Test three b Flashcards
Two types of HF based on cause
Primary causes = underlying cardiac props (CAD, cardiomyopahy)
Precipitating causes = anemia, pulmonary disease, hypervolemia
Others: diabetes, tobacco, obesity, lipids, age
NOT GENETICS
Systolic HF
Pathophysiology: heart has thin walls, so LV can’t pump well
Etiology: impaired contractile function (MI); increased afterload (HTN), cardiomyopathy, or mechanical abnormalities
Diagnosis: decrease in LV EF
Diastolic HF
Pathophysiology: heart has thick walls, so ventricals can’t relax and fill –> decreases SV and CO –> venous engorgement in pulmonary and systemic systems
Etiology: LV hypertrophy from chronic htn, aortic stenosis, or hypertrophic cardiomyopathy
Diagnosis: presence of HF symptoms with normal EF
Mixed HF
Pathophysiology: Poor systolic function is further compromised by dilated LV walls that are unable to relax
Etiology: seen in disease states such as dilated cardiomyopathy
Symptoms: Low systemic BP, low CO, and poor renal perfusion
Compensation: Ventricular dilation, ventricular hypertrophy, activation of SNS and RAAS
Left sided HF
most common
blood backs up into LA and pulmonary veins
pulmonary congestion and edema
Right sided HF
usually caused by LSHF, but not always
blood backs up into RA and venous circulation
peripheral edema, hepatomegaly, JVD
**cor pulmonale can also cause RSHF
Manifestations of HF
Fatigue and anemia
edema
skin changes
behavioral changes
angina
LSHF signs and symptoms
Signs
-LV heaves
-pulsus alternans
-elevated HR
-PMI displaced inferiorly and posteriorly
-crackles
-S3 and S4
-pleural effusion
-mental status changes
-restlessness/confusion
-shallow respirations, dry cough, pink sputum
Symptoms
-dyspnea and orthopnea
-wekaness
-paradoxical nocturnal dyspnea
-nocturia
RSHF signs and symptoms
Signs
-RV heaves
-murmurs
-JVD
-edema
-weight gain
-elevated HR
-ascites
-anasarca
Symptoms
-fatigue
-anxiety/depression
-anorexia and GI bloating
-nausea
-dependent, bilateral edema
-RUQ pain
-hepatomegaly
Clinical manifestations of Acute Decompensated Heart Failure
CAD –> LV failure –> Pulmonary edema where alveoli fill with serosanguineous fluid
-anxiety, pallor, cyanosis, cold/clammy skin
-dyspnea, RR over 30, orthopnea
-coughing with blood tinged sputum
-lung crackles, wheezes, rhonchi
-tachycardia, htn, hpotn,
Etiology of mitral valve stenosis
rheumatic heart disease usually
also:
congenital mitral stenosis
rheumatoid arthritis
systemic lupus erythematosus
mitral valve regurgitation etiology
MI
rheumatic heart disease
mitral valve prolapse
ischemic papillary muscle dysfunction
infective endocarditis
aortic valve stenosis etiology
congenital aortic valve stenosis in kids
in older ppl, its bc of rheumatic fever or degeneration
aortic valve regurgitation etiology
Acute: IE, trauma, aortic dissection
chronic: htn, rheumatic heart disease, congenital bicuspid aortic valve, syphilis, chronic arthritic conditions
results of mitral and aortic stenoses
mitral
-higher pulmonary vascular pressure due to backup
aortic
-left ventricular hypertrophy and increased myocardial oxygen consumption from increased myocardial mass
results of mitral and aortic regurgitation
mitral (chronic)
-left atrial enlargement
-LV dilation, hypertrophy, and decreased CO
aortic
-volume overload
-declining myocardial contractility and increased volume in LA/lungs
-pulmonary htn
-RV faliure
Mitral valve stenosis clinical manifestations
dyspnea on exertion
hemoptysis
fatigue
afib
palpitations
loud S1
low diastolic murmur
mitral valve regurgitation manifestation
Acute
-new systolic murmur with rapid dvlpmt of pulmonary edema and cardiogenic shock
Chronic
-weakness
-fatigue
-exertional dyspnea
-palpitations
-S3 gallop
-murmur throughout systole
Aortic valve stenosis manifestations
angina
syncope
dyspnea on exertion
normal or soft S1
diminished or absent S2
systolic murmur
S4
Aortic valve regurgitation manifestation
Acute:
-abrupt onset of dyspnea, chest pain
-LV failure and cardio shock
Chronic
-fatigue
-exertional dyspnea
-orthopnea
-parxysmal nocturnal dyspnea
-water hammer pulse
-heaving precordial impulse
-diminished or absent S1, S3, or S4
-Austin Flint murmur
Drugs for atrial dysrhythmias
ccb
bb
digoxin
antidysrhythmic drugs
electrical cardioversion
Non drug treatment for valve issues
percutaneous transluminal balloon valvuloplasty
-through femoral artery to stenotic valve
-inflate and separate leaflets
-good for old ppl who can’t handle surgery
surgeries for valve issues
mitral commissurotomy (stenosis)
open surgical valvuloplasty (regurgitation)
annuloplasty
what should INR be?
