Week 4 Flashcards
What happens during systolic heart failure
LV weakened and muscle cant contract as well
What happens during Diastolic heart failure
LV muscle thickens and can’t relax normally
Define cardiac failure
Heart loses ability to pump properly
Myocardium cannot generate enough force to expel blood from ventricle
- ejection fraction is low
- low stroke vol
- normal end diastolic vol
- high end systolic vol
Define diastolic failure
Myocardium loses ability to relax and accept blood
Myocardium has decreased compliance so during diastole it is
unable to expand and fill with blood
• Ejection fraction is normal
• Low stroke volume
• Low end diastolic volume
• Normal/Low end systolic volume
What happens with right sided heart failure
Failure of the right ventricle to pump enough blood
- Pitting oedema something to look for
What are the symptoms of right sided heart failure
- fatigue
- increased venous pressure
- distended jugular veins
- Ascites
- Enlarged liver & spleen
- Weight gain
- Anorexia & GI distress
- dependent oedema
What are the symptoms of left sided heart failure
- Paroxysmal nocturnal dyspnea
- Elevated pulmonary pressure
- Pulmonary congestion
- Couch, crackles, wheezes, blood-tinged sputum, tachypnea
- Restlessness
- Confusion
- Tachycardia
- External Dyspnea
- Fatigue
- Cyonosis (peripheral)
What happens with left sided heart failure
Failure of the left ventricle to adequately pump enough blood
What is Biventricular failure?
When failure occurs in both ventricles, left and right.
What is the difference between acute and chronics heart failure?
Acute is sudden onset, chronic is progressive worsening
What is Starlings Law?
Define this…
What are the causes of heart failure?
Ischaemic heart disease • STEMI • NSTEMI Hypertension Valvular disease Cardiomyopathy Diabetes Mellitus Causes
What is ischemic heart disease?
- most common cause of heart failure
Caused by myocardial scarring and loss of contracting heart tissue post infarct
event.
What is arterial hypertension?
Elevated BP common cause of LV hypertrophy
May lead to LV diastolic and systolic dysfunction and heart failure
What happens during mitral valve stenosis?
Hardening and thickening of the valve vessel
Going to get reduce blood filling in ventricle. Leading to diastolic heart failure which leads to thickening of the myocardium.
What happens during mitral valve regurgitation
Loose valve which leads to backflow into atrium and into either pulmonary of venous system.
What is cardiomyopathy
- Series of multiple of issues
Characterised by enlargement of chambers
What type of failure does cardiomyopathy lead to?
Systolic heart failure
What are the pathological features of cardiomyopathy?
- Dilated cardiomyopathy
Characterised by enlargement of chambers
Stretching of myocytes and loss of contractility
->systolic HF
- Hypertrophic cardiomypathy
Characterised by thickening of heart muscle
Wall of myocardium become thick and non-compliant
- > First causes diastolic then systolic heart failure
- Restrictive cardiomyopathy
Characterised by increasing stiffness of ventricular
wall
Wall of myocardium become non-complaint
->Diastolic HF
What is the difference between hydrostatic pressure and osmotic pressure?
Hydrostatic - Pushes fluids across membranes due to blood pressure
Osmotic pressure - Pulls fluid across membranes to balance concentration
What happens during acute pulmonary oedema?
- Heart failure causes a decrease in LV function
- Activation of compensatory mechanisms
- Increase in left ventricular end diastolic pressure
- Transmission of pressures back through LA into pulmonary arteries
- Increased capillary hydrostatic pressure
- Leakage of serous fluid into alveoli
- Build up of fluid in alveoli
- Loss of surface area for gas exchange causes decrease in –SpO2 and increase in PCO2
- Loss of surfactant causes collapse of alveoli and increase in work of breathing
What are the symptoms of Acute Pulmonary Oedema
Short of breath – remember postioning Anxious High work of breathing Decreased speech Hypertensive often 150+/90+ Decreased SpO2 Tachycardia \+/- Cough Pink frothy sputum - fulminating APO
What is a differential between APO and asthma/CPOD?
High Blood pressure
When auscultating for APO what are you listening for?
-> Listen to front and back. 8 places in each
-Fine inspiratory crackles
Bilateral
-Starts at bases and move up
chest with progression
-Be systematic - compare left to right
How do you treat APO?
- O2 - 10+L via non re-breather
- GTN - decreased preload and afterload (reduce arterial pressure and systemic venous return)
- R+R
- CPAP
- Diuretics (ICP level) - decreases blood volume
What are the contraindications for CPAP?
GCS < 13 Facial trauma Pneumothorax Active vomiting Life threatening arrhythmias The need for a secure airway Hypoventilation
What are the indications for the removal of CPAP?
Cardiac/respiratory arrest • Mask intolerance/patient agitation • Nil improvement after 1 hour of treatment • HR < 50 or SBP < 90mmHg • Loss of consciousness or GCS < 13 • Decreasing SpO2 • Loss of airway control • Copious secretions • Active vomiting
What are some common issues associated with CPAP?
Claustrophobic
Noisy
Uncomfortable
Patient feel like they are suffocating
What is cardiogenic shock?
Persistant hypotension and tissue hypoperfusion caused by cardiac dysfunction in the
presence of adequate intravascular volume and left ventricular filling pressure.
What are the causes of cardiogenic shock?
AMI Cardiomyopathy Sepsis Myocarditis Dysrhythmias – decreased diastolic filling Metabolic abnormalities Papillary muscle rupture Aortic or mitral valve insufficiency
What is the ejection fraction?
The percentage of blood in a ventricle ejected with each contraction
What is the normal percentage of ejection fraction?
55-75%
<40% - Low
<25% - constantly symptomatic
