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Congestive Heart Failure
Terms in this set (37)
What is the definition of congestive heart failure?
Congestive heart failure is the syndrome in which the heart has a reduced ability to fill or pump blood. This leads to a state where the heart is not pumping enough blood to get tissues adequate oxygen.
What are the four ways in which heart failure can be classified?
Heart failure can be classified as systolic or diastolic, high output or low output, left sided or right sided, and acute or chronic
What are the 6 major risk factors for the development of congestive heart failure?
Coronary artery disease, hypertension, diabetes, valvular heart disease, cardiomyopathy, and obesity
What is the equation for cardiac output?
Cardiac output is the heart rate multiplied by the stroke volume
What is the equation for stroke volume?
Stroke volume is the end diastolic volume minus the end systolic volume
What is the definition of preload?
Preload is the pressure required to distend the ventricle to a given left ventricular end diastolic volume
What is the definition of afterload?
Afterload is the dynamic resistance against which the heart contracts
What is the pathophysiology of systolic heart failure?
The heart develops decreased contractility which leads to a decreased ejection fraction. To compensate the body activates the renin-angiotensin-aldosterone system, the sympathetic nervous system, and released BNP from the ventricles.
What is the pathophysiology of diastolic dysfunction?
In diastolic dysfunction there is a decrease in ventricular compliance and therefore a difficulty filling.
What are some of the conditions that can lead to decreased ventricular compliance, and therefore to diastolic heart failure?
Hypertension leading to concentric wall thickening, amyloidosis and hemochromatosis leading to chamber stiffness, hypertrophic cardiomyopathy, and myocardial ischemia
How does heart failure lead to pulmonary congestion?
If there is left sided heart failure there can be a back up of fluid into the lungs
What are some causes of high output heart failure, where the cardiac output is elevated, but the heart can still not meet metabolic demands?
Causes of high output heart failure of wet beri beri, hyperthyroidism, and AV malformation
Most symptoms of heart failure are caused by pulmonary congestion, what are some of these symptoms?
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough and wheezing
If there is right sided heart failure leading to third spacing what are some other clinical manifestations that may be observed?
Peripheral edema and weight gain
What are some of the causes of acute decompensated heart failure?
Myocardial infarction or arrhythmia, diet or medication non-compliance, illness, and recent bleeding
What should be done on the physical examination when congestive heart failure is suspected?
The heart should be auscultated, PMI palpated, jugular venous distention checked, lungs auscultated, hepatojugular reflex checked, and a peripheral exam to look for signs of edema
Which chemotherapy drugs are known for causing dilated cardiomyopathy leading to CHF?
Daunirubicin and doxirubicin
If on cardiac auscultation there is an S3 heart sound heard, what does this mean?
S3 heart sound is the sound of blood rushing into a partially filled ventricle indicating systolic dysfunction
If on cardiac auscultation is S4 heart sound is heard, what does this mean?
S4 heart sound indicates a stiffened ventricle indicating diastolic dysfunction
If rales are heard on lung auscultation what does this signify?
What virus is known for causing heart and pericardial problems?
Although heart failure is typically diagnosed by the history and physical, what are some of the diagnostic tests and imaging that can be used?
Chest x-ray, EKG, BNP level, and echo
What is considered to be a normal BNP level?
A normal BNP level is less than 100 pg per ml, and a level over 500 indicates that there is likely congestive heart failure
What exacerbating factor could make BNP levels higher than they should be?
Should a CBC and CMP be done in patients with congestive heart failure?
Yes, these tests can help rule out underlying causes or sequalae. LFTs can show if there is hepatic congestion, electrolytes may be low, and with hemachromatosis red blood cells may be extra elevated.
What is the mnemonic for the acute treatment of pulmonary edema?
Lasix, morphine, nitroglycerin, and oxygen
What is the agent of choice for treating cardiogenic shock?
What three agents show a mortality benefit when treating systolic dysfunction?
Beta blockers, ACE inhibitors, and aldosterone antagonists such as spironolactone or eplirinone
How do ACE inhibitors help with congestive heart failure?
ACE inhibitors reduce afterload and attenuate the sympathetic compensation
What should be given to patients that cannot tolerate ACEs or ARBS?
The combination of isosorbine and hydralazine
How do beta blockers help with congestive heart failure?
Beta blockers have both antiarrhythmic activity and block the sympathetic activation
What lab needs to be closely monitored in patients taking spironolactone and eplerenone?
Potassium, because they are both potassium sparing diuretics
What diuretics are most commonly used in symptomatic treatment of congestive heart failure, but show no mortality benefit?
Loop diuretics such as furosemide
What thiazide diuretic is commonly added to a loop diuretic to jump start the diuresis?
While digoxin is used for the treatment of CHF it does not decrease mortality and has a low therapeutic index. What are some of the effects of digoxin toxicity?
It can lead to anorexia, nausea, and vomiting, changes in vision to a yellowish color, and arrhythmias
What can be done in patients who have heart failure and experience either ventricular fibrillation or symptomatic ventricular tachycardias or have an ejection fraction less than 35%?
A cardiac defibrillator can be implanted
What is one of the criteria for implantation of a biventricular pacemaker?
A prolonged QT interval
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