Congestive Heart Failure Overview

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Questions and Answers

What is a recommended nonpharmacologic treatment for congestive heart failure (CHF)?

Limit salt intake (correct)

Consume more alcohol

Engage in high-intensity exercise without warming up

Increase saturated fat intake

Which diagnostic test is specific for assessing heart failure?

Lipid panel

Brain natriuretic peptide (BNP) test (correct)

Complete blood count (CBC)

Urinalysis

What is the significance of measuring the ejection fraction (EF) in heart failure?

It measures the heart's ability to pump blood (correct)

It determines lung capacity

It assesses the blood sugar level

It indicates the presence of high cholesterol

What does preload refer to in the context of heart function?

The pressure in the right atrium from incoming blood Signup and view all the answers

Which of the following lifestyle modifications is NOT suggested for managing CHF?

Ignore fluid restrictions Signup and view all the answers

In the context of congestive heart failure, which statement about edema is correct?

Edema is a common symptom caused by fluid retention. Signup and view all the answers

What condition describes the situation when blood backs up into the periphery, such as the liver and feet?

Right-sided congestive heart failure Signup and view all the answers

What is the primary consequence of increased afterload on the heart?

Decreased stroke volume due to increased resistance Signup and view all the answers

Which of the following is an outcome of fluid overload in congestive heart failure?

Pulmonary congestion and peripheral edema Signup and view all the answers

Hypertrophy of the cardiac muscle in congestive heart failure is primarily a response to what condition?

Increased afterload from vascular resistance Signup and view all the answers

What is the primary physiological role of the left ventricle?

To pump oxygenated blood into the aorta Signup and view all the answers

Which condition is NOT associated with fluid overload in heart failure?

Hypertension Signup and view all the answers

In congestive heart failure, which statement about the right atrium is correct?

It experiences increased pressure due to fluid retention Signup and view all the answers

What condition is characterized by blood backing up in the lungs, causing breathing problems?

Congestive heart failure Signup and view all the answers

What happens to the ventricles during congestive heart failure?

They are dilated Signup and view all the answers

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

Orthopnea Signup and view all the answers

Which of the following indicates right-sided heart failure?

Enlarged liver and ascites Signup and view all the answers

What is a common positioning symptom in heart failure that helps relieve breathing difficulties?

Tripod positioning Signup and view all the answers

What does increased peripheral venous pressure indicate?

Right-sided heart failure Signup and view all the answers

Which symptom is NOT typically associated with congestive heart failure?

Unexplained weight loss Signup and view all the answers

What does an increase in pulmonary capillary wedge pressure suggest?

Fluid overload in the lungs Signup and view all the answers

Study Notes

Congestive Heart Failure (CHF)

Hypertrophy (muscle enlargement) is a feature of CHF
Preload is pressure in the right atrium
Afterload is resistance left ventricle faces to push oxygenated blood
Right-sided CHF: fluid backs up in periphery (e.g., liver, feet)
Left-sided CHF: fluid backs up in lungs causing dyspnea and pulmonary edema
CHF symptoms include: fluid overload, dyspnea, pulmonary congestion, orthopnea, cyanosis, tripod positioning, peripheral venous pressure, ascites, enlarged liver/spleen, distended jugular veins, and weight gain/dependent edema
Four stages of CHF
Non-pharmacologic treatment includes limiting salt, alcohol, saturated fat, and encouraging exercise
Diagnostic tests: BNP (<100) or echocardiogram (EF <50%)
Digoxin (Lanoxin) is a cardiac glycoside that increases contractility, decreases heart rate, decreases conduction, and increases stroke volume
Check heart rate before digoxin administration
Diuretics interact with digoxin, leading to hypokalemia
Digoxin toxicity symptoms: GI symptoms, bradycardia, visual disturbances (yellow halos)
Digibind is the antidote for digoxin toxicity
Milrinone (Primacor) is a phosphodiesterase inhibitor for short-term CHF
Primacor is administered IV in ICU and has fatal ventricular dysrhythmias as potential adverse effects
Nesiritide (Natrecor) is a natriuretic peptide for acute heart failure, common adverse effect is hypotension
ACE inhibitors, diuretics and potassium are nephrotoxic, monitor BUN & creatinine
Atherosclerosis is a cause of coronary artery disease & high lipid intake
Lipid build-up from high dietary lipids is a major cause of coronary artery disease
Treat CHF by unloading the patient quickly

