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218: Patho Part II > Week 3: Heart Failure > Flashcards

Week 3: Heart Failure Flashcards

1
Q

What are the two biggest health conditions that contribute to the development of heart failure?

A

DM and HTN

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2
Q

What is the most common type of heart failure and what is it?

A

The most common type of heart failure is systolic heart failure is the most common of HF. It is characterized as an impaired ability of the heart to PUMP blood.

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3
Q

What is diastolic heart failure?

A

Diastolic heart failure is characterized as an impaired ability for the heart to FILL during diastole.

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4
Q

Heart failure can be sudden, acute or slow, with a progressive onset. As the ability of the heart continues to decline, what are the four major compensatory mechanisms that kick in to assist the muscle?

A
  1. ventricular dilation
  2. ventricular hypertrophy
  3. increases SNS stimulation
  4. neurohormonal response
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5
Q

What is ventricular dilation?

A

When pressure in the left ventricle is increased over a period of time, its muscle fibers stretch out and the ventricular chamber is enlarged. As elastic fibers become damaged, eventually impairs the ability of the ventricle to fully contract and the ejection fraction is diminished.

  • results in ventricular hypertrophy.
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6
Q

What is ventricular hypertrophy?

A

Ventricular hypertrophy occurs when there is demands made on the heart with conditions such as HTN and CAD.

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7
Q

Hypertrophic heart tissue results in what changes or risks to the body?

A
  • decreased contractility
  • increased oxygen demand
  • increased risk of ischemia
  • increased risk of dysrhythmia’s
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8
Q

What changes occur in the kidneys when the heart is compromised?

A

When the heart is compromised, kidney perfusion is reduced. The juxtaglomerular apparatus senses a decrease in blood pressure, which releases rennin, a hormone that increases blood pressure. Renin is converted to angiotensin II that stimulates the release of aldosterone which causes vasoconstriction to increase BP.

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9
Q

What is hepatomegaly?

A

Hepatomegaly is enlargement of the liver secondary to right-sided heart failure.

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10
Q

What is jugular venous distension?

A

Jugular venous distension is distension of the jugular vein in the neck which is typically caused by heart failure or HTN

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11
Q

What is cor pulmonale?

A

Cor Pulmonale is right-sided heart dilation and hypertrophy due to heart failure.

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12
Q

Pulmonary edema manifests as a progression through three phases. Describe each one.

A
  1. Pulmonary congestion begins to increase the amount of fluid in the interstitium around the pulmonary capillaires. S&S slight increased RR and decreased arterial oxygen levels
  2. Further congestion occurs at the capillary beds. The lymph system cannot keep up with drainage, and interstitial swelling occurs. This is the actual manifestation of pulmonary edema. S&S: increased respiratory rate (tachypnea), SOB
  3. Fluid begins to escape the interstitium and enters the aveoli. Serosanguinous fluids collect in the lung, causing alveolar edema!
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13
Q

What are S&S of pulmonary edema?

A

The S&S of pulmonary edema are unmistakable. The patient will be cold, clammy, pale, and possibly cyanotic with increased anxiety, heart rate and RR (>30) and dyspnea

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14
Q

What are the clinical manifestations of heart failure?

A
  1. fatigue
  2. dyspnea
  3. tachycardia
  4. edema
  5. nocturia
  6. skin changes
  7. behavioural changes
  8. chest pain
  9. weight changes
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15
Q

Why do patients who are experiencing heart failure feel fatigued?

A

Patients with HF are fatigued because of the lack of oxygen to the body tissues and cells.

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16
Q

Why do patients who are experiencing heart failure feel dyspnea?

A

Patients with HF experience dyspnea because of pulmonary congestion

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17
Q

Why do patients who are experiencing heart failure feel tachycardia?

A

Patients with HF experience tachycardia because the body’s first response to decreased cardiac output is SNS stimulation causing epi/norepi to make the heart beat faster

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18
Q

What are the complications of severe heart failure?

A
  1. pleural effusion
  2. dysrhythmias
  3. left ventricular thrombus
  4. hepatomegaly
  5. renal failure
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19
Q

What is pleural effusion?

A

Pleural effusion is an accumulation of fluid in the pleural membranes surrounding the lungs, it reduces lung compliance.

