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heart failure

Who has the highest mortality in heart failure women & african americans
what is the coorelation with heart failure and african americans HTN
what is heart failure heart cannot pump enough blood to meet the metabolic needs of the body; low flow to the kidneys which starts RAA
clinical syndrome of heart failure results in volume overload due to RAA activation; inadequate tissue perfusion; poor exercise tolerance
heart failure AKA CHF; cardiac insufficiency; ventricular failure
what does heart performance depend on contractility;preload;afterload; heart rate
contractility = pumping
preload = amount of blood in ventricle at end of diastole
afterload = the pressure against which the left ventricle ejects
patho of heart failure abnormal loading; abnormal muscle function; limited ventricular filling; cor pulmonale
cause of abnormal loading heart valve disorders; congenital defects
cause of abnormal muscle function scarring; dead muscle from MI
cause of limited ventricular filling hypertrophy of the ventricle; cardiomyopathy
cor pulmonale right sided heart failure from right valvular disease; right heart MI; COPD
what happens with untreated unilateral heart failure will lead to bilateral heart failure
sx of left side heart failure dyspnea; orthopnea;pallor;tachycardia;cough;PND;crackles;wheeze;renal failure;decreased LOC;S3-S4;blood sputum;cyanosis;tachypnea;vasoconstrict;hypoxemia;fatigue
ejection fraction percentage of blood ejected from the ventricle during systole; Norm 60-70%
complications of left side heart failure acute pulmonary edema; Medical emergency
signs of pulmonary edema frothy blood tinged sputum;abrupt onset; drowning in own secretions; fear and anxiety from hypoxemia
sx of right side heart failure venous congestion;hepatomegaly;cirrhosis;dependent edema;anarsarca;fear;elevated liver enzyme;RUQ pain;jugular venous distension
diagnostic test for heart failure x-ray;echocardiogram;ECG;radionuclide imaging
x-ray findings in heart failure cardiomegaly; pulmonary effusion; infiltrates
echo findings in heart failure ejection fraction; valve function
ANP or BNP peptide that opposes the RAA system;higher peptide = worse heart failure;
Marker for CHF ANP artial natriuetic peptide or BNP brain naturietic peptide
what releases ANP excessive atrial/ventricular stretch
what does ANP do causes natriuresis and reduction in blood
ANP norm < 100 pg/ml
medical management of heart failure O2; digoxin; diuretics;Iv inotropic drugs (dopamine, dobutamine); invasive cardiac monitoring (swan-ganz)
main goal in heart failure optimize preload and decrease afterload ( w/antihypertensive) Possible need to reduce preload
purpose of digoxin increase contractility & cardiac output
therapeutic range of digoxin narrow 0.8-2.0 ng/ml
sx of digoxin overdose N/V/D; anorexia; palpitations; heart block; visual changes; lethargy; ataxia
what to assess when using digoxin e-lytes; especially potassium; if hypokalemic more likely to be digtoxic; assess pulse (hold if < 60)
drug for digoxin overdose digiband
iv administration of digoxin over 5 min
when to take digoxin levels 4 hours after iv and 6 hours after oral
purpose of diuretics reduce fluid overload; reduce preload
what to assess w/ diuretics e-lytes; daily weight
diuretic of choice for heart failure lasix or potassium sparring diuretic aldactone
how to administer lasix at a rate of 20mg/min
complications caused by lasix to rapid infusion can = hearing loss due to ear bone calcium loss; can waste magnesium as well as calcium
purpose of antihypertensives in heart failure reduce AFTERLOAD
antihypertensive of choice for heart failure beta blocker COREG
purpose of beta blockers in heart failure block renin secretion; slow HR; METOPROLOL-hypoglycemia, bronchospasm
purpose of ace inhibitors in heart failure block angioten 1 change to angioten 2; CAPTOPRIL- dry cough; angioedema
purpose of ace receptor blockers block receptor that recieve enzyme; COZAAR-cough
why no calcium channel blockers with heart failure they relax the muscle & interfere w/ myocardial contractility
nursing management of heart failure maintain cardiac output by: ECG rhythms; vs; I&O; asses heart & lung sounds; assess peripheral pulses; effectiveness of meds; balance activity & rest; small frequent meals
goal of heart failure stable VS. urinary output wnl; regular cardiac rhythm
maintaining fluid balance w/ heart failure I&Os; assess for edema; abdominal assess (hepatomegaly); fluid sodium restriction, assess lung sounds;effectiveness of diuretics; assess wt (1 kg = 1L of fluid)
goal of fluid balance in heart failure maintain normal weight; clear lung sounds; less edema
when is weight gain a concern in heart failure more than 2 pounds in one day or 5 in one week
activity intolerance and heart failure space activities; schedule rest periods; monitor response to activity; increase activity as tolerated
