Quiz #2 Cardiac
Study Guide
1) Heart Failure
A) Description
Heart failure (HF) is an abnormal clinical syndrome that involves inadequate pumping
and/or filling of the heart.
This results in the inability of the heart to provide sufficient blood to meet the oxygen
needs of the tissues.
In clinical practice, the terms acute and chronic HF have replaced the term
“congestive HF” (CHF), because not all HF involves pulmonary congestion. However,
the term CHF is still commonly used.
B) etiology/patho
Inadequate cardiac output (depends on preload, afterload, myocardial contractility,
heart rate), Myocardial hypertrophy, Pulmonary and systemic congestion
Primary causes: conditions that directly damage the heart (HTN, CAD,
Rheumatic heart disease, Congenital heart defects, Pulmonary HTN,
Cardiomyopathy, Hyperthyroidism, Valvular disorders, Myocarditis)
Precipitating causes: conditions that increase workload of ventricles
(Anemia, Infection, Thyrotoxicosis, Hypothyroidism, Dysrhythmias,
Pulmonary embolism, Paget’s disease, Hypervolemia)
Ventricular failure leads to low BP, low CO and poor renal perfusion
Abrupt or subtle onset
Overload heart uses compensatory mechanisms to try to maintain adequate CO
C) Systolic Heart failure vs Diastolic Heart Failure
- Left ventricular ejection fraction
Amount of blood ejected from left ventricle per heart beat
-Systolic failure (HFrEF less than 40%) results from an inability of the heart to pump
blood effectively
-Systolic failure is a decrease in the Ejection Fraction
-Systolic failure is caused by impaired contractile function (MI), increased afterload
(HTN), cardiomyopathy and mechanical abnormalities (valvular heart disease)
-Diastolic failure (HFpEF) is the ability of the ventricles to relax and fill during diastole
-Approx, 50% patients with HF have diastolic failure and HTM is the most important
cause
-Is characterized by high filling pressures because of stiff ventricles. Decreased filling of
the ventricles results in decreased stroke volume and CO
HFpEF is diagnosed by the following criteria: (1) signs and symptoms of
HF, (2) normal EF, and (3) evidence of LV diastolic dysfunction by
echocardiography or cardiac catheterization
- Mixed systolic and diastolic failure is seen in disease states such as dilated
cardiomyopathy (DCM).
- DCM is a condition in which poor systolic function is further compromised by a dilated
LV wall that is unable to relax.
, -These patients often have extremely low EFs (less than 35%), high pulmonary
pressures, and biventricular failure (both ventricles are dilated and have poor filling and
emptying capacity).
D) Left-sided heart failure vs right-sided heart failure
- Expected findings
Left sided HF is most common form
Dyspnea (with mild exertion or at rest), orthopnea (shortness of breath
while lying down: often accompanies dyspnea, chair to aid breathing),
paroxysmal nocturnal dyspnea (during sleep: wakes in panic, has feeling
of suffocation, reabsorption of fluid from dependent body areas when pt.
flat)
Fatigue (one of the earliest symptoms of chronic HF)
Displaced apical pulse (hypertrophy)
S3 heart sound (gallop)
Pulmonary congestion (dyspnea, cough, bibasilar crackles)
Frothy sputum (can be blood-tinged)
Altered mental status
Manifestations of organ failure: e.g., oliguria
Results either from the inability of the left ventricle to empty adequately during
systole or fill adequately during diastole (left ventricular dysfunction)
Can be further classified as systolic, diastolic, or mixed systolic and diastolic failure.
Manifests as pulmonary congestion and edema
Right-sided HF occurs when the right ventricle (RV) fails to pump effectively.
Jugular vein distention
Ascending dependent edema (legs, ankles, sacrum)—(Sudden weight gain
of >3 lb (1.4 kg) in 2 days may indicate ADHF, an exacerbation of chronic
HF***)
Abdominal distention, ascites
Fatigue, weakness
Nausea and anorexia
Polyuria at rest (nocturnal)
Liver enlargement (hepatomegaly) and tenderness
Weight gain
When the RV fails, fluid backs up into the venous system.
This causes movement of fluid into the tissues and organs (e.g., peripheral edema,
abdominal ascites, hepatomegaly, jugular venous distention).