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20
Q

Pulmonary edema occurs with left or right-sided heart failure?

A

Pulmonary edema occurs with left-sided heart failure.

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21
Q

What two hormones does the heart produce that counters the effects of aldosterone and angiotensin II and what effect do they have on the body?

A

Atrial nanriuretic heart peptide
Brain natriuretic peptide

They cause vasodilation and increased glomerular filtration; more blood moves into the vascular “reserve pool” and salt and water are eliminated in the kidneys

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22
Q

What is left-sided heart failure?

A

The left ventricle usually fails first. When this happens, the left side cannot keep up with the volumes produced by the right. As a result, congestion occurs and pulmonary circuit pressures increase. With the increase in pulmonary hydrostatic pressures, the pulmonary oncotic pressures are insufficient to adequately pull back serum filtered out of the blood at the pulmonary capillary beds. As a result, pulmonary edema occurs that eventually “leaks” out into the alveoli, often with some blood.

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23
Q

This type of heart failure will give the patient a pink, frothy productive cough. What causes the pink froth?

A

Left-sided heart failure secondary to pulmonary edema leaking into the alveoli, often with some blood.

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24
Q

What is right-sided heart failure?

A

When the right side of the heart fails, pressure backs up out into the vena cava and affects the organs that are closest by way of circulation distance. Increased backpressure to the liver results in liver enlargement called hepatomegaly. Jugular venous distension can be observed. Vascular congestion of the GI system causes noticeable symptoms and peripheral edema can occur

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25
Q

As cardiac tissues are damaged, which two cytokines cause major destruction to the heart, including contractile dysfunction, muscle myopathy, and fatigue that accompanies heart failure?

A

Tumor necrosis factor

Interleukin

26
Q

Why are there behavioural changes that occur in someone who has heart failure?

A

In HF, and with ↓ cardiac output, cerebral blood flow can become compromised. When this occurs, the lack of oxygen to the brain results in restlessness, confusion, and decreased attention span or memory.

27
Q

Problems with coronary circulation compound when combined with the increased work of the heart in HF. This results in angina.

A

Myocardial ischemia

28
Q

What is atrial fibrillation?

A

As the heart becomes enlarged (dilation and hypertrophy), disturbances in its neural systems may occur. Atrial fibrillation results in poor ventricular filling and results in a CO decrease of 10-20%.

29
Q

Additionally, non-circulating areas of atrial blood may clot, and an atrial thrombus can occur. If the thrombus detaches, what effect can this potentially have on the body?

A

A detached thrombus becomes an embolus, which increases the individual risk for developing a stroke.

30
Q

What changes occur in right-sided heart failure?

A

In right-sided heart failure, venous blood return to the heart backs up from the inferior vena cava to the liver, causing blood congestion in the liver’s lobules (hepatomegaly). As a result, hepatocytes die, and fibrosis and cirrhosis can occur.

31
Q

What occurs if there is decreased perfusion to the kidneys?

A

Decreased blood perfusion to the kidneys results in renal insufficiency or renal failure.

32
Q

How are the classifications of heart failure determined?

A

Classifications of heart failure are determined by the occurrence of the symptoms dyspnea, angina, palpitations, and fatigue impairing increase in physical activity.

33
Q

Class 1 heart failure

A

no limitation of normal physical activity

34
Q

Class 2 heart failure

A

slight limitation of physical activity

35
Q

Class 3 heart failure

A

Marked limitation of physical activity

36
Q

Class 4 heart failure

A

Class 4 – Symptoms limit the ability to perform any physical activity. Symptoms may be present at rest.

37
Q

Decreasing intravascular volume to decrease venous return (decreases preload) helps to manage heart failure. Describe what drug is used and what effect it has on the heart.

A

Loop diuretics are used to reduce intravascular fluid volumes. By reducing intravascular fluid volumes, venous return is reduced, and preload is decreased. Decreasing the preload results in more efficient left ventricular contractions and improved cardiac output.

38
Q

In the treatment of heart failure, loop diuretics help to decrease intravascular volume, resulting in more efficient improved CO. What other benefits result from this decrease in fluid?

