(Pre-) ch 17 Left and Right Heart Failure Flashcards
Question 1 of 5
When left ventricular failure occurs, which of the following signs and symptoms relate to the backward effects of heart failure? Select all that apply.
Increased ejection fraction Pulmonary edema Jugular vein distension Hypotension Paroxysmal nocturnal dyspnea
Pulmonary edema
Paroxysmal nocturnal dyspnea
Question 2 of 5
What are the causes of left ventricular failure? Select all that apply.
Increased pressure within the venous system
Increased stiffness of ventricle muscle
Reduced relaxation of ventricle muscle
Reduced forward pumping strength of the ventricle muscle
Decreased pulmonary arterial blood flow
Increased stiffness of ventricle muscle
Reduced relaxation of ventricle muscle
Reduced forward pumping strength of the ventricle muscle
Question 3 of 5
A patient presents with peripheral edema, hepatosplenomegaly, and jugular vein distention. What do these signs and symptoms represent?
Backward effects of right ventricular failure
Forward effects of right ventricular failure
Forward effects of left ventricular failure
Backward effects of left ventricular failure
Backward effects of right ventricular failure
Question 4 of 5
Where would fluid accumulate in a patient due to the increased level of hydrostatic pressure caused by left ventricular failure?
Jugular veins
Pulmonary interstitial spaces
Kidneys
Hepatic portal veins
Pulmonary interstitial spaces
Question 5 of 5
Which of the following are expected in response to left ventricular failure? Select all that apply.
Increased anti-diuretic hormone Decreased heart rate Decreased sodium and water reabsorption Increased angiotensin II Increased urine output
Increased anti-diuretic hormone
Increased angiotensin II
Question 1 of 8
Howard, age 58, presents to the emergency department with a variety of signs and symptoms. Howard has a history of cardiac difficulties, including a myocardial infarction 5 years ago. Since that time, Howard has continued to struggle with lifestyle modifications, such as diet and exercise, to reduce his risk of future cardiac events.
As the first clinician to see Howard, you record the following signs and symptoms: headache and memory loss; cyanosis; heart rate of 100 bpm; BP of 100/70 mm Hg; ascites; orthopnea; paroxysmal nocturnal dyspnea; pulmonary crackles and edema; peripheral edema; and cool, pale extremities.
Which of his signs and symptoms are associated with right-sided heart failure? Select all that apply. Ascites Headache and memory loss Cyanosis Peripheral edema Cool, pale extremities
Ascites
Peripheral edema
When the right side of the heart fails, fluid backs up into the systemic venous system. Ascites and peripheral edema occur, as the fluid in the capillaries increases. The other signs and symptoms listed are not specific to right-side heart failure.
Question 2 of 8
Which of his signs and symptoms are associated with the backward effects of left-side heart failure? Select all that apply.
Headache and memory loss Orthopnea Paroxysmal nocturnal dyspnea Pulmonary crackles Pulmonary edema
Orthopnea
Paroxysmal nocturnal dyspnea
Pulmonary crackles
Pulmonary edema
Backward effects of left-side heart failure results in fluid back up on the pulmonary system. Orthopnea, paroxysmal nocturnal dyspnea, pulmonary crackles, and pulmonary edema are all signs of the left ventricle failing to pump blood forward and backward effects of fluid accumulation in the lungs developing.
Question 3 of 8
Which of his signs and symptoms are associated with the forward effects of left-side heart failure? Select all that apply.
Headache Decreased blood pressure Increased heart rate Pulmonary crackles Pulmonary edema
Headache
Decreased blood pressure
Increased heart rate
Forward effects of left-side heart failure result from an inability of ventricle to adequately pump blood into systemic circulation, resulting in decreased blood pressure and increased heart rate to compensate. Headache may occur due to poor perfusion of the brain. Pulmonary crackles and pulmonary edema are due to backward effects of LV failure.
