03-Congestive Heart Failure Overview

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Questions and Answers

What is the primary characteristic of patients classified as Stage B heart failure?

  • Patients at high risk for developing heart failure
  • Patients requiring specialized interventions
  • Patients with symptoms of heart failure
  • Patients with left ventricular dysfunction without symptoms (correct)

Which pharmacological treatment is indicated for decreasing both blood pressure and afterload in heart failure management?

  • Diuretics
  • Beta-blockers
  • Digitalis
  • ACE Inhibitors (correct)

Which laboratory test is considered a key diagnostic indicator of heart failure?

  • Echocardiogram
  • Urinalysis
  • Serum electrolytes
  • B-type Natriuretic Peptide blood test (BNP) (correct)

What is a common side effect associated with the use of beta-blockers in heart failure treatment?

<p>Hypotension (C)</p> Signup and view all the answers

In the classification system, which stage refers to patients with refractory end-stage heart failure?

<p>Stage D (C)</p> Signup and view all the answers

What is the function of diuretics in the management of heart failure?

<p>Decrease fluid volume overload (C)</p> Signup and view all the answers

Which of the following is a potential complication of administering digitalis?

<p>Bradycardia (B)</p> Signup and view all the answers

Which diagnostic method is NOT typically used for heart failure assessment?

<p>Pulmonary function test (D)</p> Signup and view all the answers

What symptom is primarily associated with left-sided heart failure?

<p>Pulmonary crackles that do not clear with cough (A)</p> Signup and view all the answers

What is a common characteristic of Class III heart failure according to the NYHA classification?

<p>Marked limitation during physical activity (A)</p> Signup and view all the answers

What is a symptom that may indicate low perfusion in right-sided heart failure?

<p>Abdominal pain (A)</p> Signup and view all the answers

Which of the following is NOT a symptom of left-sided heart failure?

<p>Hepatomegaly (B)</p> Signup and view all the answers

What distinguishes Class IV heart failure from Class III?

<p>Symptoms at rest and during activity (C)</p> Signup and view all the answers

What are the common causes of heart failure?

<p>Atherosclerosis and hypertension (D)</p> Signup and view all the answers

Which sign is commonly associated with right-sided heart failure?

<p>Dependent edema in lower extremities (B)</p> Signup and view all the answers

Which type of heart failure is characterized by a weakened heart muscle and reduced ejection fraction?

<p>Systolic heart failure (D)</p> Signup and view all the answers

What diagnostic symptom could indicate the need to assess for heart failure?

<p>Generalized weakness (A)</p> Signup and view all the answers

What does the ejection fraction (EF) percentage normal range indicate?

<p>The efficiency of the heart to pump blood (C)</p> Signup and view all the answers

What is a potential pharmacological treatment for managing symptoms of heart failure?

<p>Diuretics (D)</p> Signup and view all the answers

Which symptom is typically associated with left-sided heart failure?

<p>Pulmonary congestion (B)</p> Signup and view all the answers

What is the typical ejection fraction finding in patients with diastolic heart failure?

<p>Normal EF (A)</p> Signup and view all the answers

How is heart failure classified?

<p>Based on the side of the heart affected and heart muscle function (D)</p> Signup and view all the answers

Which diagnostic method is primarily used to assess ejection fraction in heart failure?

<p>Echocardiogram (B)</p> Signup and view all the answers

What is a common symptom of right-sided heart failure?

<p>Peripheral edema (D)</p> Signup and view all the answers

What characterizes systolic heart failure?

<p>The heart muscle does not contract with sufficient force. (B)</p> Signup and view all the answers

What is the normal range for ejection fraction (EF)?

<p>55% - 65% (D)</p> Signup and view all the answers

Which condition is NOT associated with heart failure?

<p>Asthma (C)</p> Signup and view all the answers

In diastolic heart failure, what is the typical characteristic of the heart muscle?

<p>It is stiff and noncompliant. (C)</p> Signup and view all the answers

What type of heart failure is indicated by a severely reduced ejection fraction?

