MDC3 Final Study Guide
•Left Sided Heart Failure (left side: backs up into the lungs)
Left atrium, Left ventricle, mitral valve, or aortic valve
oEjection fraction needed to dx LHF <40
oCauses: HTN, Coronary artery disease (CAD), valvular disease
o
(report 2lb in 1 night or 3-5lb in 1-week weight gain), report sleep sitting up, use pillows to prop themselves up, notify provider is increase swelling, and decreased activity tolerance, med compliance (no skipping Lasik’s)
oSigns and symptoms: increased BP and pooling of blood, pink frothy sputum, dyspnea and
night, crackles, fatigue, pulmonary congestion, crackles, wheezing
oThe main goal is to prevent exacerbation in chronic conditions
oDiagnosis: Ejection fraction (echocardiogram), Lab: BNP (fluid overload), Chest Xray,
ECG
oInterventions: Oxygen, position, assess lung sounds, assess VS, cough, and deep breath
oTx: DASH Diet,
▪Medications: Overall goal is to manage fluid volume and help the heart to control the fluid volume that is there.
•Diuretics-----------Enhance selective excretion of various
electrolytes & water
oLoop: furosemide: monitor potassium and electrolytes, dehydration (monitor daily weight and I&O, skin turgor, MOITOR BP before giving). If IV push give slowly. Adverse effects: Tinnitus (chronic)
oThiazide: monitor potassium, possible supplements
oPotassium Sparing- Spironolactone: Monitor POSTASSIUM – This is potassium sparing.
•Ace inhibitors (-pril)
•Arbs
•Beta Blockers (-olol): lowers HR
Page 1 of 35Education: restrict sodium, and possible fluid restriction, daily weight o•Digoxin---------Enhance Contractility, reduce HR, inhibit
sodium potassium
oComplications: Fluid overload (Pulmonary Edema)
•Heart Failure in General
oEducation: monitor daily weight, stay active, low sodium diet,
possible fluid restrictions, Med adherence, avoid NSAID (can lead to sodium and fluid
retention)
oWhat labs do you monitor for HF: BNP (if elevated anticipation that diuretic because it is
showing that the heart is stressed, and it shows that more fluid is on the heart)
oBest tool for dx of HF in general- Echocardiogram. This looks at the blood flow
Difference between Left and Right HF: Left backs up into lungs, right backs up into the rest of you. Right side of heart is systemic edema.
Left side is pulmonary edema and the left will lead to the right. Know
the signs and symptoms of each and the differences between them
oWhat else leads to heart failure in general: HTN, valve disorders, cor pulmonal, smoking, DM, A Fib, MI.
oPRIORITY IS ALWAYS YOUR ABC’s.
oEnd stage heart failure, the last treatment would be a transplant. They will also be on the LVAD. Education post-transplant: immunosuppressant (avoid large crows, infection, do not eat raw fish or meat, no fresh flowers hand washing, lab and med adherence, watch for low grade fever), confusion
oHypertension with right sided HF, Hypotension with left sided HF
•Right sided heart Failure
oRF: Left sided HF (left ventricular failure), Right ventricular MI,
Lung disease, Pulmonary Hypertension, pulmonary fibrosis Right atrium
Tricuspid Valve Right
ventricle
Page 2 of 35 oPulmonary valve
Signs and symptoms: abdominal ascites, peripheral edema, JVD, weight gain, fatigue, nocturia
oDiagnosis: Echocardiogram, Lab: BNP (best lab), electrolytes, H&H
oManifestations: Positive JVD, increased ascites (and girth), hepatomegaly (congestive liver), Nausea, Vomiting, peripheral edema, malaise, enlarged liver and spleen, anorexia, dependent edema, distended jugular veins,
oTx: Same as Left sided HF, unless the cause is dt lung disease, then we will be tx lung disease.
oCHF has an S3 gallop (this can be normal in athletes)
•Mitral Valve Prolapse
oThis is on the left side of our heart, between the left atrium and
ventricle.
oIf this prolapses it means the valve leaflets are going to fall back into left atrium
oUsually benign, it can progress to mitral valve regurgitation
oYou will hear this as a murmur in the heart
Causes
•Valve Stenosis
oNarrowing of the valve causing a decrease in amount of blood that can
flow through. Blood then backs up into lungs.
oThis can lead to left sided heart failure
oThe valves become stiff, which can narrow the valvular opening
Page 3 of 35•Marfan syndrome
•Congenital heart disease • Genetics oBlood will back up and cause hypertrophy of the left ventricle. They will have HF manifestations
dt back up of blood. They may also have
A. Fib or clots
Causes
treatment
diuretics, blockers, Ca+ blockers
oPresents with an S4 gallop
•Mitral Valve Regurgitation
oThe backflow of blood into the left atrium, causing hypertrophy of left
atrium and ventricle because not all the blood is leaving the heart.
Causes
oThis can lead to heart failure. Signs and symptoms tachycardia, fatigue, weakness, high pitched murmur, neck pain, pooling of blood that leads to edema and JVD (this is dt it is backing up into the lungs and then further into the right side of the heart causing symptoms of right sided HF)
Treatment
similar tx for HF; diuretics, low sodium diet, decreased overall volume, surgery to repair or replace valve.
oYou will hear this as a murmur in the heart.
oIf manifestations of hf occur, they may discuss procedures to repair valve.
