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Cardiac Unit
Med/Surg - Chapter 29
| Question | Answer |
|---|---|
| _____________is a clinical syndrome resulting from structural or functional cardiac disorders that impair the ability of the ventricles to ll or eject blood | Heart failure (HF) |
| In the past, HF was often referred to as congestive heart failure (CHF), because many patients experience what? | pulmonary or peripheral congestion with edema |
| HF is recognized as a clinical syndrome characterized by signs and symptoms of what? | fluid overload or inadequate tissue perfusion |
| Etiology (Cause) of Left heart failure (congestive heart failure) | MI, Hypertension, Aortic valve disease |
| Dx testing for Left Side heart failure | Chest x-ray and BNP lab test |
| What excreted from cardiac tissue when the ventricle are stretched? | BNP |
| Finish the pathology of Left Heart Failure ---Decrease left ventricle emptying (decrease perfusion to body tissues) --> increase volume/pressure in left ventricle -> increase volume/pressure in left atrium -> increased volume in pulmonary veins-> | increased volume in capillary bed--> fluid transudate moves from capillaries to alveoli---> Alveolar space fills with Fluid --> Pulmonary Edema |
| S/S of Left Heart Failure (Congestive Heart Failure) (5) | 1. Exertional and nocturnal dyspnea 2. Hemoptyis 3. Orthopnea 4. cyanosis 5. Elevated pulmonary capillary pressure |
| what is Hemoptysis and in what heart condition could you find it and why? | blood tinged sputum - Left sided heart failure due to blood backing up in the lungs. |
| Difficult or labored breathing | Dyspnea |
| Most often, HF is a chronic, progressive condition that is managed with __________ and __________ to prevent episodes of acute compensated heart failure | lifestyle changes and medications |
| What are the 2 major types of HF that are identified by assessment of left ventricular function, usually by echocardiogram. Explain the difference between the 2. | Systolic heart failure (most common) - characterized by a weakened heart muscle. Diastolic heart failure (less common) - characterized by a stiff and non-compliant heart muscle, making it difficult for the ventricle to fill |
| What is the primary cause of HF? | atherosclerosis of the coronary arteries |
| Systolic HF results in decreased blood ejected from the ventricle. The decreased blood ow is sensed by baroreceptors in the aortic and carotid bodies. The sympathetic nervous system is then stimulated to release ___________ and __________. why? | epinephrine and norepinephrine - initial response is to increase heart rate and contractility and support the failing myocardium, but the continued response has multiple negative effects. |
| Why is the continued response of the release of epinephrine and norepinephrine in systolic HF a problem? | sympathetic stimulation causes vasoconstriction in the skin, gastrointestinal tract, and kidneys. A decrease in renal perfusion due to low CO and vasoconstriction then causes the release of renin by the kidneys. |
| With systolic HF the decrease renal perfusion causes the release of renin by the kidneys. Renin converts the plasma protein angiotensinogen to angiotensin I, which then circulates to the lungs. How does this contribute to HF? | Angiotensin-converting enzyme (ACE) in the lumen of pulmonary blood vessels converts angiotensin I to angiotensin II, a potent vasoconstrictor which then increases the blood pressure and afterload. |
| What does angiotensin II do in Systolic HF? | AII increase BP & afterlood. It also stimulates the release of aldosterone , resulting in sodium and fluid retention by the renal tubules and an increase in blood volume. These mechanisms lead to the fluid volume overload commonly seen in HF |
| Angiotensin, aldosterone, and other neurohormones lead to an increase in preload and afterload, which increases stress on the ventricular wall, causing an increase in cardiac workload. How does the body try to counter this? | Atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are released from the overdistended cardiac chambers. These substances promote vasodilation and diuresis but are not usually not strong enough to overcome the negative effects. |
| What are the clinical manifestations of pulmonary congestion? (6) | - dyspnea - cough, - pulmonary crackles - low oxygen saturation levels - orthapnea - paroxysmal nocturnal dyspnea |
| difficulty breathing when lying at | orthopnea |
| sudden attacks of dyspnea at night | paroxysmal nocturnal dyspnea (PND) |
| What is the cough like initially with left sided heart failure? how does it progress | dry and nonproductive - The cough may become moist over time. Large quantities of frothy sputum, which is sometimes pink or tan (blood tinged), may be produced, indicating acute decompensated HF with pulmonary edema. |
| Why does oliguria happen with left side heart failure? Why does nocturia happen? | Reduced Cardiac Output & catecholamines decrease blood flow to the kidneys -- urine output drops. - when the patient is sleeping, the cardiac workload is decreased, improving renal perfusion, which in some patients leads to frequent urination at night |
| With left side heart failure what causes dizziness, lightheadedness, confusion, restlessness, and anxiety | Decreased brain perfusion due to decreased oxygenation and blood flow. |
| Congestion from from right heart failure effects what? | liver, GI tract, limbs and the right ventricle may be unable to pump blood efficiently to lungs and left ventricle |
| s/s for right heart failure | -JVD and increased capillary hydrostatic pressure throughout the venous system. -(dependent edema) -hepatomegaly (enlargement of the liver) - ascites (accumulation of fluid in the peritoneal cavity) - weight gain due to retention of fluid. |
| Hepatomegaly may also increase pressure on the diaphragm, causing __________ __________. | respiratory distress. |
| Pathology of right side heart failure | decrease right ventricle emptying --> decrease blood supply to lungs--> increased volume/pressure cause back up thru-out blood stream, increase volume in distensible organs, increase cap. pressure, peripheral edema and serous effusion |
| ____ is specific for heart failure and______ and ______ are specific for MI (tissue death) | BNP, CK-MB and Troponin |
| Why may Anorexia (loss of appetite), nausea, or abdominal pain result for m right sided heart failure? | Anorexia (loss of appetite), nausea, or abdominal pain may result from the venous engorgement and venous stasis within the abdominal organs. |
| Left-sided HF refers to failure of the left ventricle; it results in ___________ _________. Right-sided HF, failure of the right ventricle, results in congestion in the_________ ________ and the viscera. | pulmonary congestion, peripheral tissues |
| The overall goals of management of HF are what? (3) | 1. to relieve patient symptoms 2.to improve functional status and quality of life 3. to extend survival |
| Managing the patient with HF begins with providing comprehensive __________ and counseling to the patient and _________. | education, family |
| What are the recommended lifestyle changes recommend for HF patients? | -restriction of dietary sodium -avoidance of smoking, including passive smoke -avoidance of excessive fluid and alcohol intake - weight reduction when indicated - regular exercise |
Created by:
sbertelsen
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