Pathophysiology and Patient Assessment Flashcards
What is the #1 reason for hospital readmission?
Heart Failure
25% within 30 days, 50% within 6 months
What is Heart Failure?
a decrease in cardiac output (heart can’t meet demands of the body)
What is Cardiac Output?
the amount of blood leaving your heart
important- tissues and organs require oxygen to function, and blood is the carrier
Equation for Cardiac Output
CO= SV x HR
What is Systolic Dysfunction?
Problem with PUMPING
Also called HFrEF. Ventricle can fill, but cannot pump (squeeze)
What is Diastolic Dysfunction?
Problem with FILLING
Also called HFpEF
What is an Ejection Fraction?
The % of blood that leaves your left ventricle when it contracts
What is a normal ejection fraction? How much blood normally remains?
Normal- 50-70%, remaining is 30-50%
What is the equation for EF?
EF= Stroke Volume/End Diastolic Volume
What is HFrEF and what %?
Heart Failure with REDUCED ejection fraction
Less than 40% of the blood in your ventricle leaves when it contracts
What is HFmrEF and what %?
Heart failure with MILDLY REDUCED ejection fraction
HFpEF getting worse or HFrEF getting. better
EF= 40-50%
What is HFpEF and what %?
Heart failure with PRESERVED ejection fraction
The LV doesn’t fill properly, but does contract, so the same % of blood leaves the ventricle, but from a smaller starting volume
EF= > 50%
What does an echocardiogram evaluate?
Ejection Fraction/Wall Motion abnormalities, chambers of the heart, valves
What is hypoperfusion?
Not enough oxygenated blood moving forward from the heart to perfuse the vital organs
What is congestion?
Blood backs up from the LV to the lungs, possible RV, and beyond
What are the symptoms of hypoperfusion?
Tachycardia, fatigue, cyanosis, cold extremities, organ dysfunction, Increased: serum creatinine and LFTs, confusion AMS
What are the symptoms of Congestion?
Weight gain, SOB, Orthopnea, Paroxysmal Nocturnal Dyspnea, Pleural effusion on CXR, crackles/rales on ausculation, S3 and S4, peripheral edema, BNP, JVD
What does a Chest Xray test?
Cardiac enlargement, pulmonary edema, pleural effusions
What does an ECG test?
May help you identify a cause for HF exacerbations (ACS, arrythmias)
What does CBC/BMP test?
Hypoperfusion, hyponatermia, anemia
BNP or NT-BNP values?
BNP > 100ng/mL
NT-pro BNP > 300ng/mL
ACC Classification: At risk for structural heart disease, no symptoms
Class A
ACC Classification: Yes structural heart disease, no symptoms
Class B
ACC Classification: Yes structural heart disease, Yes symptoms
Class C
ACC Classification: Yes structural heart disease, refractory symptoms
Class D
NYHA Classification: No limitation of physical activity, ordinary activity does not cause any HF symptoms
Class I
NYHA Classification: Slight limitation of physical activity, comfortable at rest, but ordinary activity results in HF symptoms
Class II
NYHA Classification: Marked limitation of physical activity, comfortable at rest, but less than ordinary activity results in HF symptoms
Class III
NYHA Classification: Symptoms at rest
Class IV
What is the most common cause of HF?
Myocardial Infarction
What is the #1 Cause of Death in a Patient w HF?
Sudden cardiac death from ventricular tachycardia/fibrillation
What is an exacerbation or ADHF?
Rapid onset of symptoms causing clinic, ED, hospital admission
What causes an acute exacerbation?
Non compliance (with medications or diet), NSAID use, and comorbidities (afib, MI, and infection)
Classification of ADHF: Class I
Warm & Dry
Classification of ADHF: Class II
Warm & Wet
Classification of ADHF: Class III
Cold & Dry
Classification of ADHF: Class IV
Cold & Wet