A

Decreasing intravascular volume, reduces pulmonary congestion and makes for more effective gas exchange at respiratory membranes.

39
Q

What drug is used to decrease venous return (preload)?

What changes occur in the cardiovascular system to enhance the condition of the heart?

A

Nitroglycerine can be used to decrease preload by dilating peripheral blood vessels.

Nitroglycerine decreases the after-load and vasodilates coronary vasculature increasing oxygen supply to the heart.

40
Q

Reducing venous return to the heart reduces _______.

A

preload

41
Q

Reducing systemic vascular resistance reduces _____.

A

afterload

42
Q

What type of drug would be used to dilate BOTH veins and arteries to decrease preload and afterload?

A

Nitroprusside’s decrease preload and afterload

43
Q

This drug has been known to reduce preload and afterload because it dilates systemic and pulmonary vessels, it improves pulmonary circulation and reduces congestion, improving gas exchange.

A

morphine

44
Q

Any medications that vasodilate both arteries and veins have a really high risk of what type of complication?

A

orthostatic-hypotensive complications. Monitor clients’ BPs frequently.

45
Q

What three interventions can be used to improve gas exchange in someone who suffers from heart failure?

A
  1. anti-anxiety medication reduces respiratory and muscoskeletal activity, reducing the need for oxygen
  2. administration of oxygen to increase available oxygen in blood
  3. Positive-airway-pressure-devices such as CPAP that prevent the lungs from fully deflating.
46
Q

When the use of loop-diuretics, vasodilator, and morhpine sulfate fail to stablize cardiac function, what other types of more aggressive procedures or drugs are used to treat HF?

A

Pulmonary arterial catherter

Inotropic drugs to increase heart contractility

47
Q

Diuretics _____ blood volume, ______ venous pressure and preload. Additionally, they help to mobilize edematous fluid accumulations.

A

reduce; lowering

48
Q

What is the action of thiazide diuretics and what are they useful in treating?

A

Thiazide diuretics increase sodium and water excretion by inhibiting sodium and water reabsorption at the distal tubule, lowering blood volumes.

They are useful in treating edema from HF and hypertension.

49
Q

What is the action of loop diuretics?

Give an example of a loop-diuretic drug.

A

Loop diuretics are potent diuretics that act on the ascending loop of Henle to promote sodium and water excretion.

Drugs: Lasix; furosemide

50
Q

This classification of drugs are used as the first-line treatment of heart failure.

A

ACE-inhibitors such as Ramipril greatly reduce afterload

51
Q

What is angiotensin II?

A

Angioensin II is a potent vasoconstrictor that increases blood pressure and cardiac work requirements.

52
Q

What is the action of beta-blockers?

A

Beta-blockers inhibit the effects of norepinephrine and epinephrine on the heart and body blood vessels. They lower the heart rate.

Watch for HYPOTENSION

53
Q

Sympathomimetic drugs, are inotropes that mimc the effect of these hormones.

A

Sympathomimetic drugs are positive inotropes mimic the effects of epinephrine and norepinephrine. They simulate the heart, increasing its contractility and output.

Used in short-term treatment due to impairment of the SNS

54
Q

What is the action of Phosphodiesterase inhibitors, another type of inotropes?

A

Phosphodiesterase inhibitors increase calcium flow through ion channels and increase the heart’s muscle contractility.

They also work as potent dilators.

55
Q

What is the action of digitalis drugs?

Name one drug.

A

Digitalis, also known as “cardiac glycosides”, stabilize the hearts rate of firing, correcting fibrillation. They decrease the conduction speed of cardiac nerve fibres, lowering the heart rate.

56
Q

What is a major concern when administering Digitalis drugs, such as digoxin?

A

Toxicity is a major concern with the use of digitalis medications. Individuals taking them require frequent serum-drug concentration monitoring.

57
Q

What is the action of vasodilators?

A

Vasodilators increase heart contractility by reducing the preload.

58
Q

Nitrates are what classifcation of drug?

A

Vasodilators

59
Q

Do Nitrates vasodilate the ateries or veins?

A

Veins

60
Q

This refers to the ongoing measurement of pressure, flow, and oxygenation within the cardiovascular system.

A

Hemodynamic monitoring

218: Patho Part II (8 decks)

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