Unit 8 Heart Failure Flashcards
What is heart failure essentially?
Ventricular dysfunction
What is cardiac remodeling?
Changes in the size, shape, structure, and function of the heart, after injury to the heart muscle.
If a PT has an EF of < 40% what should they be on?
ACEi
African Americans use what Rx’s for HF?
What race tends to have increased incident of ACEi related cough?
- isosorbide
- hydralazine
(both dilators)
Asians
What does the heart release in HF?
What does the brain release?
ANP (released with fluid overload)
BNP (released with ventricular perfusion)
What are causes of heart failure?
CAD
Hypertension
Cardiomyopathy
Valvular Heart Disease
Arrhythmias (A-Fib)
Cardiac infections and inflammation
COPD leads to (“Cor Pulmonale” R sided HF from the lung condition)
What is Cor Pulmonale?
R sided HF from lung disease such as COPD
What are the ways to classify HF?
Right or Left
Acute or Chronic
Systolic or Diastolic
Describe LEFT sided HF.
Most common form of HF
Changes most often seen in pulmonary circulation
Can lead acute decompensation and acute pulmonary edema.
Can lead to RHF
What are signs and symptoms of LEFT sided HF?
S/S of decreased cardiac output:
- AMS
- Cool clammy skin
- Fatigue
- Weak pulses
- Chest pain
- Tachycardia
- Palpations
S/S of pulmonary congestion:
- PND/orthopnea (SOB when laying down, relieved by sitting or standing; PND is during sleep.)
- Pink frothy sputum
- Crackles and wheezes
- Cough
- CXR shows vascular congestion “batwing”
What are the causes of R sided HF?
Left sided HF
Right ventricular infarction
Pulmonary HTN
COPD
What are signs and symptoms of RHF?
HJR/JVD - Hepatic juglar reflux (pressing RUQ = juglar vein distends)
RUQ pain
Hepatomegaly
Anorexia (from back up of pressure into veins and organs)
Swelling/edema
Ascites
Polyuria at night
Describe Systolic vs. Diastolic Failure. What are the causes of each?
Systolic failure:
- HF associated w/ decreased EF
- Impaired contraction and decreased stroke volume
causes: CAD, Ischemia, cardiomyopathy, valve abnormality
Diastolic Failure:
- HF associated with normal EF
- Impaired relaxation and decreased filling (ventricles are stiff, not enough blood into ventricles)
causes:
HTN, Hypertrophic cardiomyopathy (HCM)
What are diagnostics for HF?
**Echocardiogram (EF, ventricular size and motion) BMP BNP (should be < 100 normally) CBC ABG's Cardiac injury profile Liver function tests CXR (cardiomegaly-heart is enlarged, pulmonary congestion) 12 lead EKG Cardiac Cautherization Hx and physical
What is the purpose of pulmonary catheterization?
To measure CVP (central ventricular pressure) which helps indicate R sided HF by measuring after-load of R ventricle.
The normal is 0-10.
and to measure PCWP (pulmonary capillary wedge pressure) which helps measure pre-load of the L ventricle to indicate LEFT sided heart failure
(left end diastolic pressure)
Normal range is 8-12.