The most common cause of right-sided HF is left-sided HF.
As the LV fails, fluid backs up into the pulmonary system, causing increased
pressures in the lungs.
The RV has to work harder to push blood to the pulmonary system.
Over time, this increased workload weakens the RV and gradually it fails.
, Other causes of right-sided HF (independent of the function of the LV) include RV
infarction, pulmonary embolism, and cor pulmonale (RV dilation and hypertrophy
caused by pulmonary disease).
E) Health promotion and disease prevention
Fatigue
Activity limitations
Chest congestion/cough
Edema
Shortness of breath
Maintain an exercise routine after consult with provider
Diet: ↓ sodium, fluid restrictions, and consult with the provider regarding diet
specifications.
Refrain from smoking.
Follow medication regimen, and follow up with the provider as needed.
F) Laboratory and diagnostic procedures: know purpose, nursing considerations,
contraindications, pt. education
- BNP
Clients with dyspnea
Increase hBNP confirms HP diagnosis rather than respiratory origin
hBNP levels: direct aggressiveness of treatment
< 100 pg/mL: no heart failure
100 to 300 pg/mL: suggests heart failure
> 300 pg/mL: mild heart failure
> 600 pg/mL: moderate heart failure
> 900 pg/mL: severe heart failure
- Echocardiogram
Measure systolic and diastolic function
Left ventricular ejection fraction: volume of blood pumped from LV into arteries
per heart beat
Right ventricular ejection fraction: volume of blood pumped from RV to the
lungs per heart beat
Expected reference range
Left ventricular ejection fraction (LVEF): 55% – 70%
Right ventricular ejection fraction (RVEF): 45% – 60%)
Preprocedure: explain reason for test, Noninvasive and takes up to 1-hour
Intraprocedure: Instruct pt to lie on left side and remain still
Postprocedure: Provider review test and plan for follow-up care with pt
- Transesophageal echocardiogram (TEE)
Uses a transducer placed in the esophagus behind the heart to obtain a
detailed view of cardiac structures.
Preparation: same as upper endoscopy
- CXR
Study Guide
1) Heart Failure
A) Description
Heart failure (HF) is an abnormal clinical syndrome that involves inadequate pumping
and/or filling of the heart.
This results in the inability of the heart to provide sufficient blood to meet the oxygen
needs of the tissues.
In clinical practice, the terms acute and chronic HF have replaced the term
“congestive HF” (CHF), because not all HF involves pulmonary congestion. However,
the term CHF is still commonly used.
B) etiology/patho
Inadequate cardiac output (depends on preload, afterload, myocardial contractility,
heart rate), Myocardial hypertrophy, Pulmonary and systemic congestion
Primary causes: conditions that directly damage the heart (HTN, CAD,
Rheumatic heart disease, Congenital heart defects, Pulmonary HTN,
Cardiomyopathy, Hyperthyroidism, Valvular disorders, Myocarditis)
Precipitating causes: conditions that increase workload of ventricles
(Anemia, Infection, Thyrotoxicosis, Hypothyroidism, Dysrhythmias,
Pulmonary embolism, Paget’s disease, Hypervolemia)
Ventricular failure leads to low BP, low CO and poor renal perfusion
Abrupt or subtle onset
Overload heart uses compensatory mechanisms to try to maintain adequate CO
C) Systolic Heart failure vs Diastolic Heart Failure
- Left ventricular ejection fraction
Amount of blood ejected from left ventricle per heart beat
-Systolic failure (HFrEF less than 40%) results from an inability of the heart to pump
blood effectively
-Systolic failure is a decrease in the Ejection Fraction
-Systolic failure is caused by impaired contractile function (MI), increased afterload
(HTN), cardiomyopathy and mechanical abnormalities (valvular heart disease)
-Diastolic failure (HFpEF) is the ability of the ventricles to relax and fill during diastole
-Approx, 50% patients with HF have diastolic failure and HTM is the most important
cause
-Is characterized by high filling pressures because of stiff ventricles. Decreased filling of
the ventricles results in decreased stroke volume and CO
HFpEF is diagnosed by the following criteria: (1) signs and symptoms of
HF, (2) normal EF, and (3) evidence of LV diastolic dysfunction by
echocardiography or cardiac catheterization
- Mixed systolic and diastolic failure is seen in disease states such as dilated
cardiomyopathy (DCM).