goal for activity intolerance improved level of activities w/out dyspnea
rheumatic heart disease inflammatroy disorder caused by group A beta- hemolytic strep
rheumatic fever diffuse inflamm disease which can affect the heart valves
rheumatic heart disesase affects what aortic & mitral valves (left side)
when to tx strep infection in 9 days of diagnosis to reduce risk of rheumatic fever
patho of rheumativ heart disease immune response causes inflamm lesion in connective tissues of heart, joints, skin ; pericardial & myocardial inflamm is mild & self limiting; endocardial inflamm causes swelling and vegetative lesions on valve leaflets leading to scarring/deformity
endocarditis inflamm of any part of the endothelial lining of the heart; valves are usually affected; infectious; uncommon
risk factors for endocarditis previous heart damage; iv drug use (tricuspid); invasive catheters; dental procedures; oral injections; any invasive procedure
patho of endocarditis veg lesions from platelet-fibrin collect on valves; organisms colonize the vegetations & covers bacterium; they can embolize and travel to other organs; they can scar valves causing turbulance (stenosis or regurg)
sx of endocarditis fever;malaise;arthralgias;cough;dyspnea;murmur;anorexia;abd pain;heart failure;splenomegaly;infarct of organs (emboli); abcess;aneurysm
embolic complications of endocarditis petechiae; splinter hemorrhage; osler nodes; janeway lesions; roths spots
osler's nodes painful pea sized nodules on fingertips, toes
janeway lesions flat non tender spots on palms, soles
roth's spots white or yellow center spots with red halos on the optic disc
edocarditis meds antibiotics; 1 hr for preventitive dental, IV for active infection 2-8 weeks, 6-8 week IV for prosthetic valve infections
surgical tx for endocarditis replace/remove valve if fungal infection, remove large vegetations
stenosis narrowed fused valve obstructs forward flow of blood through heart
complications with stenosis decreased CO & SV; backflow will occur; increased workload BEHIND incompitent valve
what does mitral stenosis affect left atrium
stenosis leads to what hypertrophy, dilation and eventual heart failure
regurgitation valve fails to close properly allowing blood to flow back through the chamber the blood just left
cause of regurgitation deformity/erosion of valve cusp caused by MI or dilation due to heart failure
why does valve not close w/ regurgitation valve annulus is stretched so edges no longer close
true for all valve disorders may be asymptomatic; can cause decreased fillin of the chamber BEFORE it and this will decrease CO as filling is decreased ( mitral = left ventricle);all cause dilation of chamber BEHIND it as pressure increase (mitral = left artium),
mitral valve prolapse common in young women; RHD; ischemic HD; usually benign; marfan's syndrome
aortic/mitral disorders cause sx of left sided failure as disease progresses
tricuspid/pulmonic disorders cause sx of right sided failure as disease progresses
diagnostic tests for valve disorders echocardiography (TEE, NPO, sedation); chest x-ray; ECG; cardiac cath
medical tx of valve disorders percutaneous balloon valvuloplasty; open valve repair; valve replacement
pericarditis acute or chronic inflammation of the parietal and visceral pericardium
what is acute pericarditis usually viral
normal pericardial fluid 50cc
amount of pericardial fluid in pericarditis 100-3000 cc
subjective sx of pericarditis mimic MI pain or pleurisy, malaise, joint pain, N/V
objective sx of pericarditis pericardial friction rub; temp; elevated ESR; elevated WBC; cardiac ezymes norm or elevated
interventions for pericarditis sitting up relieves pain; NSAIDs; rest
diagnostic tests for pericarditis echocardiogram; usually transthoracic
cardiac tamponade life threating; blood/fluid accumulate in pericardium;compress the heart; cause hypotension; decreased CO
when does cardiac tamponade occur post open heart; trauma
pulsus paradoxis occurs with cardiac tamponade; a decrease in the systolic pressure by 10 mmHg w/ inspiration
immediate intervention for cardiac tamponade pericardiocentesis
cardiomyopathy heart muscle disorder
dilated cardiomyopathy most common; involves dilation of both sides of heart; muscle fiber deteriorate & replaced with fibrotic tissue
cardiomyopathy causes poor contractility and blood pooling
causes of cardiomyopathy alcohol; toxins; pregnancy; connective tissue disorders; genetics
Tx of cardiomyopathy tx like heart failure; pt with poor EF% (10-15%) are placed on a transplant list
aorta anotomical site rt of sternum 2nd intercostal space
pulmonic anotomical site left of sternum 2nd intercostal space
erb's point 3rd left intercostal space
tricuspid anatomical site left 5th intercostal space
mitral anatomical site apex
S1 loudest at mitral;tricuspid
S2 loudest at aortic;pulmonary
S3 & S4 loudest at mitral
Created by: aclelan