Week 3 - Heart Failure Flashcards
what is heart failure
- abnormal clinical syndrome involving impaired cardiac pumping and/or filling & ventricular dysfunction
- heart has loss the ability to meet the body’s needs
what is HF characterized by (4)
- ventricular dysfunction
- reduced exercise tolerance
- diminished quality of life
- shortened life expectancy
what are risk factors for HF (7)
- MI
- HTN
- CAD
- DM
- smoking
- obesity
- high cholestrol
what are some chronic causes of HF (9)
- CAD
- HTN
- congenital heart disease
- pulmonary disease
- cardiomyopathy
- anemia
- endocarditis
- valve disorders
- DM
what are some acute causes of HF (6)
- MI
- dysrhythmias
- pulmonary embolus
- thyrotoxicosis
- HTN crisis
- myocarditis
what are precipitating factors
- factors that increase the workload of the ventricles
what are some precipitating factors of HF (10)
- anemia
- infection
- pulm. emboli
- pulm. disease
- hypothyroidism
- thyrotoxicosis
- dysrhythmias
- endo/myocarditis
- nutritional deficiencies
- hypervolemia
what effect does HF have on the ventricles
- get thickened (hypertrophy) ventricles
- dilation of heart chambers
what are 2 types of HF
- left sided
2. right sided
what does RSHF cause
- backward blood flow into the venous circulation
= venous congestion
what is the primary cause of RSHF
- LSHF
what does LSHF cause
- fluid backs into the pulmonary veins
- eventually causes biventricular failure (both sides fail)
what are symptoms of RSHF (11)
- peripheral edema
- weight gain
- hepatomegaly
- ascites
- jugular venous distension
- pleural effusion
- fatigue
- tachycardia
- anorexia, nausea, GI bloating
- chest pain
- dyspnea
- nocturia
- behavioral changes
peripheral S&S
what are symptoms of LSHF (10)
- tachycardia
- crackles
- dyspnea
- fatigue
- cough
- pulmonary edema
- nocturia
- orthopnea
- chest pain
- behavioral changes
pulmonary S&S
why does a pt with HF get nocturia
- HF = decreased CO = impaired renal perfusion and decreased urinary output during day
- at night, fluid move from the interstitial space back into vascular space = increased renal perfusion
why does chest pain occur in a pt with HF (2)
- decreased coronafy perfusion from decreased CO
- increased myocardial work
why do behavioral changes occur in a pt with HF
- cerebral circulation is impaired d/t decreased CO and decreased gas exchange
what are some complications of HF (5)
- pleural effusion
- dysrhythmias
- emboli
- hepatomegaly
- renal failure
why does pleural effusion occur in a pt with HF
- d/t increased pressure in the pleural capillaries
= fluid shifts into pleural space
(mainly w LSHF)
how can HF lead to dysrhythmias
- HF = enlargement of chambers of heart = alteration in the normal electrical pathway (esp. in the atria)
what dysrhythmia is especially common in a pt with HF
- atrial fibrillation
where do thrombi often from during HF
- in the left ventricle
why does left ventricular thrombus occur in HF
- enlarged LV and decreased CO = blood sitting there = formation of clot
what is the concern w left ventricular thrombus in a pt with HF (3)
- decrease left ventricular contractility
- decrease CO
- further worsen pts perfusion
what type of HF can specifically lead to hepatomegaly? what does hepatomegaly lead to
- RSHF
= impaired liver fnxn
how does HF lead to renal failure
- decreased CO = decreased perfusion to kidneys = renal insufficiency & failure
what can be used to diagnose HF (10)
- history
- physical exam
- chest xray
- ECG
- lab data
- hemodynamic assessment
- echo
- stress test
- cardiac catheterization
- measure ejection fraction
what is ejection fraction
- how much blood the ventricles pump out w each contraction
HF is an ejection fraction of…
<40%
how is HF classified
- functional classifications based on a pt’s tolerance of physical activity
how many classes of HF are there? which is best and which is worst?
classes 1 (best) to 4 (worst)
what are the goals of treatment for HF (6)
- decrease intravascular volume
- decrease venous return/preload
- decrease afterload
- improve gas exchange & oxygenation
- increase CO
- reduce anxiety
what treatment is done to decrease intravascular volume (2)
- diuretics (ex. lasix)
- ultrafiltration
what is the benefit of using diuretics to decrease intravascular volume (8)
- may be administered IV
- acts on kidneys rapidly
- decreases preload
- heart can contract more efficiently
- improved CO
- improves gas exchange
- decreases pulm vascular pressure
- improves left ventricular fnxn