week 5: heart failure/dysrhythmias Flashcards
what is the definition of heart failure?
when the heart’s ability to pump blood has been compromised leading to ↓ CO
why can heart failure occur?
Due to impaired cardiac pumping or filling, or both
two major: pump or sqeezing action of heart muscle
lack of heart filling - either stiff heart or smaller than normal
true or false due to heart failure?
Results in accumulation of fluid in lungs and/or the periphery
* Can be acute or chronic
* Major reason for hospital admission in adults over 65 years
true
what can heart failure also be called?
pump failure - when heart is not pumping correctly
what is one thing to remember about heart failure? think CO
Co = SV x HR
CO should be 3-6L/min
what are the five factors affecting CO?
cardiac contractility
heart rate
preload
afterload
blood volume
what does r side heart failure back up to ?
systemic circulation
what does l side heart failure back up to?
pulmonary circulation
what does heart failure affect (just checking if you get it)
cardiac functioning
what are the risk factors of developing heart failure?
- CAD
- HTN
- DM
- Smoking
- Obesity
- High cholesterol
why is CAD and HTN bolded as risk factors of HF?
CAD: obstruction in the coronary arteries, reduces blood flow to myocardial - can lead to cardiac tissue damage which affect the pumping function of the heart
HTN: afterload - increase in resistance against heart pumping action - thickening of ventricle wall - leads to dysfunction
what does DM, smoking, obesity and High chlosterol cause - related to HF?
atherosclerosis - triggers an inflammatory response
what are the chronic causes of HF?
CAD - contractility
Cardiomyopathy - disease to the myocardial, many different kinds, contractility
HTN - afterload, systemic - right sided - high pressur eand higher workoad
Pulmonary disease - afterload
Valvular Disease - valves become tight - stenosis, loose dont close properly
what are the acute causes of HF?
Acute MI- contractility
Myocarditis - contractility, inflammation of the heart in response to an infection
Hypertensive crisis - aftrload, bp goes up quickly
Rupture of papillary muscle (preload increasing filling pressure and backflow into chambers of heart) - leads to regurgitation of backflow
Dysrhythmias - HR
what is ejection fraction?
percentage of end-diastolic blood volume that is ejected during systole
blood is left behind, below 40% ejection is not providing enough blood- may be in heart failure
what is normal ejection fraction (EF)?
50-70% - it I s a misconception that all the blood in the heart gets pumped out
what is an important measurement we use to determine the functioning of the heart amount of blood every time it beats
ejection fraction
___ means contraction, so when we are talking about heart failure that is caused by pump problems. This would include conditions where the muscle is destroyed. Name these type of conditions
systole, and conditions such as myocardial ischemia, cardiomyopathy, or long standing HTN can be an example.
Name the two characteristic of pathology of heart failure
HF with Reduced EF ( systolic dysfunction )
HF with Preserved EF ( diastolic dysfunction )
what is the most common form of HF ? and what does this do ?
the most common form is HF with reduced EF ( systolic dysfunction )
the heart is unable to pump blood effectively
LV cannot contract strongly enough to pump blood into aorta: this undergoes which pathology of heart failure ?
HF with Reduced EF ( systolic dysfunction )
True or False. HF with reduced EF ( systolic dysfunction ) : EF usually less than 40%.
true
What is HF with Preserved EF ( Diastolic dysfunction )
inability of ventricles to relax and fill during diastole
decreased filling results in decreased SV
This is high filling pressure to to poorly complaint ventricles and ventricular hypertrophy common.
HF with preserved EF ( diastolic dysfunction )
what is a pumping problem and what is a filling problem ?
HF with reduced EF ( systolic dysfunction ) and HF with preserved EF ( diastolic dysfunction )
Why is dialostic dysfunction more complicated than HF with reduced EF ( systolic dysfunction ) ?
cardiac muscle is working but cannot relax, reduced cardiac output and stroke volume
what is a mixed HF ?
both systolic and diastolic dysfunction, the patient with combination have extremely low ejection fraction less than 35 %- poor cardiac output
HF : compensatory mechanisms ( what are the different kind of mechanisms )
SNS activation
neuro hormonal response ( RAS )
ventricular dilation
ventricular hypertrophy
The release Catecholamines, in which increases this mechanism, most immediate mechanism that will come to rescue
SNS activation
What happens when the heart rate becomes too rapid?
the heart ability to fill during diastole is limited and cardiac output is decreased. Increase in arterial vasoconstriction tightening of the vessels, affect the SV because it increase afterload.
