Congestive Heart Failure- pathophysiology and clinical manifestations


Questions Answers
Definition of Congestive Heart Failure A state in which the heart is no longer able to pump sufficient blood to meet all of the metabolic needs of the body system.
Sudden onset of symptoms, usually following an acute onset ot a new illness- symptoms may appear over several hours. Acute CHF
Very slow and insidious onset of symptoms, which may follow a new onset of an illness-symptoms may take years to become apparent. Chronic CHF
Acute MI, tachycardic dysrhytmias, pulmonary emboli, Thryrotoxicosis, HTN crisis, ventricular septal defect, and rupture of the papillary muscle of hear valves are signs of which type of CHF? Acute CHF
What happens when the papillary muscle of the heart rupture? Prevents appropriate valve closing
What is Thyrotoxicosis? Extreme tachycardia.
CAD, rheumatic hrt disease, congenital hrt ds, cor pulmonale, anemia, bacterial endocarditis are signs of which CHF? Chronic CHF
In which patients are you more likely to see cor pulmonale? COPD patients
How does anemia cause chronic CHF? Due to acute hypoxia of cardiac tissue.
The ability of the cardiac fibers to stretch and snap back appropriately. Starling's Law.
What happens when the myocardial fibers exceed their stretching limits? prolonged and excessive stretching will equal to ventricular hypertrophy, muscle will lose ability to snap back or recoil, which will equal decreased contractility leading to decreased ability of the heart to pump blood.
The ability of the heart muscle to contract. Contractility
The pressure that the ventricles must pump against to empty the chamber effectively. Afterload
The amount of blood that is ejected with each ventricular contraction. Stroke Volume
The amount of blood that is available to fill the ventricles before contraction. Preload
The stroke volume x the heart rate Cardiac output.
Increased contractility improves ventricular emptying during systole, thereby increasing what? Stroke Volume.
What occurs when there is a decreased function in afterload? It impairs the ventricular emptying which will decrease stroke volume and cardiac output
How does hypertension and vasoconstriction affects afterload? By increasing pressure that produces increased resistance to pumping and requires an increase in ventricular tension to eject blood.(increase afterload and arterial pressure, therefore the ventricle must pump against higher resistance to empty adequately.
What are compensatory mechanisms? Mechanisms the heart uses to maintain cardiac output (in response to decreased cardiac output).
Name some of the compensatory mechanisms the heart uses to maintain cardiac output. Tachycardia, ventricular dilation, ventricular hypertrophy.
What happens once all of the compensatory mechanisms of the heart have failed? The client will show symptoms of CHF.
Tachycardia as a compensatory mechanism causes...? An increased heart rate, which increase filling time of the ventricles, leads to decreased cardiac output eventually.
What happens when the heart uses ventricular dilation as a compensatory mechanism? Heart will dilate to allow more bld to collect in ventricle. This increase stroke volume. This will eventually fail due to stretching of the myocardial fibers as the chambers lose contractile force.
What is the third and final compensatory mechanism the heart tries to use to maintain cardiac output? Ventricular Hypertrophy
What occurs during this last mechanism? the heart fibers increase in size known as remodeling. this will increase the force of contraction.
What happens when the last and final compensatory mechanism fails? the body will not be able to supply enough blood to this greatly enlarged heart, results in symptoms of CHF
What is left ventricular heart failure? Most common heart failure. When the left ventricular cardiac output is less than volume received from the pulmonary circulation.
What happens when blood accumulates in the LV, and LA? The ventricle losses its pumping action. The blood cannot pump forward therefore decreasing CO- large amount of blood back up into LA, and pulmonary veins and lungs.
Names some of the clinical manefestations of LV heart failure. Fatigue, dry cough, dyspnea, .les (rales), orthopnea, PND, cheyne stokes resp. anxiety, nocturia, oliguria, htn.
Symptom of CHF due to hypoxia, decreased cardiac output and poor waste removal. Fatigue
Dyspnea in a person with CHF is an indicative of? poor oxygenation.
A person with CHF, what causes the .les in the lungs? Plasma leaks out of engorged pulmonary vessels into the small airways and interstitial spaces in lungs.
A patient with CHF is unable to lay flat with comfortable breathing and assumes a sitting position leaning forward. This is an advanced finding called? Orthopnea
Client wakes up gasping for air. C/O feeling as if they are smothered which caused them to suddenly wake up from their sleep. This is called? PND-paroxysmal nocturnal dyspnea
Observing a client with severe CHF, you noticed client experiencing alternating periods of apnea and hyperpnea, what is this called? Cheyne stokes respirations.
What causes Cheyne-stokes respirations in a person with CHF? The respiratory center of the brain is suppressed due to decreased oxygenation.
When listening to heart sounds of a client with CHF, you hear extra sounds that sounds like a horse galloping over the mitral area. Theses sounds are called? S3 and S4 heart sounds
When you hear S3 and S4 heart sounds, what does it indicate? The sounds reflect the resistance of ventricular filling. the walls of the ventricle actually vibrate during filling.
Anxiety, irritability, confusion, memory loss may be due to what in clients with CHF? decrease cerebral perfusion-cerebral blood flow is diminished.
Hypertension is due to what in the heart? Increased Blood Volume.
How does Hypertension affect the blood volume in the heart? The renin angiotensin system increases salt and water retention which increases the workload of the heart.
Right ventricular cardiac output is less than volume received from the peripheral venous circulation; blood accumulates in the RV, RA, and peripheral venous system. Right Ventricular Heart Failure.
Most common cause of Rt. Ventricular Heart Failure is? Why? left sided heart failure.-leads to increased workload of the Rt. ventricle to pump blood into an already congested lungs.
Why is large amount of blood is left in the right ventricle? the right ventricle lost ability to pump blood into lungs from the ventricle.
Excess blood from the right ventricle will eventually go where instead of into the lungs? Blood will back up into the right atria, then into superior vena cava and inferior vena cava.
Peripheral congestion will occur in the venous circulation and plasma will be pushed out of the veins into to surrounding tissues leading to what condition? Peripheral edema.
What happen to the organs when the venous circulation become congested? Organs become congested- hepatomegaly and splenomegaly.
Engorged vena cavas will lead to what symptom of a client with RVCHF? engorged jugular veins with jugular distention.
A client with RVCHF is showing signs of anorexia, nausea, and bloating. These signs are due to what ? venouse congestion of the GI system.
Why do congested vena cavas affect organs so bad? organs are connected to the vena cavas.
Client with RvCHF has signs of swelling to the LE, symmetrically, with pitting edema is a sign of? Dependent Edema
When is dependent edema most prominent, why is it ususally gone by morning? Mostly prominent at the end of the day, and gone by morning due to feet elevation.
Describe pitting edema. Leaves an indentation in the edematous are when pushed on by the examiners fingers.
The edema associated with CHF? Pitting edema.
What is the main goal of caring for a client with CHF? To improve the pumping action of the heart and reduce myocardial workload.



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