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88 terms

Heart Failure

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Heart Failure
a clinical syndrome that emerges when there is an impaired ability for the ventricals to fill with enough blood or eject enough blood to meet the body's demand
Causes of HF
hypertension, coronary artery disease, scare tissue from a previous MI
manifestations of acute Left Sides Heart Failure
Exertional dyspnea, orthopmea, parpxysmal nocturnal dyspnea, cough, blood tinged sputum, cyanosis, elevation in pulmonary capillary wedge pressure
manifestations of right sided heart failure
fatigue, dependent edema, distntion of the jugular veins, liver engorgement, ascites, anorexia and complaints of GI distress, cyanosis, elevation in peripheral venous pressure, nocturia
Backward effects of Left sided HF
decreased emptying of the left ventricle, increased volume and pressure in left vent, increased pressure volume in left atrium, increased volume on pulmonary veins, increased volume in pulmonary capillary bed transudation of fluid from capillaries to alveoli, rapid filling of alveolar spaces = Pulmonary Edema
Forward effects of left sided HF
decreased cardiac output, decreased perfusion in tissues of body, decreased blood flow to kidneys and glands, increased reabsorption of sodium and water from the increased secretion of the sodium and water retaining hormones, increased extracellular fluid volume and total blood volume
Backward effects of Right sided HF
decreased emptying of the right ventricle, increased volume and pressure in the right ventricle, increased volume and pressure in the right atrium, increased volume and pressure in the great veins, increased volume in the systemic venous circulation, increased volume in the liver and spleen, increased pressure at capillary line, hepatomegaly and splenomegaly, dependent edema and serous effusion
Forward effects of right sided HF
decreased volume from the right ventricle to the lungs, decreased return to the left atrium and subsequent decreased cardiac output, expansion of blood volume and all the forward effects of left sided heart failure
BNP test
can rule out pulmonary causes of dyspnea because the level rises as chronic heart failure symptoms worsen
BNP a neurohormone
secreted by the heart in response to expansion of ventricular volume and pressure overload
abnormal distended jugular veins
may signal increased right atrial pressure
flat jugular veins
a sign of hypovolemia
HF caused by MI
causes damage to the myocardial tissue
Interior Wall MI
causes damage to the right side of the heart
Anterior Wall MI
causes damage to the Left side of the heart
Aortic Valve Stenosis
means the aortic valve is not opening during systole so now the heart has to work harder to push the blood out of the smaller opening. This increases afterload to the left side of the heart f causes Forward Heart failure
Pulmonic Valve Stenosis
causes forward Heart failure on the right side of the heart
Coronary Artery disease
causes HF by slowly depleting the myocardium of energy and is the primary cause of HF
Valvular Heart disease
makes the heart work harder to pump blood through the stenosis valves and you have blood backing up into the chamber and it makes the heart pump harder to empty as well
Hypertension with Forward Heart Failure
means patient has an increase in afterload
Hypertension with Right Sided HF
means patient has pulmonary vascular resistance. the heart cannot push the blood forward because there is too much pressure. can treat with vasodilators or diuretics
Hypertension with Left Sided HF
means patient has systemic vascular resistance. treatment could be vasodilators or diuretics
Forward Heart Failure
means there is something in front of the heart preventing the blood from going forward (in creased afterload): increased blood pressure or a stenosed valve. the heart has to work really hard to push the blood out.
Backward/ Systolic Heart failure
has to do with the hearts ability to contract: and inhibits their ability to empty. It is ofter from an MI which impairs the contractility of the left ventrical. It cannot eject the correct amount of blood to the body.
Dyastolic Heart failure
has to do with the hearts ability to fill. this can happen from reduced preload or from a hypertrophic cardiomyopathy or it could be that there is not enough blood and so it is not filling adequately
Forward Heart Failure
Is inadequate delivery of blood to the arteial blood system. It can be caused from constricted arteries which increases afterload and could happen on the right or left side of the heart. the blood is backing up now into the lungs and pulmonary arteries
Increased Pulmonary vascular resistance
caused right side of the heart to not be able to push the blood forward from too much pressure being there
Systolic / Backward Heart Failure
happens from a problem with the pumping actions of the heart and it can be on the right side or left side of the heart
Positive Inotropes
medication treatment for the heart when there is a problem with the pumping.
increased afterload or preload
can cause forward right sided HF or backward right sided HF or systolic right sided HF
Diastolic Heart Failure
happens because the ventricles cannot fill properly. they maybe too stiff from a cardiomyopathy, maybe from in adequate preload, they may be too stretched out, or may not have enough blood to fill them from hypovolemic shock
Beta Blockers for diastolic HF
decrease the heart rate and so increase the filling time
Heart Failure definition
a chronic, progressive condition in which the heart muscle is unable to pump enough blood through the heart to meet the body's needs for blood and oxygen. the heart cannot keep up with its work load.
