Heart Failure Overview and Risk Factors

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Questions and Answers

What primary physiological issue characterizes systolic heart failure?

Fluid accumulation in the lungs

Increased stiffness of the ventricle

Decreased heart rate

Inability of the left ventricle to contract effectively (correct)

Which of the following symptoms is typically associated with left-sided heart failure?

Weight gain

Orthopnea (correct)

Pitting edema

Ascites

What does a reduced ejection fraction of less than 40% indicate?

Heart failure with reduced ejection fraction (correct)

Heart failure with preserved ejection fraction

Heart failure with midrange ejection fraction

Normal cardiac function

What commonly leads to right-sided heart failure?

Inability to accommodate returning blood from venous circulation Signup and view all the answers

Which risk factor is associated with a higher likelihood of developing heart failure?

Cigarette smoking Signup and view all the answers

How does the body respond to decreased blood flow in systolic heart failure?

Stimulates renin release from kidneys Signup and view all the answers

What is considered a key diagnostic indicator for congestive heart failure?

BNP level Signup and view all the answers

Which of the following symptoms suggests poor perfusion in heart failure?

Muscle wasting Signup and view all the answers

What effect does ventricular dilation have on contractility in systolic heart failure?

Decreases contractility Signup and view all the answers

Which type of heart failure is characterized by preserved ejection fraction?

Diastolic heart failure Signup and view all the answers

What does the presence of JVD (Jugular Venous Distension) indicate?

Increased pressure in the venous system Signup and view all the answers

Which symptom is associated with high levels of ANP and BNP in heart failure?

Pulmonary congestion Signup and view all the answers

What lifestyle change can effectively manage heart failure?

Regular exercise and physical activity Signup and view all the answers

What is a hallmark sign of congestive heart failure due to left-sided failure?

Pulmonary edema Signup and view all the answers

What characterizes Stage A heart failure?

Patients are at high risk for developing left ventricular dysfunction Signup and view all the answers

Which treatment is indicated for Stage C heart failure?

Diuretics and sodium restriction Signup and view all the answers

What is a sign that a patient may have cardiac tamponade?

Chest X-ray showing an enlarged silhouette Signup and view all the answers

Which medication is NOT recommended for heart failure patients?

NSAIDs Signup and view all the answers

What is one of the main roles of dobutamine in heart failure management?

Increase myocardial force and cardiac output Signup and view all the answers

What is the primary intervention for patients with refractory end-stage heart failure?

Heart transplantation Signup and view all the answers

What is a common characteristic of Stage D heart failure?

Symptoms despite maximum medication therapy Signup and view all the answers

Which medication is likely to be administered for increasing blood pressure in a hypotensive patient during cardiac arrest?

Norepinephrine Signup and view all the answers

What can be a side effect of direct-acting arterial vasodilators?

Hypotension and edema Signup and view all the answers

What is the primary purpose of cardiac resynchronization therapy?

To treat electrical conduction defects Signup and view all the answers

Which of the following is a critical nursing intervention for patients with heart failure?

Monitoring vital signs and lung sounds Signup and view all the answers

What does the term 'pulsus paradoxus' refer to in cardiac tamponade?

A drop in systolic BP during inhalation Signup and view all the answers

Which of the following treatments uses a catheter to remove fluid from around the heart?

Pericardiocentesis Signup and view all the answers

How often should Epinephrine be given during cardiac arrest if there is no pulse?

Every 3-5 minutes Signup and view all the answers

Study Notes

Heart Failure

A clinical syndrome where the heart is unable to pump enough blood to meet the body's needs.
Resulting from myocardial disease with either systolic dysfunction (contraction) or diastolic dysfunction (filling).
Chronic and progressive.
Can be managed with lifestyle changes or medications.
Patients over 65 are at higher risk for hospitalization, hospital stay, and readmission.

Risk Factors for Heart Failure

African Americans and Latinos.
Age (over 60).
Gender (men more likely than women).
Major cardiac disorders.
Diabetes.
Cigarette smoking.
Obesity.
Metabolic Syndrome.
Coronary artery disease, cardiomyopathy, poorly managed cholesterol.