<p>Systolic heart failure (A)</p> Signup and view all the answers

What is the primary action of milrinone in heart failure treatment?

<p>Increase the heart's contractility and promote vasodilation (A)</p> Signup and view all the answers

Which of the following is the most appropriate dietary recommendation for managing heart failure?

<p>Limit fluid intake to avoid retention (B)</p> Signup and view all the answers

In which situation would cardiac synchronization therapy be indicated?

<p>For patients with heart failure who do not improve with standard therapy (C)</p> Signup and view all the answers

What is a key nursing intervention for managing fluid volume in heart failure patients?

<p>Monitor fluid status through body weight and lung auscultation (A)</p> Signup and view all the answers

Which complication should healthcare providers monitor for in patients undergoing heart failure treatment?

<p>Hypokalemia and hyperuricemia (D)</p> Signup and view all the answers

Which symptom is NOT typically associated with right-sided heart failure?

<p>Pulmonary crackles (A)</p> Signup and view all the answers

What symptom may indicate low perfusion in left-sided heart failure?

<p>Nocturia (C)</p> Signup and view all the answers

Which NYHA classification stage describes a patient who may experience palpitations and shortness of breath during typical physical activity?

<p>Class II (C)</p> Signup and view all the answers

What common symptom would a patient with right-sided heart failure likely experience?

<p>Distended jugular veins (C)</p> Signup and view all the answers

Which of the following symptoms is part of the clinical presentation of left-sided heart failure?

<p>Low oxygen saturation (D)</p> Signup and view all the answers

What symptom is a key characteristic of Class III heart failure according to the NYHA classification?

<p>Noticeable limitation of physical activity (A)</p> Signup and view all the answers

In which situation would a patient likely experience paroxysmal nocturnal dyspnea?

<p>Left-sided heart failure (C)</p> Signup and view all the answers

Which stage classification of heart failure is characterized by patients with left ventricular dysfunction and current symptoms of heart failure?

<p>Stage C (C)</p> Signup and view all the answers

What is a potential side effect to monitor when administering ACE Inhibitors in heart failure management?

<p>Hypotension (D)</p> Signup and view all the answers

What is the primary function of diuretics in the management of heart failure?

<p>Decrease fluid volume overload (B)</p> Signup and view all the answers

Which pharmacological therapy is used to improve cardiac contractility in heart failure treatment?

<p>Digitalis (D)</p> Signup and view all the answers

Which stage of heart failure is classified as requiring specialized interventions due to being refractory and end-stage?

<p>Stage D (B)</p> Signup and view all the answers

What laboratory test is noted as the key diagnostic indicator of heart failure?

<p>B-type Natriuretic Peptide blood test (BNP) (A)</p> Signup and view all the answers

Which of the following medications is a Peripheral Vasodilator used in heart failure management?

<p>Hydralazine (B)</p> Signup and view all the answers

Which component of pharmacological therapy helps relieve symptoms of heart failure by decreasing blood pressure and afterload?

<p>Angiotensin II Receptor Blockers (C)</p> Signup and view all the answers

What is an important observation when using beta-blockers in heart failure patients?

<p>Dizziness and fatigue (D)</p> Signup and view all the answers

Which test is typically performed to assess the ejection fraction in heart failure patients?

<p>Echocardiogram (A)</p> Signup and view all the answers

Flashcards

Stage A Heart Failure

High risk for heart failure, but no symptoms yet.

Stage B Heart Failure

Heart dysfunction, but no symptoms of heart failure.

Stage C Heart Failure

Heart dysfunction with current symptoms of heart failure.

Stage D Heart Failure

Refractory, end-stage heart failure, needing advanced interventions.

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BNP levels in Heart Failure

High levels of BNP indicate heart failure.

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ACE Inhibitors

Medications that lower blood pressure and afterload, easing heart failure symptoms.

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ARBs (Angiotensin II Receptor Blockers)

Blood pressure lowering drugs, easing heart failure symptoms, preventing progression.