Question 4 of 8
Based on assessment findings and mixed signs and symptoms, you suspect total heart failure.
Which of the following are correct statements regarding the body’s attempts to compensate for heart failure? Select all that apply.
Heart rate elevates in response to parasympathetic activation.
Fluid retention by the body is an attempt to increase blood pressure by increasing blood volume.
Pale, cool extremities result from increased blood flow to the skin in attempt to divert excess blood away from the heart.
Baroreceptors detect falling blood pressure and initiate increased heart rate to compensate.
Peripheral vasodilation is the primary cause of the peripheral pitting edema.
Fluid retention by the body is an attempt to increase blood pressure by increasing blood volume.
Baroreceptors detect falling blood pressure and initiate increased heart rate to compensate.
Left-side heart failure results in a fall in blood pressure that is detected by the baroreceptors. These receptors activate the sympathetic nervous system to increase heart rate and compensate for the pressure loss. The body also retains fluid to compensate for heart failure. An increase in blood volume results in an increase in pressure. However, excess fluid in the body increases the likelihood of edema.
Question 5 of 8
Which of the following signs and symptoms, although not present in Howard’s initial examination, are also associated with right-side heart failure? Select all that apply.
Jugular vein distention Orthopnea Enlarged liver and/or spleen Crackles in the lungs Pulmonary edema
Jugular vein distention
Enlarged liver and/or spleen
Jugular vein distention (JVD) and hepatosplenomegaly (enlarged liver or spleen) are common signs of right-side heart failure. With this condition, blood backs up in the large veins that deliver blood to the heart, causing the veins and organs to enlarge. The other answers listed are associated with left-side heart failure.
Question 6 of 8
The edema present in Howard’s lungs and extremities indicates the presence of excess fluid in the body. Which of the following signals are associated with retention of fluid? Select all that apply.
Decreased ADH Increased aldosterone Decreased angiotensin Increased natriuretic peptide Increased renin
Increased aldosterone
Increased renin
Fluid retention results from the activation of the renin-angiotensin-aldosterone system (RAAS) and the release of ADH. Thus, increased renin, increased angiotensin, and increased aldosterone either directly or indirectly contribute to fluid retention. Natriuretic peptide increases urine output and reduces blood volume.
Question 7 of 8
Howard undergoes further testing. Which value may provide further evidence that Howard has left ventricular failure?
Increased pulmonary capillary wedge pressure (PCWP)
Increased albumin
Decreased PAP
Increased JVD
Increased pulmonary capillary wedge pressure (PCWP)
Pulmonary capillary wedge pressure (PCWP) testing estimates the pressure in the left atria. In left ventricular pressure, as fluid backs up in the left side of the heart, PCWP increases. Increased CVP, or central venous pressure, is the measurement used to evaluate right-side heart failure.
Question 8 of 8
Given Howard’s current health status, what are some medication options? Select all that apply.
Diuretics Beta blockers Agents to reduce heart contractility Positive inotropic agents ACE agonists
Diuretics
Beta blockers
Positive inotropic agents
Diuretics reduce the fluid overload that occurs in heart failure, while beta blockers reduce the work load of the heart. Positive inotropic agents stimulate more effective heart contractility. Agents to reduce heart contractility would be determinantal in someone suffering heart failure, as would ACE agonists. ACE inhibitors are usually prescribed to reduce fluid overload and vasoconstriction.
Question 1 of 5
Which of the following pairs are incorrectly matched?
Low-output failure - Decreased venous return
Systolic dysfunction - Difficulty contracting and pumping effectively
High-output failure - Elevated demands on the heart
Diastolic dysfunction - Difficulty ejecting blood
Diastolic dysfunction - Difficulty ejecting blood
Question 2 of 5
In response to hypertension, the left ventricle may undergo hypertrophy, reducing filling volume of the left ventricle. This is an example of _____________.
systolic dysfunction
diastolic dysfunction
total heart failure
backward effects
diastolic dysfunction