- DCM is a condition in which poor systolic function is further compromised by a dilated
LV wall that is unable to relax.
, -These patients often have extremely low EFs (less than 35%), high pulmonary
pressures, and biventricular failure (both ventricles are dilated and have poor filling and
emptying capacity).
D) Left-sided heart failure vs right-sided heart failure
- Expected findings
Left sided HF is most common form
Dyspnea (with mild exertion or at rest), orthopnea (shortness of breath
while lying down: often accompanies dyspnea, chair to aid breathing),
paroxysmal nocturnal dyspnea (during sleep: wakes in panic, has feeling
of suffocation, reabsorption of fluid from dependent body areas when pt.
flat)
Fatigue (one of the earliest symptoms of chronic HF)
Displaced apical pulse (hypertrophy)
S3 heart sound (gallop)
Pulmonary congestion (dyspnea, cough, bibasilar crackles)
Frothy sputum (can be blood-tinged)
Altered mental status
Manifestations of organ failure: e.g., oliguria
Results either from the inability of the left ventricle to empty adequately during
systole or fill adequately during diastole (left ventricular dysfunction)
Can be further classified as systolic, diastolic, or mixed systolic and diastolic failure.
Manifests as pulmonary congestion and edema
Right-sided HF occurs when the right ventricle (RV) fails to pump effectively.
Jugular vein distention
Ascending dependent edema (legs, ankles, sacrum)—(Sudden weight gain
of >3 lb (1.4 kg) in 2 days may indicate ADHF, an exacerbation of chronic
HF***)
Abdominal distention, ascites
Fatigue, weakness
Nausea and anorexia
Polyuria at rest (nocturnal)
Liver enlargement (hepatomegaly) and tenderness
Weight gain
When the RV fails, fluid backs up into the venous system.
This causes movement of fluid into the tissues and organs (e.g., peripheral edema,
abdominal ascites, hepatomegaly, jugular venous distention).
The most common cause of right-sided HF is left-sided HF.
As the LV fails, fluid backs up into the pulmonary system, causing increased
pressures in the lungs.
The RV has to work harder to push blood to the pulmonary system.
Over time, this increased workload weakens the RV and gradually it fails.
, Other causes of right-sided HF (independent of the function of the LV) include RV
infarction, pulmonary embolism, and cor pulmonale (RV dilation and hypertrophy
caused by pulmonary disease).
E) Health promotion and disease prevention
Fatigue
Activity limitations
Chest congestion/cough
Edema
Shortness of breath
Maintain an exercise routine after consult with provider
Diet: ↓ sodium, fluid restrictions, and consult with the provider regarding diet
specifications.
Refrain from smoking.
Follow medication regimen, and follow up with the provider as needed.
F) Laboratory and diagnostic procedures: know purpose, nursing considerations,
contraindications, pt. education
- BNP
Clients with dyspnea
Increase hBNP confirms HP diagnosis rather than respiratory origin
hBNP levels: direct aggressiveness of treatment
< 100 pg/mL: no heart failure
100 to 300 pg/mL: suggests heart failure
> 300 pg/mL: mild heart failure
> 600 pg/mL: moderate heart failure
> 900 pg/mL: severe heart failure
- Echocardiogram
Measure systolic and diastolic function
Left ventricular ejection fraction: volume of blood pumped from LV into arteries
per heart beat
Right ventricular ejection fraction: volume of blood pumped from RV to the
lungs per heart beat
Expected reference range
Left ventricular ejection fraction (LVEF): 55% – 70%
Right ventricular ejection fraction (RVEF): 45% – 60%)
Preprocedure: explain reason for test, Noninvasive and takes up to 1-hour
Intraprocedure: Instruct pt to lie on left side and remain still
Postprocedure: Provider review test and plan for follow-up care with pt
- Transesophageal echocardiogram (TEE)
Uses a transducer placed in the esophagus behind the heart to obtain a
detailed view of cardiac structures.
Preparation: same as upper endoscopy
- CXR
