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Heart FailureMedical Surgical Nursing

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What cytokines are released by cardiac myocytes in response to cardiac injury and what do they do?
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Tumor Necrosis Factor (TNF) and Interleukin-1 (IL-1). They cause cardiac hypertrophy, contractile dysfunction, and myocyte cell death
What causes the cardiac wasting, muscle myopathy and fatigue associated with heart failure?
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The systemic inflammatory response
________ is the enlargement of the chambers of the heart from elevated pressures.
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Dilation: note...usually occurs in the left ventricle
How does dilation eventually lead to reduction in cardiac output?
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The elastic elements of the muscle fibers in the cardiac chambers are overstretched and can no longer contract effectively
________ is an increase in the muscle mass and cardiac wall thickness in response to overwork and strain.
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Hypertrophy
How is hypertrophic heart muscle different from normal heart muscle? (4)
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It requires more oxygen, has poorer contractility, becomes ischemic more readily and is prone to ventricular dysrhythmias
ANP is a hormone that serves as a counterregulatory mechanism. It is produced by...
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The atriums of the heart
BNP is a hormone that serves as a counterregulatory mechanism. It is produced by...
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The ventricles
What effect does ANP and BNP have?
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They promote arterial and venous dilation, block RAAS, promote diuresis by blocking aldosterone and endothelin
What triggers the release of ANP? BNP?
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ANP-released when volumes increase BNP-released when pressures increase
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What is the most common form of heart failure?
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Left Ventricular heart failure
What are the common manifestations of left-sided heart failure?
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Pulmonary congestion and edema from blood backing up into the atrium and pulmonary veins
What are the common manifestations of right sided heart failure?
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JVD, hepatomegaly, splenomegaly, vascular congestion of the GI tract, and peripheral edema from the back up of blood into the right atrium and venous circulation
What is the primary cause of right-sided heart failure?
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Left sided heart failure
What conditions can lead to right sided heart failure?
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Left sided heart failure, Cor Pulmonale, or Right ventricle infarction
_______ is characterized by right ventricle hypertrophy and dilation caused by pulmonary disease.
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Cor pulmonale
Acute decompensated heart failure (ADHF) typically manifests as __________.
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Pulmonary edema
What are the signs/symptoms associated with the interstitial edema phase of pulmonary edema?
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Tachypnea and SOA out of proportion to activity level
What changes in ABG's are expected for a patient in the alveolar edema phase of pulmonary edema?
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Low PaO2, increased PaCO2, respiratory acidemia
What are the clinical manifestations of pulmonary edema?
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Anxiety, cyanosis, pallor, clammy & cold skin, severe dyspnea, use of accessory muscles, orthopnea, respiratory rate greater than 30, frothy pink sputum, crackles, wheezes, rhonchi in the lungs, rapid HR
What is the earliest symptom of heart failure?
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Fatigue
  
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