briefly explain the HF : compensatory mechanisms
SNS activation : increase in heart rate, increase in contractility , peripheral vasoconstriction
Neuro hormonal Response ( RAS ) : NA/ Water retention, increase periph vaso. , ADH causes water retention
ventricular dilation : enlargement of the heart chambers ( usually LV ) , muscle fibers of heart stretch ( initially good but over time stretch too far and decrease CO )
ventricular hypertrophy : increase muscle mass and ventricular wall thickness
why would neuro hormonal response be a bad thing in the long run ?
helping us in the moment but in the future it is actually increasing our fluid overload
ventricular dilation is poor conduction that can lead to dysthymias, is this true or false.
true
when the chamber wall thickens - there is less room for filling during diastole
this is true
cardiac hormones release by the heart if it’s under stress or what state ? this causes strecth and causes diuresis ( increase peeing, widening of the vessels and work against the raas system.
heart failure
ADH is also referred to as
vasopressin
what does vasopressin mean
causes fluid retention, with this blood volume increase venous return to the heart goes up, high preload
what happens if u have constantly high preload
causes stretches to accomodate to the end of diastole ventricular dilation
although the enlargement of the chambers how can it contribute to not being helpful?
at some point becomes over stretched and cardiac output will drop off
ventricular hypetrophy is common where ?
long standing HTN and the muscle grows to meet the increased workload demands
types of heart failure : acute vs chronic and left vs. right sided
acute comes quickly ( pulm edema) and chronic happens over years ( neuro- hormonal activation)
acute on chronic heart failure
both are equally life threatening
types of heart failure :
left vs right sided
left sided HF symptoms due to decrease CO or pulmonary congestion
right sided HF symptoms related to increase systemic venous congestion
failure of one pump will eventually cause other pump to fail = biventricular failure
what is the classic symptom of acute heart failure is the development of ?
flash pulmonary edema
what are the compensatory of chronic patients ? can you name an example for this ?
associated with neuro hormonal activation to compensate to maintain cardiac output, for example , result of long standing hypertension ( standing against that resistance, lead to HF)
what does the right side receive and where does it go , what happens when the right side fails ?
right side received deoxygenated blood from the body and brings it to pulmonary circulation
when the right side fails there is a backup of blood into the peripheral veins - venous circulation
As the pressure rises in the veins, fluid begins to leak into the interstitial which occurs all over the body, is this true or false?
this is true
right sided heart failure head to toe : ** hint this is referring to fluid over load **
jugular vein distention
swollen hands and fingers
anorexia and nausea
distended abdomen
enlarged liver and spleen
polyuria at night
dependent edema
a person can also develop ascites and not being hungry ( feeling full )
what are the general symptoms of right sided heart failure ?
weight gain and increased BP
Right sided heart failure is usually referring to
referring to that accumulation of fluid everywhere
left sided heart failure
Decreased CO
fatigue/weakness
confusion, restless
tachycardia
angina
oliguria
pallor, weak
peripheral pulses
cool extremities
faitgue/weakness and confusion/restless is more common in older adult when it comes to left sided heart failure
yes this is true
left sided heart failure what does it relate to ?
relate to decreased perfusion to the tissues, not receiving adequate blood flow
left sided heart failure :
pulmonary congestion
cough
dyspnea : orthopnea , paroxysmal nocturnal dyspnea
crackles/wheezes
frothy, pink tinged sputum
s3/s4 gallop
what is paroxysmal nocturnal dyspnea ?
waking up at night suddenly SOB ( suffocation )
where is the cardiac electrical system found ?
this is found in the right atrium - the SA node
what part of the heart has the ability to depolarized ?
Sa node have the ability to depolarized, depolarization means that the cell goes form neg. charged to becoming positive resulting in a contraction.
name the characteristics of the cardiac electrical system
impulse is iniated in SA node
travels down atria to AV node ( signal is delayed for ventricular filling )
signal then travels down bud;le of his to L and R bundle of branches and purkinje fibers
why is the impulse delayed?
it allows for increase ventricular filling so that tricuspid will remain open for longer ( stronger contractions moving forward )
The atria and ventricle are isolated from each other, what is the only way a signal can pass from atrium toventricle ?
through an AV node
what are the properties of cardiac cells : ACCE
automacity
contractility
conductivity
excitability
The atrium depolarize via what ?
ventricles
what is the ability to transmit an impulse called ?
conductivity
The electrocardiogram : what is it ?
when electrolodes are place on the skin, an electrical signal of the entired heart is observed ( EKG )
what signs can an ecg give u
ecg can give a lot of signs of muscles not getting enough blood, it can tell cardiac muscle is thicker than normal
what else can ecg pick up ?
electrolytes imbalances ( potassium imbalances )
what type of abnormalities can and EKG see?