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Peripheral Vasodilators

Medications that widen blood vessels to decrease blood pressure and afterload.

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Beta-blockers

Medications that dilate blood vessels, decrease afterload, ease symptoms, improve exercise.

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Diuretics

Medications, such as loop and thiazide diuretics, reducing fluid buildup, easing symptoms.

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Digitalis (Digoxin)

Medication that improves cardiac contraction, easing heart failure symptoms.

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IV Milrinone

Pulmonary vasodilator for heart failure patients.

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Heart Failure

Inability of the heart to pump enough blood to meet the body's needs.

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Congestive Heart Failure (CHF)

A syndrome with symptoms of fluid buildup and poor blood flow.

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Systolic Heart Failure

Heart muscle doesn't contract forcefully enough.

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Diastolic Heart Failure

The heart contracts normally, but ventricles don't relax properly.

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Ejection Fraction (EF)

Percentage of blood pumped out of the ventricle during a heartbeat.

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Normal EF

A healthy heart's pumping efficiency, usually 55%-65%.

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Systolic HF EF

Severely reduced EF occurs in this type of heart failure.

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Diastolic HF EF

Normal EF percentage in this type of heart failure.

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Right-sided Heart Failure

Fluid buildup in the body's periphery and organs, due to right ventricle weakness.

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Left-sided Heart Failure

Fluid buildup in the lungs due to left ventricle weakness.

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Atherosclerosis

A disease where plaque builds up inside the arteries.

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CAD (Coronary Artery Disease)

A condition that impacts blood flow from the heart.

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Hypertension

High blood pressure.

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Valvular Diseases

Problems with the heart valves.

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Cardiomyopathy

Disease of the heart muscle.

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Left-Sided Heart Failure

A type of heart failure where the left side of the heart struggles to pump blood effectively, leading to pulmonary congestion.

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Right-Sided Heart Failure

A type of heart failure where the right side of the heart struggles to pump blood effectively, leading to congestion in peripheral tissues and viscera.

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Pulmonary Congestion

Buildup of fluid in the lungs, often a symptom of left-sided heart failure.

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Peripheral Tissues and Viscera Congestion

Fluid buildup in the body outside the lungs. A symptom of right-sided heart failure.

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Dyspnea

Shortness of breath

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Orthopnea

shortness of breath while lying down

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Dependent edema

Swelling in the lower extremities due to fluid buildup.

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Paroxysmal nocturnal dyspnea

Sudden and severe shortness of breath that awakens a person from sleep

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Cough

A symptom related to both left and right heart failure, usually worse when lying down or with exertion.

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Pulmonary crackles

A sound the physician can hear with a stethoscope, indicating fluid in the lungs

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Low Oxygen Saturation

A reduced level of oxygen in the blood, often linked to heart failure

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S3 or Ventricular Gallop

A specific heart sound related to heart failure, the physician may hear this sound with a stethoscope

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Weight gain

Abnormal weight gain linked to fluid retention, a symptom of Heart failure.

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NYHA classification of Heart Failure

A system used to categorize the severity of heart failure by symptoms during physical activity.

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Low Perfusion/ Low Cardiac Output

Reduced blood flow and heartbeat leading to symptoms in different parts of the body.

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Oliguria

Low urine output.

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Nocturia

Frequent urination at night.

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Altered digestion

Disruptions in digestion, common in heart failure.

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Anorexia

Loss of appetite.

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Nausea

Feeling sick to the stomach.

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Abdominal pain

Pain in the abdomen, related to poor digestion or the fluid build-up.

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Generalized weakness

Overall feeling of weakness or tiredness.

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Fatigue

Extreme tiredness, often related to low energy levels.

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Distended jugular veins

Swollen neck veins, a sign of heart failure.

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Heart Failure

The heart's inability to pump enough blood to meet the body's needs.

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Congestive Heart Failure (CHF)

A clinical syndrome characterized by fluid buildup and poor blood flow, often a consequence of heart failure.

