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</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</p> Signup and view all the answers

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

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

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

    <p>Bradycardia</p> Signup and view all the answers

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

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

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

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

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

    <p>Hepatomegaly</p> Signup and view all the answers

    What distinguishes Class IV heart failure from Class III?

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

    What are the common causes of heart failure?

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

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

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

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

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

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

    <p>Diuretics</p> Signup and view all the answers

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

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

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

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

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

    <p>Echocardiogram</p> Signup and view all the answers

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

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

    What characterizes systolic heart failure?

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

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

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

    Which condition is NOT associated with heart failure?

    <p>Asthma</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.</p> Signup and view all the answers

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

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

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

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

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

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

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

    <p>Nocturia</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</p> Signup and view all the answers

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

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

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

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

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

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

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

    <p>Hydralazine</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</p> Signup and view all the answers

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

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

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

    <p>Echocardiogram</p> Signup and view all the answers

    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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    Description

    This quiz covers important aspects of Congestive Heart Failure (CHF), including its definition, types, and diagnostic measures. You will learn about systolic and diastolic heart failure and how ejection fraction plays a critical role in diagnosis. Test your knowledge of the heart's functioning and related conditions.

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