EKG can detect abnormalities in cardiac conduction, ischemia, infraction, hypertrophy, and electrolyte imbalances
how are waveforms form in EKG ?
waveforms are produced by charged ions moving across membranes of myocardial cells
At rest what is the inside of the cell’s charge ?
negative
What happens when the cell is stimulated ?
there is a change in charge, from neg. to pos. ( depolarization )
where is the wave that corresponds with atrial repolarization?
it occurs with the ventricular depolarization - it gets hidden in the QRS complex
the movement of the impulse and subsequent depolarizaition of the atria and ventricles from the SA Node all the way to the purkinje represents as what wave ( s )
P WAVE, QRS complex, and T WAVE
the corresponding mechanical activity is contraction of atria followed by contraction of ventricle - the heartbeat
what does the action potential represent ?
represents the change in voltage across the single cell due to impulse
how does action potential occurs ?
when the charge across the membrane changes from neg. to pos., the changes in charge is due to the movement of ions in and out of the voltage gated channels.
ECG waveform represents ……
an impulse moving through the entire heart
how many phases can depolarization of a cell divide ?
4 phases
Conduction on ECG : what is NSR
a term used to describe a normal ECG rate and rhythm, generated in the sinotrial node
Sa node cells depolarize faster than other cardiac cells, what does this mean ?
it sets the pace of conduction
ONLY an impulse from where will derived a coordinated cardiac cycle with good stroke volume
SA NODE
what are the ‘backups’ if the SA node is not functioning properly ( intrinsic rates )
AV/junctional
ventricular and purkinje fibers ( this is not fast enough to maintain CO )
what are the two types of ECGs
12 lead ECG
continuous cardiac monitoring
what is the 12 lead ECG
10 electrolodes placed on chest and limbs, giving 12 views of the heart
- diagnostic ( rhythm, ST elevation )
what is the continous cardiac monitoring ?
3 electrolode placed on chest
gives 5 views of heart
monitor rhythym , ST elevation ( changes or diagnosis always made with 12 lead )
12 lead is used for what? and telemetry is used for …?
to diagnose
and telemetry is used for monitoring
if pateint is in risk of low ischemia and low cardaic output then we can identify as t changes quickly and intervene
any changes can be confirmed with ….
12 lead ECG
acute cardiac symptoms or heart rate has suddenly become irregular, what are we utilizing in term of ecg ?
12 lead ecg
ECG analysis w, another word for leaders in ( 12 lead ECG ) is what ?
views
when we are looking at the ECG what are we looking at ? and what does those specific changes lead to or indicate?
we are looking at the angle of the heart, and those specific changes indicates problem with the coronary artery ( or oxygenated blood )
if there is an ST eleavtion , what does this tell you ?
obstruction in the artery ( most liely )
what does the 12 different leads or views help us diagnose ?
helps diagnose location of the MI or determine where blockages are happening
why would you want to print a telemetry result out?
tells you the patients baseline rhythm so we can compare if it changes
the st segment - review
what is a st segment depression
ischemia caused by partial occulusion of ca coronary artery : unstable angina and non stemi
what is st segment elevation ?
complete occlusion of the coronary artery, the entire thickness of the myocardium becomes ischemic : stemi
Potassium Imbalances and ECG changes , what does this effect?
effects the myocardium resting potential and ability to repolarize
what is the important electrolyte in part of the depolarization and repolarization
potassium
K imbalances tend to _____ through the AV node and the myocytes
slow impulse conduction
what are the characteristics of hypokalemia in ecg changes
prolonged PR
depressed ST
low or inverted T
appearance of U
increase in QT ( which predisposes to torsade de pointe )
name the characteristics of hyperkalemia in ecg
diminished or absent P
widening of the QRS
characteristic peaked T
cells become unexcitable
can rapidly progress to VT or VF and cardaic arrest
what is a lethal rhythm
torasde de pinte ( increase in QT )
characteristics peaked T in hyperkalemia can put the PT for risk lethal what?