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Systolic Heart Failure

Heart muscle doesn't contract forcefully enough, resulting in reduced blood pumped out.

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Diastolic Heart Failure

The heart contracts normally, but the ventricles don't relax properly, hindering filling.

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Ejection Fraction (EF)

Percentage of blood pumped out of the ventricle with each heartbeat.

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Normal EF

Healthy heart’s pumping efficiency (typically 55-65%).

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Systolic HF EF

Significantly decreased EF in systolic heart failure.

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Diastolic HF EF

Normal EF percentage in diastolic heart failure.

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Right-sided Heart Failure

Fluid (congestion) buildup in the body outside the lungs, due to right ventricle weakness.

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Left-sided Heart Failure

Fluid (congestion) buildup in the lungs, due to left ventricle weakness.

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Atherosclerosis

A disease characterized by the buildup of plaque inside the arteries.

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CAD (Coronary Artery Disease)

A disease affecting the blood flow to the heart muscle.

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Hypertension

High blood pressure.

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Valvular Diseases

Problems with the heart valves.

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Cardiomyopathy

A disease affecting the heart muscle itself.

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Stage A Heart Failure

High risk for heart failure development, but no symptoms yet.

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Stage B Heart Failure

Heart dysfunction exists, but no heart failure symptoms are present.

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Stage C Heart Failure

Heart dysfunction with current symptoms of heart failure.

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Stage D Heart Failure

Refractory heart failure needing advanced interventions.

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BNP Levels in Heart Failure

High BNP levels often signal heart failure.

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ACE Inhibitors

Medications lowering blood pressure and afterload, easing heart failure symptoms.

Signup and view all the flashcards

ARBs (Angiotensin II Receptor Blockers)

Blood pressure lowering drugs improving heart failure symptoms, preventing progression.

Signup and view all the flashcards

Peripheral Vasodilators

Medications widening blood vessels, decreasing blood pressure and afterload.

Signup and view all the flashcards

Beta-blockers

Medications dilating blood vessels, decreasing afterload, easing symptoms, improving exercise.

Signup and view all the flashcards

Diuretics

Medications reducing fluid buildup, easing heart failure symptoms.

Signup and view all the flashcards

Digitalis (Digoxin)

Medication improving cardiac contraction for easing heart failure symptoms.

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IV Milrinone

Pulmonary vasodilator for heart failure patients.

Signup and view all the flashcards

Left-sided Heart Failure

Fluid buildup in the lungs due to left ventricle weakness.

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Right-sided Heart Failure

Fluid buildup in the body's periphery and organs, due to right ventricle weakness.

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Pulmonary Congestion

Fluid buildup in the lungs.

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Peripheral Tissues and Viscera Congestion

Fluid buildup in the body outside the lungs.

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Dyspnea

Shortness of breath.

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Orthopnea

Shortness of breath while lying down.

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Dependent Edema

Swelling in the lower extremities due to fluid buildup.

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Paroxysmal Nocturnal Dyspnea

Sudden and severe shortness of breath that awakens a person from sleep.

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Cough

A symptom related to both left and right heart failure, usually worse when lying down or with exertion.

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Pulmonary Crackles

A sound the physician can hear with a stethoscope, indicating fluid in the lungs.

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Low Oxygen Saturation

A reduced level of oxygen in the blood, often linked to heart failure.

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S3 or Ventricular Gallop

A specific heart sound related to heart failure, the physician may hear this sound with a stethoscope.

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Weight Gain

Abnormal weight gain linked to fluid retention from heart failure.

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NYHA Classification of Heart Failure

A system used to categorize the severity of heart failure by symptoms during physical activity.

Signup and view all the flashcards

Low Perfusion/ Low Cardiac Output

Reduced blood flow and heartbeat leading to symptoms in different parts of the body.

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Oliguria

Low urine output.

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Nocturia

Frequent urination at night.

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Altered Digestion

Disruptions in digestion, common in heart failure.

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Anorexia

Loss of appetite.

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Nausea

Feeling sick to the stomach.

