Unit A Congestive Heart Failure Study Notes
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| show | low output high output, systolic vs. diastole, right vs. left, acute vs. chronic
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| a state in which the heart is no longer able to pump sufficient blood to meet all metabolic needs of the body systems. | show 🗑
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| show | low output HF
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| cardiac output remains above normal or normal; caused by increased metabolic needs or hyperkinetic conditions- septicemia, anemia, hyperthyroidism | show 🗑
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| show | systolic HF
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| increase preload with decrease contractility, increase afterload as a result of increase peripheral resistance. | show 🗑
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| The percentage of blood ejected from the heart during systole. | show 🗑
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| decreased ejection fraction leads to what? | show 🗑
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| show | diastolic HF
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| Inadequate relaxtion equals what to the heart? | show 🗑
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| show | 60-70%
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| class I (ny heart assoc. classification of heart failure) | show 🗑
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| show | symptoms of heart failure occur with maximal exertion.
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| Class III | show 🗑
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| show | symptoms at rest.
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| What is the most common cause of acute onset of CHF? | show 🗑
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| How does dysrhythmias cause acute onset of heart failure? | show 🗑
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| show | due to xtreme tachycardia and increase o2 demand
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| show | end organ damage of the heart
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| Rupture of the papillary muscles affects the heart how? | show 🗑
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| show | hole between 2 ventricles
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| show | MI, Dysrhythmias, pulmonary emboli, thyroid disorders, HtN crisis, rupture of the papillary muscle, ventricular septal defect, infection, stress, hypervolemia.
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| show | CAD, rheumatic heart disease, congenital heart disease, pulmonary disease, anemia- d/t acute hypoxia of cardiac tissues, bacterial endocarditis, cessation of meds.
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| show | men, elderly, htn, cad, smokers, dm, hyperlipidemia. women after menopause.
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| The amount of bld ejected with each ventricular contraction; normal 70ml/contraction | show 🗑
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| show | preload, contractility, afterload
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| the degree of fiber stretch at the end of diastole, heart is relaxed; corresponds to end diastolic volume and pressure | show 🗑
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| show | contractility
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| show | afterload
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| Preload depends on what in order to work properly? | show 🗑
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| show | starling's law
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| show | increased SNS stimulation, positive inotropes, decreased with hypoxemia, decreased negative inotropes. increased preload = increased contractility
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| show | tone of systemic arterioles, systemic vascular resistance, bld viscosity
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| show | myocardial oxygen demand increases.
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| _________ in aorta and carotid responds to increase CO2 and sends impulses to basomotor center in the medulla which stimulate nervous system to respond. | show 🗑
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| Increased afterload leads to what and why? | show 🗑
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| show | disintergration of cells into membrane-bound particles that are eliminated by phagocytosis or shedding. (programmed cell death.)
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| show | epinephrine, norepinephrine, aldosterone, angiotensinII, BNP
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| What is hBNP? | show 🗑
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| show | renin-angiotensin system. Occurs when there is a reduced blood flow to the kidneys, d/t low-output states.
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| show | Vasoconstriction becomes more pronounced in response to angiotensin 2 and aldosterone secretion causes h2o and nacl retention. Preload and afterload increase.
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| which hormone from the RAS system contributes to ventricular remodeling? | show 🗑
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| What happens to the heart once it begins the ventricular remodeling process? | show 🗑
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| show | Adequate perfusion, pressure, and cardiac output.
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| show | Increased SNS= beta 1, beta 2 stimulation; increased peripheral vasoconstriction, RAS activated
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| Neurohormonal control- compensatory mechanisms | show 🗑
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| show | beta 1: Tachycardia
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| show | increase heart rate to increase cardiac output.
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| show | the heart rate will be so rapid that the filling time of the ventricles will decrease.
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| Ventricular Dilation | show 🗑
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| show | Muscle fibers begin to lengthen, increase vol. in the ventricles, stretched muscle fibers contracts more forcefully, heart requires more o2, less bld flow, and compensate more than tachycardia.
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| show | the heart loses its elasticity after it stretches beyond the natural stretch, muscle walls get thicker.
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| show | Ventricular Hypertrophy
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| Describe the events of the heart during ventricular hypertrophy | show 🗑
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| What happens to the heart as the heart enlarges and the wall thickens? | show 🗑
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| show | asymptomatic.
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| Once all compensatory mechanism of the heart have failed the client will show what______? | show 🗑
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| Normal BNP levels? | show 🗑
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| show | excludes the symptoms of dyspnea- an increase BNP best differentiates between the dyspnea of HF and that associated with lung dysfunction.
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| BNP > 400 | show 🗑
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| Usually the first to fail; the ventricle is unable to pump the sufficient blood in a forward direction. | show 🗑
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| Blood build up in left ventricle causes: | show 🗑
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| What happens to blood flow in left sided HF? | show 🗑
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| Early clinical manifestations of Left HF: | show 🗑
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| show | Crackles- d/t leaking of plasma into lungs and pulmonary artery engorgement; orthopnea, PND, cheyne-stokes respirations, cardiac asthma
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| The inability to lay flat with comfortable breathing. | show 🗑
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| Wake up with shortness of breath. | show 🗑
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| irregular breathing pattern- apnea/tachypnea breathing | show 🗑
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| show | Cardiac asthma.
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| Heart sounds associated with left heart failure. | show 🗑
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| decreased tissue perfusion to the brain causes these symptoms in client with left HF | show 🗑
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| Renal symptoms in heart failure include: | show 🗑
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| Why does nocturia happens at night? | show 🗑
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| show | due to decreased cardiac output= to decreased kidney perfusion= decreased kidney output
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| One of the cardiac clinical manifestations include laterally displaced PMI, why? | show 🗑
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| show | become diminished or weak
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| show | occurs when the proportional pulse pressure is less than 25%, and is described as weak and strong pulses alternates.
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| Left sided HF is the most common cause of this type of heart failure. | show 🗑
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| How does left sided heart failure cause right sided heart failure? | show 🗑
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| show | Large amt of blood build up in rt ventricles, unable to pump bld forward into lungs due to decreased CO; bld back up to rt. atria-then to vena cavas- into peripheral vessels
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| In rt ventricular heart failure, peripheral congestion in venous system causes what to the body? | show 🗑
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| show | Liver and spleen become congested and large. (hepato/spleno- megaly)
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| show | Weakness, JVD, anorexia, nausea and bloating, hepatomegaly, dependent edema, cyanosis of nailbeds.
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| show | sticks out. Jugular venous distention JVD
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| show | nausea, anorexia, bloating.
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| Client with RHF c/o abdominal pain, and have jaundice, due to? | show 🗑
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| show | dependent edema, pitting edema.
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| show | venous congestion and compromised perfusion.
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