arythmias
what type of wave is the depolirazation of atria
P wave
ST segment of depression is caused by
ischemia
T wave can be affected by …?
low potassium ( lower than normal or inverted )
U wave is unique to what characteristic ?
hypokalemia ( low potassium )
Q and T - is related to
this is related to slowing the conduction when we have low intervals
Sinus Rhythym :
what is the description
clinical associations
description : normal conduction
clinical associations : healthy adults
Sinus rhythm : ECG characteristics
clinical significance
treatment
rate 60-100 beats/min, regular, p wave precedes each QRS, PRI normal, QRS complex normal
none
none
true or false. each beat should be equal distant apart this is our heart rate when the beats is equal it is considered normal
true
true or false. always have a visibly P wave that is upright and comes before QRS complex, there should be a P wave for every WRS in the strip.
true
The QRS complex should always be narrow, it should always be followed by a rounded and upright T wave , we do not want to see U wave. Is this a true statement?
true
Sinus Bradycradia: what can impact this and what condition?
PNS , and hypothyrodism
Cardiac muscle is strong therefore you have a higher stroke volume and do not need the heart rate to be as high ( sinus bradycardia ) when u are an athlete
yes this is true
What is the description for sinus bradycardia
same conduction pathway as SR but SA node fires at a rate below 60 beats/ min
sinus bradycardia : clinical associations
may be normal in aerobically trained athleetes, secndary to medications, vegal stimulation, hypothermia, hypothyrodism , increase CP , Inferior Mi
sinus bradycardia : ecg characteristics and clinical significance
rate below 60 beats/min, regular , p wave precedes each QRS, PRI normal, QRS complex normal
if patient does not tolerate low heart rate may become pale, col skin, hypotensive, weak, angina dizziness, confusion , SOB
sinus bradycardia , do u have low or high co
low
sinus bradycardia how is the conduction pathway
conduction pathway is normal, the wave patterns follow the same rules develops fast rhythms because of SNS inhibition
Sinus tachycardia description
same conduction pathway as SR but SA node fires at a rate above 100 beats/min ( vagal inhibition or SNS )
what is the clinical associations of sinus tatchycardia
stress, exercise, pain, hypotension, hypovolemia, anemia, hypoxia, hypoglycemias, MI, heart failure
ECG characteristics of sinus tatchycardia
rate above 100 beats/min, regular, p wave precedes each QRS, PRI normal, QRS complex normal
what is the clinical significance of sinus tatchycardia and treatment
Clinical Significance: patient may develop dizziness, dyspnea and hypotension Treatment: based on cause
true or false. Sinus tatchycardia shortens the time of filling during the diastole period. ( less to feed the muscle )
this si true
coronary arteries fill during diastole which is shortened with increased HR can lead to what ?
angina
what is atrial fibrillation ?
total disorganization of atrial activity cause by multiple ectopic foci, loss of atrial contraction, most common dysrthmia, may be chronic or acute
what is the clinical associations of atrial fibrillation
occurs in patients with underlying heart disease, throtoxios, alcohol intox, caffeine use, electrolyte imbalances, stress
atrial fibrillation ecg characteristics :
atrial rate may be up to 600 bpm, ventricular rate varies between 50 - 180 ( irregular ) , p waves replaced by wavy baseline
what is the clinical significance of atrial fibrillation
decrease in CO ( loss of atrial kick and rapid ventricular response ) thrombus may be form because of stasis ( stroke risk increase 3-5 times )
we have a situation where there is decreased time time for ventircular during the time for diastole ( this drops co even more )
atrial fibrillation
statis ( the blood is just sitting there ) - increase risk of blood ( stroke ) what is this being reffered to ?
multiple ectopic foci
atrial tatchycardia , what occurs here
we are going to see rapid atrial contraction, many p waves in a row
atrial wave is so fast, and its almost not distinguish ( can be 600 waves per minute )
where are the impulses coming in a trial fibrillation
impulses are coming all the way from the atrium
there are multiple ectopic foci - these are impulse coming outside of where ?
sinotrial node ( stimulated so fast there is no time for normal contraction )
After Mi or longstanding heart failure ( alcohol or caffeine or stress , electrolyte imbalances can lead to ______ )
AFIB
not getting real contraction - not efficiently moving forward, this can be chronic or acute. This is so fast we arent able to do anything with the P wave
AFIB, we will notice they are not distance apart ( irregular rhythm ) because of occlusion going through av node at a irregular rate
the ventricular responses is faster or slower sometimes