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Abdominal Pain

Pain in the abdomen, related to poor digestion or the fluid build-up.

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Generalized Weakness

Overall feeling of weakness or tiredness.

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Fatigue

Extreme tiredness, often related to low energy levels.

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Distended Jugular Veins

Swollen neck veins, a sign of heart failure.

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Milrinone

A phosphodiesterase 3 inhibitor that improves heart contraction and reduces lung blood pressure (pulmonary vascular resistance). It also widens blood vessels, reducing pressure on the heart.

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Dobutamine

A medication used for cardiogenic shock and severe heart failure, sometimes for cardiac stress tests. Administered intravenously.

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Cardiogenic shock

A life-threatening condition where the heart can't pump enough blood to meet the body's needs.

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Pulmonary vascular resistance

Pressure in the blood vessels of the lungs opposing blood flow.

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Dietary Sodium Restriction

Limiting sodium intake to no more than 2 grams per day, to reduce fluid retention.

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Fluid Restriction

Reducing fluid intake to minimize fluid retention and symptoms related to fluid buildup in the body and lungs

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Implantable Cardioverter Defibrillator (ICD)

A device implanted to correct abnormal heart rhythms (dysrhythmias).

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Cardiac Synchronization Therapy

Treatment to better coordinate heart chambers' contractions for patients with heart failure not improving with standard drugs.

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Coronary Artery Bypass Grafting (CABG)

Surgical procedure that improves blood flow to the heart muscle.

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Heart Valve Surgery (Balloon Valvuloplasty)

Surgical procedure to repair or replace faulty heart valves that limit blood flow.

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Implantable Left Ventricular Assist Device (LVAD)

An assistive device surgically implanted to aid the left ventricle in pumping blood.

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Heart Transplant

Surgical procedure to replace a diseased heart with a healthy donor heart

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Study Notes

Congestive Heart Failure (CHF)

  • CHF is the inability of the heart to pump enough blood to meet the body's needs.
  • It was formerly known as "Congestive heart failure".
  • CHF is a clinical syndrome marked by fluid overload and inadequate tissue perfusion.
  • Two main types of heart failure are systolic and diastolic.

Types of Heart Failure

  • Systolic Heart Failure: The heart muscle does not contract forcefully enough, leading to reduced blood pumped out. Characterized by a weakened heart muscle. It is the most common type.
  • Diastolic Heart Failure: The heart muscle does not relax properly, preventing the ventricles from filling adequately. Characterized as a stiff and noncompliant heart muscle. Less common than systolic.

Diagnosing Heart Failure

  • Ejection Fraction (EF): A measurement taken via ECG to determine if HF is systolic or diastolic. EF is the percentage of blood ejected from the left ventricle during each contraction.
  • Normal EF is 55-65% of ventricular volume.
  • Systolic HF has severely reduced EF.
  • Diastolic HF has a normal EF.

Causes of Heart Failure

  • Atherosclerosis
  • Coronary Artery Disease (CAD)
  • Hypertension (High Blood Pressure)
  • Valvular Heart Disease
  • Cardiomyopathy

Signs and Symptoms of Heart Failure

  • Right-sided Heart Failure: Peripheral and visceral congestion.
  • Left-sided Heart Failure: Pulmonary congestion.
  • Signs and symptoms are related to congestion and poor perfusion.

Left-sided Heart Failure Symptoms

  • Pulmonary congestion (e.g., dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, crackles, low oxygen saturation)
  • Low perfusion/low cardiac output (e.g., oliguria, nocturia, altered digestion, dizziness, restlessness, confusion, cool clammy skin, fatigue)

Right-sided Heart Failure Symptoms

  • Peripheral tissues and viscera congestion (e.g., dependent edema, abdominal bloating, ascites, hepatomegaly, weight gain)
  • Low perfusion/low cardiac output (e.g., anorexia, nausea, abdominal pain, generalized weakness, distended jugular veins)

NYHA Classification of Heart Failure

  • Class I: No symptoms during normal physical activity.
  • Class II: Comfortable at rest, but normal physical activity causes symptoms like fatigue, palpitation and shortness of breath.
  • Class III: Comfortable at rest, but limited physical activity causes symptoms.
  • Class IV: Symptoms present even while at rest; significant limitations in physical activity.

