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wvc cardiac chap 37
wvc cardiac chap 37 winter 2011
| Question | Answer |
|---|---|
| Left sided heart failure (pulmonary congestion) | fatigue, weakness, oliguria during day & nocturia, angina, confusion restlessness, tachycardia, palpations, pallor, weak peripheral pulses, cool extremities, cough worse at night, crackles, pink sputum, tachypnea, S3/S4 |
| Right sided heart failure (systemic congestion) | JVD, enlarged liver & spleen, anorexia, nausea, ascites, dependent edema, swollen hands, polyuria at night, weight gain, increased BP. |
| Left sided heart failure is: | hypertensive coronary artery and valvular disease involving the mitial or aortic valve. Decreased tissue perfusion & from poor CO & pulmonary congestion from increased pressure in the pulmonary vessels. |
| Ejection fraction | the percentage of blood ejected from the heart during systole. |
| Systolic heart failure (systolic ventricular dysfunction) | results when the heart cannot contract forcefully enough during systole to eject adequate amounts of blood into circulation. Preload increases with decreased contractility. |
| Diastolic heart failure | when the left ventricle cannot relax adequately during diastole. Inadequate relaxation or ‘stiffening’ prevents the ventricle from filling with sufficient blood to ensure output. |
| Right sided heart failure is: | right ventricle cannot empty completely, increased volume and pressure develop in the venous system. |
| High output failure | in this type of heart failure the output remains near normal levels but the body demands are greater than the heart can produce. |
| Heart failure compensatory mechanisms | sympathetic nervous system, rennin angiotensin system activation, other chemical responses, myocardial hypertrophy. |
| Hypoxia related state in heart failure stimulates the CNS to: | increase heart rate (beta adrenergic response) and vasoconstriction (alpha adrenergic response). |
| Reduced blood flow states associated with heart failure result in a renal compensatory response | activation of the renin-angiotenssin system; vasoconstriction and aldosterone secretion causes water and sodium retention. |
| Natriuretic peptides | promote vasodilatation and diuresis as a response to excess fluid as a result of heart failure. |
| Low cardiac output causes decreased cerebral perfusion | the posterior pituitary gland secretes ADH which causes vasoconstriction & fluid retention making HF worse. |
| Myocardial hypertrophy | the wall of the heart thickens to provide more muscle mass for a more powerful contraction. Hypertrophy can result in inadequate perfusion to the heart, resulting in other heart related issues. Seen in X-rays |
| Common risk factors for heart failure | hypertension, CAD, cardiomyopathy, substance abuse, dysrhytmias, diabetes, smoking, family history, hyperthyroidism |
| Assessment questions related to HF | med history, hypertension, angina, MI, rheumatic disease, valvular disorders, endocarditis or pericarditis. |
| Paroxysmal nocturnal dyspena (PND) | sudden awaking after 2-5 hours of sleep (dependent edema is filling in the lung tissue) |
| Orthpnea | difficulty breathing while at rest or lying flat. |
| Multigated angiography MUGA | a raidonucletied test that is extremely useful in diagnosing heart issues |
| Pulmonary artery catheters | assess volume status in HF patents pulmonary artery pressure (PAP) and pulmonary artery wedge pressure (PAWP) are diagnostic tests associated with pulmonary artery catheters. |
| Indications of worsening or recurrent heart failure | weight gain (3lbs/ Wk or 2 lbs/day) decrease in activity tolerance lasting 2-3 days; cold symptoms lasting more than 3-5 days; development of dyspena or angina at rest; worsening angina; increased dependent edema. |
| Mitral stenosis | valve leaflets fuse & become stiff the chordae tendineae contract and shorten. The valve narrows preventing blood flow from Lt. atrium to Lt. ventricle. As a result Lt. atrium dilates, pulmonary artery pressure ^; Rt. Ventricle hypertrophy. Leads to HF. |
| Mitral regurgitation | fibrotic & calcfic changes prevent the mitral valve from closing completely in during sys. Incomplete closure allows backflow. The volume that backflowed must be ejected in next sys. this leads to increased volume pressure & Lt atria & vent. hypertrophy. |
| Mitral valve prolapsed | valve leaflets enlarge and prolapse into Lt. atrium during systole. A midsystolic click and late systolic murmur may be heard at the apex of the heart. |
| Aortic stenosis (most common valve dysfunction in the US) | “Wear & Tear” The aortic valve orifice narrows & obstructs Lt. ventricle outflow. Increase resistance leads to hypertrophy. Eventually Lt. sided failure will occur & blood backs up & pulmonary congestion occurs. |
| Aortic regurgitation (insufficiency) | the leaflets of the valve do not close properly & this allows blood from the aorta back into the ventricle. The increased blood volume causes the Lt. ventricle to dilate & hypertrophy. |
| Non surgical management of valve disorders | Diuretics, beta blockers, digoxin & O2 are administed for HF related Sx. Vasodilators such as calcium channel blockers may be used to reduce regurgent flow with aortic or mitral stenosis. Anticoagulation drugs like warfarin are used to reduce thrombi. |
| Surgical management of valve disorders | Ballon valvulplasty; direct commissurotomy (incises the fused valve leaflets & removes calcium); mitral valve annuloplasty (surgical repair of valve); valve replacement (synthetic & biologic valve replacements) |
| Xenograft | biological material from another species. |
| Endocarditis pathophysiology | microbial infection involving the endocardium. Can affect a healthy heart valve. Endocardium becomes eroded (often destroying tissue & a valve); vegetative lesions form, these lesions can break off and clot distally of the heart. |
| Endocarditis signs and symptoms | recurrent fever, murmurs, HF (late stage endocarditis), weight loss, anorexia, petechia, positive blood culture, osler nodes, janeway’s lesions, splinter hemorrhages, fatigue, night sweats. |
| Treatment of endocarditis | antimicrobials |
| Diagnostics of endocarditis | positive blood culture; CBC, Transesophegeal echocardiogram (TEE), new murmur. |
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