Types of Heart Failure

Dysfunction typically occurs before a patient experiences symptoms (edema, shortness of breath, fatigue).
Systolic Heart Failure (most common): Decreased blood flow ejected from the ventricle.
Diastolic Heart Failure: Stiff ventricle will not fill, leading to decreased cardiac output.

Systolic Heart Failure

Baroreceptors sense the decreased blood flow and stimulate epinephrine release to increase heart rate for increased blood pumping.
Vasoconstriction occurs.
Kidneys release renin, which converts angiotensinogen to angiotensin I in the lungs.
Angiotensin-converting enzyme (ACE) converts angiotensin I to angiotensin II.
These actions lead to increased preload and afterload.
Cardiac chambers release Atrial Natriuretic Peptide (ANP) and B-type Natriuretic Peptide (BNP) to vasodilate.

Systolic Heart Failure Continued

Ventricular Dilation: Increased workload leads to decreased contractility. Myocardial stretching occurs, increasing the size of the ventricle.
Ventricular Hypertrophy: Abnormal changes in the structure/function of myocardial cells (ventricular remodeling). Happens under the influence of neurohormones (angiotensin II). Enlarged myocardial cells become dysfunctional and stimulate early apoptosis.

Signs and Symptoms of Heart Failure

Congestion: Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, cough, pulmonary crackles, rapid weight gain, dependent edema, abdominal bloating, ascites, JVD, fatigue.
Poor perfusion/low cardiac output: Decreased exercise tolerance, muscle wasting/weakness, anorexia or nausea, unexplained weight loss, lightheaded or dizziness, unexplained confusion or altered mental status, resting tachycardia, daytime oliguria, cool, vasoconstricted extremities, pale or cyanotic.

Left-Sided Heart Failure

Left ventricular failure, inability of the left ventricle to fill or eject blood to the body.
Signs and Symptoms: Pulmonary congestion, dyspnea, cough, crackles, low O2 sat, orthopnea (cannot lie flat), paroxysmal nocturnal dyspnea (sudden dyspnea).

Left-Sided Heart Failure Symptoms Explained

Orthopnea: Patient unable to lie flat and may require multiple pillows when sleeping.
Paroxysmal Orthopnea: Fluid accumulated in the extremities during the day is reabsorbed when the patient lies down. Impaired left ventricle cannot eject fluid to the body, and fluid becomes backed up. Alveoli cannot gas exchange.
Cough: Pink or tan sputum indicates decompensated HF and pulmonary edema.
Decreased Cardiac Output (CO): Low perfusion to organs, stimulation of catecholamines, fatigue.

Right-Sided Heart Failure

Right ventricular failure leads to congestion in the peripheral tissue and viscera.
Due to the inability to accommodate the blood returning to the heart from venous circulation.
Increased JVD due to pressure in the venous system.
Hepatomegaly (enlargement of the liver) and ascites.
Weight gain.
Pitting edema.
Anorexia.

Congestive Heart Failure

Results from left-sided heart failure.
Blood backs up and also impacts the right side of the heart.
Signs and Symptoms: Swelling of extremities, GI tract, and liver; JVD.
Pulmonary Edema: Caused by left ventricular failure. Patient will be deprived of O2 to the brain.
Signs and Symptoms of Pulmonary Edema: Restlessness, anxiety, sense of suffocation, tachycardia. It is an emergent situation.

Ejection Fraction

Determines the degree of heart failure as it measures ventricular contractility and the percentage of end-diastolic volume that is ejected with each heartbeat.
Expected: 55-65%.
Heart Failure with Reduced EF: Systolic HF, the left ventricle loses the ability to contract; EF less than 40%.
Heart Failure with Preserved Ejection Fraction: Diastolic heart failure, the left ventricle function is greater than or equal to 50% but loses its ability to relax due to stiffness.
Heart Failure with Midrange ejection fraction: EF 40-49%.

