Ejection Fraction
% of the blood ejected by left ventricle with each heartbeat
L-sided Heart Failure
-patho
-2 types
Most common form of HF
Blood backs up into L atrium and pulmonary veins, leading to pulmonary congestion and pulmonary edema
Systolic (HFrEF)
Diastolic (HFpEF)
Describe the ejection fraction of L-HF-Systolic
<40%
(normal is 55-65)
Describe the EF and SV of L-HF-Diastolic
Normal EF, but still poor SV
R-sided HF
-patho
-most common cause
Blood backs up into tissues and organs
Most common cause is L-HF
-R ventricle can’t push against the backed up blood from L-HF
Explain the counter-regulatory process of BNP and how it relates to HF
BNP is a hormone made by the heart muscle when blood backs up.
Promotes vasodilation, which reduces preload/afterload
Enhances diuresis
Prolonged HF eventually depletes BNP
Elevated BNP confirms HF
Describe manifestations of R-HF
Fatigue
Increased peripheral venous pressure
Ascites
Dependent/pitting edema
Distended jugular veins
GI distress
Weight gain
Hepatosplenomegaly
Describe manifestations of L-HF
Pulmonary symptoms!
Restless, confused, cyanotic, fatigued
(All from low O2)
Tachy, dyspnea, crackles, wheezes, cough, tachypnea, bloody sputum, wheezes
Which dysrhythmia is a potential complication of HF?
A-fib
What are the 2 main diagnostic studies for HF?
BNP: elevated
Echo: shows ejection fraction
How do ACE inhibitors help HF?
Lower BP and therefore lower afterload
How do ARBs help HF?
Used for patients who can’t tolerate ACE inhibitors
Which diuretic is particularly shown to prolong survival for those with HF?
Spironolactone
How do Beta blockers and digoxin help HF?
lower demand on the heart
Digoxin is 2nd-line
Digoxin
-indications
-considerations
-S/S of toxicity
-caution with?
Helps lower demand for HF and slightly increases contractility
Hold if HR is <60
Toxic: bradycardia, headache, confusion, visual disturbances (halos), heart block, nausea
Hypokalemia increases risk of toxicity
Caution w/ loop diuretics
How would you educate a patient to take their daily weights at home?
Every morning in the same clothes before breakfast
Contact HCP if weight gain: 3lbs in 2 days, or 3-5lbs in 1 week
What diet changes are recommended for HF patients?
DASH diet (HF patients are hypertensive)
Sodium restrictions to 2.3 g/day
Is fluid restriction recommended for HF?
No- better to just use diuretics than try to maintain a perfectly low fluid intake
Acute Decompensated Heart Failure
Emergency state of HF
-orthopnea, dyspnea, tachypnea, accessory muscle use, cyanosis, cool/clammy, pink froth in cough, crackles/wheezes, tachycardia, hypotension or hypertension
Can cause pulmonary edema
ICU monitoring, IV diuretics, vasodilators, etc