2.5 to 3.5
PAD
progressive narrowing of the arteries from the thickening of arterial walls
PAD risk factors
tobacco!!!!!
CKD
DM
HTN
high cholesterol
female
black
high CRP
fam history
hypertriglyceridemia
age
hcy
boesity
sedentary
stress
leading cause of PAD
atherosclerosis
-in femoral popliteal area (in non diabetics)
-below knees in DM
PAD clinical manifestations
intermittent claudication (from muscular anaerobic respiration)
Atypical leg symptoms (burning, tightness, weakness)
Neuropathy (tingling, numbness, shooting, burning)
-loss of bloodflow to neurons reduces pain sensation
Skin gets thin, shiny, taught, and hairless - pallor on elevation and vice versa
Rest pain often at night due to limb elevation
Critical limb ischemia = rest pain for more than 2 weeks, ulcers, gangrene –> more likely if HF, DM, or history of stroke
Complication of peripheral artery disease
atrophy of skin and muscles
delayed healing, wound infection, and necrosis
-ulcers on bony prominences –> develop gangrene
-uncontrolled pain, sepsis, or osteomyelitis indicate amputation need
Diagnostic studies for PAD
Doppler Ultrasound
Segmental blood pressure –> PAD if drops more than 30
Ankle brachial index -> divide ankle SBP by higher brachial SBP –> PAD is under 0.9 –>old ppl and those w/ DM have false high ABI
Angiography: contrast and fluroscopy
Angiography and magnetic resonance angiography determine location and extent of PAD
Risk factor modification for PAD
Stop tobacco use
Manage DM (keep HbA1C below 7%)
Manage Lipids (statins)
Manage HTN (below 140/90 if normal ppl; below 130/80 if DM or kidney issues) –> ACE inhibitors
Drug therapy for PAD
ANTIPLATLET AGENTS
-aspirin or clopidogrel
NO ANTICOAGULANTS
Cilostazol (don’t use if HF) and Pentoxifylline for claudication
Priority when giving anticoagulation meds
draw baseline labs first
do bleeding time test –> will increase once meds taken –> platelets won’t decrease
Exercise therapy for PAD
super important- esp for women
-30-45 mins at least 3x a week for 3 months
Interventional radiology catheter based procedures for PAD
PTA –> balloon pumps up narrowed vessel
Stents –> placed after balloon pump
Atherectomy –> can use disk or laser
Cryoplasty –> PTA with coldness to limit restonosis
Surgeries for PAD
Peripheral artery bypass surgery
Femoral popliteal bypass
endarterectomy and patch graft angioplasty
amputation
Post op for PAD surgeries
check extremity every 15 mins and then hourly for color, temp, cap refill, peripheral pulses, sensation, and movemnt
bleeding, hematoma, thrombosis, emolization, compartment syndrome
ABI not recommended bc could cause thrombosis
Nursing interventions for PAD
Pain management –> may be aggressive
Positioning –> get them walking; not too much time with dependent leg
Supportive care –> graduated compression stockings
Infection prevention