American College of Cardiology and AHA Classification

  • Stage A: High risk for developing left ventricular dysfunction but no symptoms (e.g. high blood pressure, diabetes)
  • Stage B: Left ventricular dysfunction but no current symptoms
  • Stage C: Left ventricular dysfunction with current symptoms.
  • Stage D: Refractory, end-stage HF requiring specialized interventions.

How is CHF Diagnosed?

  • Laboratory Tests: Electrolytes, BUN, creatinine, liver function tests, thyroid stimulating hormone, CBC, urinalysis..
  • B-type Natriuretic Peptide (BNP): A key diagnostic indicator of heart failure. Elevated levels indicate heart failure.
  • ECG, EF, Echocardiogram, Cardiac Catheterization, stress test

Medical Management: Pharmacological Therapy

  • ACE Inhibitors (Lisinopril, Enalapril): Decrease blood pressure and afterload, relieve symptoms, prevent progression. Side effects may include hypotension, potassium increase, cough & worsening renal function
  • Angiotensin II Receptor Blockers (Valsartan, Losartan): Similar effects as ACE inhibitors but alternate option if ACE inhibitors are not tolerated.
  • Peripheral Vasodilators (Hydralazine, Dinitrate): Dilates blood vessels, decreasing blood pressure and afterload. Side effects include hypotension.
  • Beta-Blockers (Metoprolol, Carvedilol): Dilate blood vessels, decrease afterload, improve exercise capacity. Side effects include hypotension, decreased heart rate, dizziness, fatigue
  • Diuretics (Furosemide, Metolazone): Reduce fluid volume overload, decrease symptoms. Side effects include electrolyte imbalance, renal issues, low blood pressure; monitor daily weights and I&O
  • Digitalis (Digoxin): Improves cardiac contractility, decrease symptoms. Side effects can include bradycardia and digitalis toxicity needs careful monitoring.

Medical Management: IV Infusion

  • Milrinone (Primacor): Pulmonary vasodilator that increases heart contractility and decreases pulmonary vascular resistance.
  • Dobutamine (Dobutarex): Used to treat cardiogenic shock and severe heart failure.

Additional Therapies

  • Supplemental oxygen

Other Interventions

  • Implantable Cardioverter Defibrillator (ICD): For patients with arrhythmias.
  • Cardiac Synchronization Therapy: For patients with heart failure that doesn't improve with standard therapies.

Nutritional Therapy

  • Low Sodium Diet: Limit sodium intake to control fluid retention.
  • Fluid Restriction: Avoid excess fluid to manage fluid retention.

Lifestyle Changes

  • Restrict Dietary Sodium: Limit sodium intake.
  • Smoking Cessation: Quit smoking
  • Avoid Alcohol: Reduce/avoid alcohol consumption.
  • Weight Reduction: Losing weight can improve symptoms.
  • Regular Exercise: Encouraged, but appropriate for each patient's capacity

Surgical Procedures

  • Coronary Artery Bypass Grafting (CABG): Surgery to bypass blocked arteries.
  • Heart Valve Surgery: Surgery to repair or replace damaged heart valves, including balloon valvuloplasty
  • Implantable Left Ventricular Assist Device (LVAD): A mechanical device that helps the heart pump blood.
  • Heart Transplantation: Used for end-stage heart failure.

Nursing Interventions

  • Promoting Activity Tolerance: Encourage appropriate activity levels.
  • Managing Fluid Volume: Monitor and manage fluid intake/output.
  • Controlling Anxiety: Provide emotional support and education.
  • Monitoring and Managing Potential Complications: Monitor for electrolyte, hydration and blood pressure issues.
  • Patient Education: Educate patients and families about self-management.

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