NR341 Exam 2 Study Notes.docx

Heart Failure

Inability to Generate Adequate Flow:

• Systolic Heart Failure: Impaired contractility
• Diastolic Heart Failure: Impaired filling

Progression:

• Typically leads to left-sided heart failure occurring first.

Heart Compensation Mechanisms:

• Hypertrophy:
  • Cardiac wall thickens, muscle mass increases due to increased workload, leading to increased oxygen demand for heart muscle/tissue.
• Dilation:
  • Chambers enlarge due to increased blood volume, muscle fibers stretch to increase contraction force.

BNP (B-type Natriuretic Peptide):

• A cardiac hormone secreted by ventricular myocytes due to wall stretching.
  • Normal: <100 pg/mL
  • Heart Failure: Increased BNP
    • Treatment for Increased BNP:
      • Diuretics
      • Digoxin (helps heart pump stronger, slows HR)
      • Beta blockers (helps heart pump better, decreases BP and HR)
      • ACE inhibitors (decreases BP and heart resistance to assist heart to pump better)
      • Sodium restriction
      • Fluid restriction
  • Treated Heart Failure: Decreased BNP
  • Differentiates Pulmonary and Cardiac Causes of Dyspnea

Right-Sided Heart Failure:

• Impaired Right Ventricle: Leads to backup of blood in the right ventricle, right atrium, and systemic circulation.
  • Increased central venous pressure
  • JVD (jugular vein distention)
  • Peripheral edema
  • Hepatomegaly and RUQ tenderness
  • Portal hypertension
  • Ascites (congestion in the liver)
  • S3 and S4 heart sounds

Left-Sided Heart Failure:

• Impaired Left Ventricle: Leads to backup of blood in the left ventricle, left atrium, pulmonary veins, and lungs.
  • Increased pulmonary capillary wedge pressure
  • Adventitious breath sounds (crackles, rales)
  • Exertional dyspnea
  • Orthopnea and paroxysmal nocturnal dyspnea
  • Cough
  • A-fib secondary to atrial distention
  • Pulsus alternans (every other beat is diminished)
  • S3 heart sounds

Treatment for Heart Failure (Mnemonics: UNLOAD FAST):

• Upright Position
• Nitrates
• Lasix
• Oxygen
• ACE Inhibitors
• Digoxin
• Fluids Decreased
• Afterload Decreased
• Sodium Restriction
• Tests: Digoxin level, ABGs, K+ level
• BNP = Nesiritide Citrate (Natrecor): Short-term treatment for acute HF

Heart Failure Complications:

• Pulmonary Edema:
  • Dyspnea
  • Cyanosis
  • Gurgles
  • Pink, frothy sputum
  • Hypoxemia
• Cardiogenic Shock: Unable to supply body with necessary oxygen demands.
  • Decreased LOC
  • Decreased output
  • Hypotension

Inflammatory Heart Disease

Pericarditis:

• Inflammation of the Pericardium
  • Causes: Viruses, MI, rheumatic fever, trauma, uremia, cancers, idiopathic
  • Complications: Effusion, tamponade, scarring
  • Signs and Symptoms:
    • Pleuritic chest pain (increases with coughing, swallowing, inspiration)
    • Pain relieved when sitting up and leaning forward
    • Fever, chills (may or may not be present)
    • Leukocytosis
    • Pericardial friction rub
    • ST segment elevation in all leads with 12-lead EKG (indicative of inflammation)