Tests for Congestive Heart Failure

Echocardiogram.
Chest x-ray.
12-lead EKG.
Electrolytes.
BUN/Creatinine.
Liver function.
TSH.
BNP (KEY diagnostic indicator).
CBC.
Urinalysis.

Heart Failure Classification (NY American Heart Assoc.)

Stage I: No limitation of physical activity. Ordinary activity does not cause fatigue, palpitation, or dyspnea.
Stage II: Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity causes fatigue, palpitation, or dyspnea.
Stage III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitations, or dyspnea.
Stage IV: Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If physical activity is undertaken, discomfort is increased.

Treatment for Classes of Heart Failure

Stage A: Patients at high risk for developing left ventricular dysfunction but without structural heart disease or symptoms of HF.
Characteristics: HTN, atherosclerosis, diabetes, metabolic syndrome.
Treatment: Lifestyle modification, control HTN, diabetes, and obesity.
Stage B: Patients with left ventricular dysfunction or structural heart disease who have not developed symptoms of HF.
Characteristics: History of MI, left ventricular hypertrophy, low ejection fraction.
Treatment: Lifestyle modifications plus ACE/ARB, BB, statin.
Stage C: Patients with left ventricular dysfunction or structural heart disease with current or prior symptoms of heart disease.
Characteristics: SOB, fatigue, decreased exercise intolerance.
Treatment: Same as A and B plus diuretics, aldosterone antagonist, sodium restriction, implantable defibrillator, cardiac resynchronization therapy.
Stage D: Patients with refractory end-stage HF requiring special interventions.
Characteristics: Symptoms despite maximal medication therapy, recurrent hospitalizations.
Treatment: Implement stages A, B, and C plus fluid restriction, end-of-life, inotropes, cardiac transplant, mechanical support.

IV Infusions for HF Patients

Used when all other treatments have failed.
Patients are usually admitted to the ICU for monitoring.
These drugs have a profound impact on BP.
Examples: Dopamine, Debutamone, Milrinone, Vasodilators.

Adrenergic Antagonists

Examples: Dobutamine, Dopamine, Epinephrine, Norepinephrine.
Dobutamine: Increase myocardial force and cardiac output.
Dopamine: Increases BP and cardiac output through positive inotropic action, which increases renal blood flow. Good for patients in renal failure.
Epinephrine: Used as an emergency to increase cardiac stimulation during cardiac arrest.
Norepinephrine: Stimulates the heart during cardiac arrest, increases BP in hypotension and shock.
Side effects: Dysrhythmias, tachycardia, restlessness, urinary incontinence.
Nursing Implications: VS, lung sounds, urinary output.

Direct-Acting Arterial Vasodilators

Relax the smooth muscle of blood vessels with vasodilation.
BP drops, and sodium and water are retained, leading to peripheral edema (may need to administer diuretics with this medication).
Helps promote blood flow to the brain and kidneys.
Side effects: Hypotension, edema, dizziness, headache, nasal congestion.
Nursing Interventions: Monitor BP. If taking nitroprusside, monitor cyanide levels for toxicity.
Examples: Nitroglycerin, Sodium Nitroprusside.

Miscellaneous Vasodilators

Similar to B-type natriuretic peptide (BNP) that allows for vasodilation of arteries and veins.
Used for the treatment of decompensated heart failure.
Side effects: Hypotension, confusion, dizziness, dysrhythmias.
Interventions: Administer via continuous IV. Monitor BP, cardiac rhythm, urine output, and body weight. Monitor for improvement of HF symptoms.
Example: Nesiritide.

Adjunct Therapy

Blood Pressure Medication: Target BP should be less than 130/80. Helps decrease the risk of morbid progression.
Iron Replacement: Anemia can be seen in patients who have HF, caused by reduced exercise capacity.
Anticoagulation therapy: Prevents clots, especially in patients who have Afib.
Antiarrhythmic Drugs: Amiodarone or evaluation for ICD (Implantable Cardioverter Defibrillator).
Statins.
Medications to AVOID: NSAIDs (ibuprofen), renal effects.

