacerbation of heart failure?
- MI
- Pericarditis
- Pneumonia
- PE
- Hypertension
- DVT
- ACS
- Tachy/ Brady
- Non compliance in medicaation
What acute presentation can be expected in exacerbation of left ventricular heart failure?
- Pulmonary oedema
- Increased dyspnoea without peripheral oedema
What acute presentation might be expected in an exacerbation of right ventricular heart failure?
- Prominent peripheral oedema
What is the function of an ICD?
- To correct a shockable arrhythmia
- To pace bradycardia
What kind of pacing is used for VT pacing?
Anti-tachycardia pacing
What kind of shocks that are delivered by an ICD?
Biphasic shocks
What is CRT in reference to heart failure managment?
Cardiac resynchranisation therapy
Where may an an ICD be fitted?
- Left subcalvian
- Mid auxilla
How many times would a ICD discharge?
- 8 times after a shockable rhythm is detected
What Joule does an ICD shock at?
40J
What may a fractured or damage lead cause?
- Accident discharge of shock
- No shock when patient is in a shockable rhythm
How far away from an ICD should an AED pad be placed?
8cm
What is the purpose of a magnet in the management of an ICD?
- To disable to the shock capacity of the ICD
When should a magnet be used?
A magnet should be used once the rhythm for which shocks are being delivered has been taken
What needs to be done if the shock delivered by the ICD is inappropriate?
- Record the rhythm
- Disable ICD with magnet
- Monitor
- Support as appropriate
If an arrhythmia is prsent and the ICD is not working, what is the appropriate plan of action?
- Record the rhythm
- Determine the rhythm
- Support and transport PT has the condition presents
If the PT is in SVT and haemodynamically stable, what is the appropriate treatment plan?
Disable the ICD with a magnet