Angina (Chest Pain)

Angina is a major symptom of coronary artery disease
Nitroglycerin is an antianginal drug. Adverse effects include hypotension and headache
Nitroglycerin relaxes coronary arteries, a vasodilator
Important to check blood pressure before administering Nitroglycerin
Nitroglycerin should be taken via oral or topical route avoiding sunlight
Atenolol is a beta blocker reducing oxygen need & anginal pain
P wave = atrial activation; QRS = ventricular activation; T wave = recovery
Class 3 antidysrhythmics like amiodarone & dronedarone prolong repolarization and are used to treat ventricular dysrhythmias
Diltiazem treats atrial fibrillation
Emergency drugs for cardiac disorders: MONA (Morphine, Oxygen, Nitroglycerin, Aspirin)

Respiratory Agents

Three lobes in the right lung, two in the left due to the heart's presence
Ventilation is the process of oxygen passing through the airways
Perfusion is the blood flow to the alveolar capillaries
Ventilation/perfusion ratio (V/Q ratio) is ideally equal
Diffusion involves gas exchange between oxygen and carbon dioxide
Common cold symptoms include sneezing, nasal congestion, cough, and sore throat; use nonpharmacologic remedies.
Decongestants (e.g., pseudoephedrine or oxymetazoline) stimulate alpha-adrenergic receptors for nasal mucosa shrinkage. Adrenergic medications should be used with caution.
Antihistamines treat allergic reactions, induce sleep, help with common cold symptoms, and treat motion sickness/Nausea
Antihistamines block the histamine 1 receptor.
Intranasal glucocorticoids are used to control inflammation, and can cause nasal dryness
Obstructive pulmonary diseases: Emphysema, COPD, Asthma
Restrictive pulmonary diseases: Fluid accumulation or elasticity loss, e.g., tumors or Scoliosis
Chronic obstructive pulmonary disease (COPD) reduces airflow reversibly.
Emphysema permanently enlarges alveoli and destroys alveolar walls.
Chronic bronchitis involves mucus hypersecretion and continuous productive cough.
Asthma involves airway inflammation, often related to allergens or irritants, causing constriction and increased mucus.
Albuterol is a beta2-agonist bronchodilator used in acute attacks (rescue inhaler)
Ipratropium bromide helps decrease bronchoconstriction and mucus secretion
Xanthines such as theophylline enhance bronchodilation/decrease bronchospasm.
Corticosteroids such as beclomethasone reduce inflammation in asthma or COPD.
Leukotriene modifiers like montelukast reduce inflammatory symptoms of asthma
Cromolyn prevents histamine release, used prophylactically in asthma

UTI Infections

Acute pyelonephritis is a kidney infection (often E.coli in females). Symptoms include chills, fever, flank pain, urinary symptoms (dysuria, frequency, urgency).
Acute cystitis is a bladder infection (often E.coli or other bacteria). Symptoms are similar to pyelonephritis, but without flank pain.
Bactrim, Nitrofurantoin, Ciprofloxacin are antibiotics used to treat UTIs. Specific advice regarding individual drugs is provided in a separate study section.

Immunizations

Active immunity involves the body's immune response to an antigen; creating its own antibodies (from vaccines).
Passive immunity involves receiving pre-formed antibodies(via breastmilk, plasma transfusion, etc)
Vaccination is an example of active immunity.
Many vaccines are contraindicated during pregnancy.
Influenza IM shots are acceptable during pregnancy
Common bacterial illnesses, like smallpox and anthrax; some infections can be caused through bioterrorism

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Description

This quiz covers essential aspects of Congestive Heart Failure (CHF), including its symptoms, diagnostic tests, and treatment options. Understand the pathophysiology involving hypertrophy, preload, and afterload, as well as the differences between right-sided and left-sided heart failure. Test your knowledge on treatment strategies and key medications used in managing CHF.