Preload
the pressure that is increased when venous return is increased. It is decreased during hypovolemia because there is less return of blood through through the venus system and therefor less ventricular filling
Increased Preload
happens when venous return is increased the end diastolic pressure for ventricular fillling is increased
Preload
the initial stretching of the caridiac myocytes prior to contraction
Frank Starling Law
the ability of the heart to change its force of contraction (stoke volume) in response to changes in venous return
Stroke Volume
the difference between the filled volume of the ventricals prior to contraction and the residual volume of blood remaining in the ventricle after each ejection
Afterload
the load that the heart must eject blood against to push it forward. it is closely related to the aortic pressure
Preload
the load of pressure from the venous return coming to the heart prior to filling
clinical signs of left ventricular failure
tachypnea, tachycardia, cough, blood tinged sputum, crackles, cyanosis, fatigue, exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, elevated pulmonary wedge pressure
paroxysmal nocturnal dyspnea
respiratory distress that awakens patient from sleep
S3 sound is a ventricular gallop
occurs after S2 and is an early symptom of heart failure because they have a lot of left over blood in the ventricule
clinical signs of Right Sided Heart Failure
peripheral edema, hepatomegaly, splenomegaly, hepatojugular reflux, ascites, weakness, anorexia, indigestion, weight gain, mental changes
high risk for HF diseases
hypertension, diabetes, obesity
high risk for HF structural diseases
leeft ventricular remodeling, left vent hypertrophy, previous MI
left vent failure
increases the work load of the right ventricle and it must pump more forcefully in order to over come the increase pressure in the pulmonary vessels
right ventricular failure
cannot push blood forward so it goes back into the venus circulation and causes symptoms of right sided heart failure
decreased in Afterload
happens from the decrease flow of the blood out of the ventricles and causes hypoperfusion to vital organs
Inotropic State of the Heart
describes the contractility state of the heart
Backward HF
A pump problem. means the heart is not pumping properly and could be due to an injury to the heard`
Increased Afterload
Forward Heart failure because the blood cannot move forward properly
S3 Systolic Ventriclar Gallop
heard during backward heart failure when the heart is filling inadaquetely
Cor Pulmonare
a right ventricular infart from an obstruction in the right coronary artery. this is an inferior wall MI and is Systolic Heart Failure
a forward heart failure
happens when afterload in increased. usually related to hypertension or aortic stenosis which does not open during systole. this causes increase afterload of the left ventricle
pulmonic stenosis and increased pulmonary resistance
increases afterload to the right ventricle
ejection fraction
falls below 40% during backward HF because there is a failure of the vent to empty due to bacward/systolic failure.
right sided heart failure
develops from forward HF due to increase in afterload and blood is backing up into the lungs and plumonary artery
Inferior wall MI
is a right ventricular infarction and is systolic heart failure
Dyastolic HF
Preload is the problem
orthopnea
a pulmonary symptom. dyspnea (SOB) feels worse when lying down, so will sleep on multiple pillows. happens because of the increase in venus return (preload). the heart is having a hard time pumping the blood out.
pulmonary symptoms
sleep apnea, hemoctasis, wheezing, weight loss or gain, bloating, N&V, hepatomegly, deceased urinary output, noctoria, renal insufficiency
valve disease
increases afterload and causes forward heart failure
dyastolic heart failure
a preload problem and can occur in with either ventricle
paroximal nocturnal dsypnea
SOB that occurs several hours after falling asleep and it is eased by sitting up. this is a very late sign of severe HF
an MI causes
Systolic HF which is also know as backward HF
a Forward HF
caused by increased afterload from valve diseases
all heart failures
lead to decrease output, decreased systemic blood pressure and decreased perfusion
people with HF
always have increase levels of angiotension 2 and that changes the treatment
Hypertrophy of the left ventricle
one of the hearts first attempt to compensate for heart failure
blood volumen before the contraction
preload
blood amount after contraction that heart needs to push out
afterload
BNP (b-type natriuretic peptide) test
levels rise with heart disease severity. less than 100 is normal. it is secreted predominantly in the left ventricle in response to an expansion in ventriular volume and pressure overload. It normally helps to maintain homeostasis by promoting diureses and natriuresis (loss of sodium in the urine)
BNP levels
below 100 not HF, above 500 probably HF,above 700 compensating HF. this is released only when the heart is stretched in HF
normal ejection fraction
above 55% and is the fraction of the preload right before the heart pumps it out
HF triple drug coctail
ace inhibitors and Aldosterone blockers to to block sodium and water retention, beta blockers to reduce BP and increase contractility,
aldactone
diuretic drug of choice for fluid retention. is an aldosterone antagonist reduces fluid retention and so preload. a maintenence drug
adverse reactions to ace or arbs
hypotension or hyperkalemia
desired effect of ace inhibitors or arbs
decreases ventricular remoldeling
beta blockers
decrease work of the heart
internal devices for HF
internal cardiac defibulator and cardiac resycronization pacemaker (ICP or CRP)
Natricore
can only be given in hospital IV. it cause vasodilation so it decreases after load and decreases fluid in the lungs. BUT can cause severe HYPOTENSION!
cardias resyncronization pacemaker
increase the ejection fraction, decreases remodeling, increases quality of life, decreases hospitalizations, used for pts who have an ejection fraction of less than 35% (50 is normal)
Digoxin drug toxicity symptoms (normal range 0.8-2.0)
changes in HR, rythym, irregular pulse, tachycardia, palpataions, and arrythmias. AND:
visual changes: halos, increase salivation, fatigue, nightmares, gi disturbances, confusion and dizzyness.
Dobutrex and Milderone
big guns used to increase contractitliy but cause increase in mortality and are only used when nothing else works. they increase O2 demand of the heart and can cause lethal arrythmias.
Dopimine and Inacore
positve inotropes and increase heart contractility
Low potassium levels
get decreased from the loop diurectics and can increase digoxin risk of toxicity and cardia dysrythmias and this causes "paroxysmal atrial tachycardia with block"
high potassium levels
get increased from ace inhibotors and arbs