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Heart Failure Flashcards

Heart Failure

  • Heart failure is characterized by an ejection fraction (EF) typically below 40%. Normal EF is 50-70%.
  • Ejection fraction (EF) represents the amount of blood ejected in one minute.

Risk Factors

  • Coronary Artery Disease (CAD)
  • Diabetes
  • Hyperlipidemia
  • Sedentary lifestyle
  • Smoking
  • High sodium diet

Types of Heart Failure

  • Right-Sided Heart Failure
  • Left-Sided Heart Failure

Systolic Heart Failure

  • Systolic function occurs during ventricular contraction.

Cardiac Output

  • Normal cardiac output is 4-8 liters per minute.
  • Low cardiac output leads to tissue and cell death due to inadequate perfusion.

Left-Sided Heart Failure

  • The left side of the heart is associated with the lungs.
  • If the left ventricle cannot effectively pump blood forward, blood backs up into the lungs.
  • Back up in the lungs leads to pulmonary congestion.

Signs and Symptoms of Left-Sided Heart Failure

  • Orthopnea (difficulty breathing when lying flat, requiring multiple pillows)
  • Cough with frothy sputum

Right-Sided Heart Failure

  • Blood backs up into the systemic circulation.
  • Peripheral tissues become congested.

Signs and Symptoms of Right-Sided Heart Failure

  • Pitting edema
  • Dependent edema
  • Jugular Vein Distension (JVD)
  • Activity intolerance
  • Decreased cardiac output
  • Decreased perfusion
  • Impaired liver function due to congestion

Causes of Right-Sided Heart Failure

  • Chronic lung disease
  • Congenital heart disease
  • Pulmonary hypertension
  • Heart valve disease
  • Left-sided heart failure

Combined Heart Failure

  • In late stages, patients may experience both left and right-sided heart failure.

Key Signs and Symptoms to Know

  • Right side: weight gain, JVD, enlarged liver and spleen, anorexia, distended abdomen, ankle edema.
  • Blood pressure may be high due to fluid overload.

Assessment

  • Health history
  • Sleeping positions (e.g., sleeping in a recliner due to orthopnea)

Management and Interventions

  • Low Sodium Diet: 2-3 grams per day, with no added salt.
  • Fluid Restriction: Limit to 2 liters per day.
  • Chest X-Ray: To assess lung condition.
  • Hemodynamic Monitoring: Typically done in the ICU to monitor arterial and pulmonary artery pressures.
  • BNP (B-type Natriuretic Peptide): A cardiac hormone.
    • Normal BNP: <100.
    • Elevated BNP: >500 indicates significant heart failure.

Common Medications for Heart Failure

  • Diuretics: To relieve fluid overload and improve breathing.

Diet

  • Low-sodium diet is recommended.

MEWTS

Patient education:

  • Medication: Take medications as prescribed and understand their purpose and side effects.
  • Avoid NSAIDs: Such as ibuprofen and naproxen (e.g., Aleve, Advil) because they cause fluid retention.
  • Activity: Stay active but avoid overexertion. Gradually increase activity, such as walking 2-3 times a week. Patients should be able to carry on a conversation while exercising.
  • Weight: Monitor weight at the same time, wearing the same clothes.

Identifying Heart Failure Type

  • Left-sided heart failure is associated with the lungs.
  • Right-sided heart failure is associated with systemic swelling.