Week 5 Heart failure and dysrhythmias Flashcards
What are the classic signs of Heart failure?
- Edema
- Pulmonary edema (auscultate lungs for crackles)
- SOB
- Crackles
What the 2 risk factors for HF?
- CAD
- HTN
What is cardiomyopathy and what are the 2 reasons it occurs?
damage to the heart muscle so it can’t pump efficiently
1. Stenosis - tight valve - increased workload
2. Loose valve- back flow
What 2 chronic conditions cause contractility heart issues?
- CAD
- Cardiomyopathy - stenosis/loose valve
What 2 acute conditions cause contractility heart issues?
- acute MI (STEMI)
- Myocarditis - inflammation
What 2 things impact afterload?
HTN
Pulmonary disease (ex COPD)
What affects preload that leads to HF?
- hypotension
- valve disease
what 4 events cause a lack of O2 to the heart coronary system?
- CAD
- Heart block
- heart Failure
- arrythmia
what is HF with reduced EF?
<40%
pump issue - systolic dysfunction
What is HF with preserved EF?
<40%
filling issue - dystolic dysfunction
What are the 4 HF compensatory mechanisms
- SNS
- RAAS
- Ventricular Dilation - LV enlarges - stretch too far = ventricular remodeling
- Ventricular hypertrophy- enlarged heart =dysrhythmias
what type of meds do we use to help reduce compensatory mechanisms?
- SNS- beta blockers
- RAAS - ACE/ARB/ARNI
- ventricular dilation-
- ventricular hypertrophy -
what are the signs of LSHF perfusion issue?
fatigue
confused
tachy (SNS compensation)
angina (less O2 to heart)
Oliguria <400ml in 24 hrs
pallor
cool
weak pulse
what are the signs of LSHF congestion issue?
cough
dyspnea (alveoli take on water)
orthopnea - can’t breathe laying down
paroxythal nocturnal dyspnea -waking at night SOB
adventisia in lungs
pink sputum - frothy
S3 & S4 sounds
how does LSHF happen?
blood backs up to the pulmonary system
issue with Left ventricle
how does RSHF happen?
blood backs up to the venous system
issue with right ventricle
What are the signs of RSHF?
weight gain - edema
increase BP - affects afterload
JVD
N&V- acities
distended abdomen
liver & speen enlarged
Polyuria at night b/c gravity at kidneys
dependent edema
Does hyperkalemia and hypokalemia slow heart impulses or increase heart impulses?
both SLOW impulses
What are the most common indicators of hypokalemia?
- *U wave
- low T wave
- PQ elongated
- QT increased
What are the most common indicators of hyperkalemia ?
- *T wave peak
- P- very low
- PQ elongated
- QRS wider
What is the most common dysrythmia?
afib
What are the after load drugs (blue)?
ARNI- sacubiteil/valsartanw(entresto)
ACE- captopril
ARBS- losartin (cozar)
Beta blocker- metoprolol
Calcium Chanel blocker - verapramil
Vasodilation - hydralazine
What are the preload drugs (green) ?
- Morphine
- SLGT-2 - canagliflozin
- Diuretics- all 3
- Beta blocker - metoprolol
- Nitrates - nitro spray - relaxes vasoapasm in coronary arteries only & veins ( isosorbide dineitrate)
what is the 3 goals of meds for heart failure?
- reduce cardiac workload (afterload)
- control pain (preload)
- prevent/destroy clots
what do contractility meds help with?
forward flow
what is an example of a contractility med?
digoxin
what are the 3 drugs for Afib that slow ventricular rate?
beta-adrinergic blockers
calcium channel blockers
digoxen
What drug helps prevent blood clots in Afib?
warfarin
why are vasodilators taken short term?
tolerance develops
what is the adverse affect of vasodilators (Hydralazine) and how do we prevent it?
reflex tachy
with beta blocker
what does aldosterone cause?
sodium & water uptake
what does angiotension II cause?
vasoconstriction
what is ventricular remodeling?
when there is to much blood so the ventricles stretch and the cells start to change. The ventricle changes because the cells are changing
why is ventricular remodeling bad?
because it causes the cells to change and demand more O2.
so ischemia
and arrythmias
what do cardiac cells release to help compensate?
naturetic peptide
blocking RAAS causes sodium and water to do what?
leave the body
What does P wave represent?
Atrial depolarization (SA to AV)
what must we know BEFORE giving Dig and why?
K+ level!
hypokalemia will cause hypereffect with dig
hyperkalemia will compete with Dig and reduce affect
what 2 conditions is dig used in?
HF and Afib
what 3 patients cannot have tPA?
- intracranial hemorrhage
- recent stroke (<3 months)
- active internal bleeding