Non-Medication Adjunct Therapy

Nutritional Therapy: Low-salt diet, fluid restriction.
Supplemental Oxygen: May only be needed during periods of activity.
Management of Sleep Disorders: Over half of HF patients have OSA. Sleep study should be performed. CPAP will help with sleep quality.

Procedures for Patients in HF

PCI or CABG: If the underlying cause is CAD.
ICD: Indicated when EF is less than 35%. Prevents sudden cardiac death.
Cardiac Resynchronization Therapy (CRT): Used to treat electrical conduction defects and synchronize ventricular contractions.
Ultrafiltration: Filters blood at the bedside. For patients who do not respond to diuretic therapy.
Heart Transplantation.

Nursing Interventions

Promoting activity tolerance: Lack of exercise worsens the condition.
Managing Fluid Volume: Diet, Auscultation of lung sounds.
Controlling Anxiety.
Minimizing Powerlessness.
Assisting patients and families to effectively manage health.
Monitor and manage complications.

Complications from Heart Disease

Cardiogenic Shock: From inadequate tissue perfusion. A life-threatening condition with a high mortality rate.
Thromboembolism: Risk factor for patients who have Afib and are immobile. Atria do not contract forcefully, which leads to slow and turbulent blood flow.
Pericardial Effusion and Cardiac Tamponade: Greater than 20 mL of fluid surrounding the heart.
Cardiac Arrest.

Clinical Manifestation of Cardiac Tamponade

Acute Tamponade: Sudden chest pain, tachypnea, dyspnea, and JVD. Hypotension for both Tamponade and Effusion.
Subacute Pericardial Effusion: Less dramatic, occurs over time.
Pulsus Paradoxus: Systolic BP that is lower during inhalation (10mmhg difference).
EKG: Tachycardia.
Chest X-ray: Enlarged silhouette.

Treatment of Pericardial Fluid

Pericardiocentesis: Catheter is inserted and drains the pericardial fluid. Patient feels instant relief.
Pericardiotomy: For recurrent pericardial effusions, a portion of the pericardium is removed to help with drainage.

Cardiac Arrest

The heart is unable to pump and circulate blood.
Usually associated with V-Fib.
Pulseless Electrical activity: Electrical activity is present on EKG but no contractions are present.
Signs and Symptoms: Consciousness, pulse, and BP are lost immediately, pupils dilate and seizures occur. Irreversible brain damage is possible with each minute that passes.

Emergency Assessment for Cardiac Arrest

1) Quick Recognition.
2) Activation of Emergency Response.
3) Performance of High-Quality CPR: Must be done on a firm surface and compressions are done at a rate of 100 compressions/minute.
Complete recoil must be done in between compressions.
Allows for cardiac refilling.
Switch providers for a break.
4) Rapid cardiac analysis and defibrillation within 2 minutes.

Medications for Cardiac Arrest

Epinephrine: Improves perfusion and myocardial contractility. Given when there is no pulse. 1 mg q 3-5 mins IV push followed by 20 mL saline.
Norepinephrine: Increases BP, given for hypotension and shock. 0.1-0.5 mcg/kg/min as an IV infusion in a central line.
Dopamine: Given to increase BP in shock. 5-10 mcg/kg/ min as IV in a central line.
Atropine: Increases SA node automaticity and AV conduction. Given to bradycardic patients. 0.5 mg IV push.

Medication for Cardiac Arrest Continued

Amiodarone: Acts on sodium-potassium and calcium channels to prolong action potential - treats pulseless VT and VF unresponsive to shock. 300 mg IV.
Sodium Bicarbonate: Corrects metabolic acidosis. 1 mEq/kg IV.
Magnesium Sulfate: Promotes adequate functioning of cellular sodium-potassium pumps. 1-2 g diluted in 10mL D5W over 5-20 mins.

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Description

This quiz covers the essential aspects of heart failure, including its definition, risk factors, and types. It highlights the clinical syndrome's chronic nature and the implications for different demographics, particularly older adults. Test your knowledge on understanding heart failure management and its complications.