Page 4 of 35•Rheumatic fever • Congenital abnormalities •Rheumatic fever
•Infective Endocarditis • Papillary muscle dysfunction
•Left Sided Heart Failure (left side: backs up into the lungs)
Left atrium, Left ventricle, mitral valve, or aortic valve
oEjection fraction needed to dx LHF <40
oCauses: HTN, Coronary artery disease (CAD), valvular disease
o
(report 2lb in 1 night or 3-5lb in 1-week weight gain), report sleep sitting up, use pillows to prop themselves up, notify provider is increase swelling, and decreased activity tolerance, med compliance (no skipping Lasik’s)
oSigns and symptoms: increased BP and pooling of blood, pink frothy sputum, dyspnea and
night, crackles, fatigue, pulmonary congestion, crackles, wheezing
oThe main goal is to prevent exacerbation in chronic conditions
oDiagnosis: Ejection fraction (echocardiogram), Lab: BNP (fluid overload), Chest Xray,
ECG
oInterventions: Oxygen, position, assess lung sounds, assess VS, cough, and deep breath
oTx: DASH Diet,
▪Medications: Overall goal is to manage fluid volume and help the heart to control the fluid volume that is there.
•Diuretics-----------Enhance selective excretion of various
electrolytes & water
oLoop: furosemide: monitor potassium and electrolytes, dehydration (monitor daily weight and I&O, skin turgor, MOITOR BP before giving). If IV push give slowly. Adverse effects: Tinnitus (chronic)
oThiazide: monitor potassium, possible supplements
oPotassium Sparing- Spironolactone: Monitor POSTASSIUM – This is potassium sparing.
•Ace inhibitors (-pril)
•Arbs
•Beta Blockers (-olol): lowers HR
Page 1 of 35Education: restrict sodium, and possible fluid restriction, daily weight o•Digoxin---------Enhance Contractility, reduce HR, inhibit
sodium potassium
oComplications: Fluid overload (Pulmonary Edema)
•Heart Failure in General
oEducation: monitor daily weight, stay active, low sodium diet,
possible fluid restrictions, Med adherence, avoid NSAID (can lead to sodium and fluid
retention)
oWhat labs do you monitor for HF: BNP (if elevated anticipation that diuretic because it is
showing that the heart is stressed, and it shows that more fluid is on the heart)
oBest tool for dx of HF in general- Echocardiogram. This looks at the blood flow
Difference between Left and Right HF: Left backs up into lungs, right backs up into the rest of you. Right side of heart is systemic edema.
Left side is pulmonary edema and the left will lead to the right. Know
the signs and symptoms of each and the differences between them
oWhat else leads to heart failure in general: HTN, valve disorders, cor pulmonal, smoking, DM, A Fib, MI.
oPRIORITY IS ALWAYS YOUR ABC’s.
oEnd stage heart failure, the last treatment would be a transplant. They will also be on the LVAD. Education post-transplant: immunosuppressant (avoid large crows, infection, do not eat raw fish or meat, no fresh flowers hand washing, lab and med adherence, watch for low grade fever), confusion
oHypertension with right sided HF, Hypotension with left sided HF
•Right sided heart Failure
oRF: Left sided HF (left ventricular failure), Right ventricular MI,
Lung disease, Pulmonary Hypertension, pulmonary fibrosis Right atrium
Tricuspid Valve Right
ventricle
Page 2 of 35 oPulmonary valve
Signs and symptoms: abdominal ascites, peripheral edema, JVD, weight gain, fatigue, nocturia
oDiagnosis: Echocardiogram, Lab: BNP (best lab), electrolytes, H&H
oManifestations: Positive JVD, increased ascites (and girth), hepatomegaly (congestive liver), Nausea, Vomiting, peripheral edema, malaise, enlarged liver and spleen, anorexia, dependent edema, distended jugular veins,
oTx: Same as Left sided HF, unless the cause is dt lung disease, then we will be tx lung disease.
oCHF has an S3 gallop (this can be normal in athletes)
•Mitral Valve Prolapse
oThis is on the left side of our heart, between the left atrium and
ventricle.
oIf this prolapses it means the valve leaflets are going to fall back into left atrium
oUsually benign, it can progress to mitral valve regurgitation
oYou will hear this as a murmur in the heart
Causes
•Valve Stenosis
oNarrowing of the valve causing a decrease in amount of blood that can
flow through. Blood then backs up into lungs.
oThis can lead to left sided heart failure
oThe valves become stiff, which can narrow the valvular opening
Page 3 of 35•Marfan syndrome
•Congenital heart disease • Genetics oBlood will back up and cause hypertrophy of the left ventricle. They will have HF manifestations
dt back up of blood. They may also have
A. Fib or clots
Causes
treatment
diuretics, blockers, Ca+ blockers
oPresents with an S4 gallop
•Mitral Valve Regurgitation
oThe backflow of blood into the left atrium, causing hypertrophy of left
atrium and ventricle because not all the blood is leaving the heart.
Causes
oThis can lead to heart failure. Signs and symptoms tachycardia, fatigue, weakness, high pitched murmur, neck pain, pooling of blood that leads to edema and JVD (this is dt it is backing up into the lungs and then further into the right side of the heart causing symptoms of right sided HF)
Treatment
similar tx for HF; diuretics, low sodium diet, decreased overall volume, surgery to repair or replace valve.
oYou will hear this as a murmur in the heart.
oIf manifestations of hf occur, they may discuss procedures to repair valve.
Page 4 of 35•Rheumatic fever • Congenital abnormalities •Rheumatic fever
•Infective Endocarditis • Papillary muscle dysfunction
