Which patient conditions increase the risk of developing heart failure quizlet

A patient with left-sided heart failure has a diminished cardiac output (CO), dyspnea, frothy, pink-tinged sputum due to pulmonary disorders, oliguria, and nocturia. In addition, an S3 gallop may be heard on auscultation. Mitral stenosis may result from rheumatic carditis due to fibrosis and calcification of valves, leading to increased atrial pressure and right ventricular hypertrophy. A patient with pulmonary edema may have a moist, frothy, productive cough with blood-tinged sputum. Right sided heart failure is associated with increased systemic venous pressure and congestion leading to hepatomegaly, neck vein distention, and abdominal girth.

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Normal CO, increased PAWP, and symptoms of congestion (dyspnea, edema, orthopnea) would be classified as wet-warm. A dry-cold profile would include a decreased or normal PAWP, decreased CO, edema, hypotension, and cool extremities. A wet-cold profile would have increased PAWP, decreased CO, altered mental status, decreased O2 saturation, reduced urine output, and shock. A dry-warm profile would be reflected by normal PAWP and CO and no signs or symptoms.

Metoprolol, which is a β-adrenergic receptor blocker, inhibits the sympathetic nervous system, causing a decrease in heart rate; therefore this drug should be withheld, and the health care provider must be notified. Diuretics, such as furosemide, are used to reduce edema, pulmonary venous pressure, and preload; the pulse rate is not affected. Morphine is used to reduce pain and anxiety, and it also decreases preload and afterload; it may be given if the patient is in pain and has a heart rate of 45 beats/min. Antihyperlipidemic drugs, such as rosuvastatin, are used to help control cholesterol in the patient; a heart rate of 45 beats/min does not indicate that it should be withheld.

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SNS activation is often the first mechanism triggered in low-cardiac-output states. In response to an inadequate stroke volume and cardiac output, SNS activation increases, resulting in the increased release of catecholamines (epinephrine and norepinephrine). This results in an increased heart rate, increased myocardial contractility, and peripheral vasoconstriction. Initially, this increase in heart rate and contractility improves cardiac output. However, over time, these factors are harmful because they increase the already-failing heart's workload and need for oxygen. Pathologic ventricular remodeling is an actual change in the structure (dimensions, mass, shape) of the heart. Ventricular remodeling in HF occurs over time in response to pressure or volume overload and/or cardiac injury and the subsequent compensatory mechanisms. Ventricular dilation and ventricular hypertrophy do not cause increased heart rate, increased myocardial contractility, and peripheral vasoconstriction.

The acronym "FACES" is used to help teach patients to identify early symptoms of heart failure. What does this acronym mean?

A. Frequent Activity leads to Cough in the Elderly and Swelling

B. Factors of Risk: Activity, Cough, Emotional upsets, Salt intake

C. Follow Activity plan, Continue Exercise, and no Signs of problems

D. Fatigue, limitation of Activities, Chest congestion/Cough, Edema, Shortness of breath

Sympathetic nervous system (SNS) activation

SNS activation is often the first mechanism triggered in low-cardiac output states. In response to an inadequate stroke volume and cardiac output, SNS activation increases, resulting in the increased release of catecholamines (epinephrine and norepinephrine). This results in increased heart rate, increased myocardial contractility, and peripheral vasoconstriction. Initially, this increase in heart rate and contractility improves cardiac output. However, over time these factors are harmful because they increase the already failing heart's workload and need for oxygen. Ventricular dilation, ventricular hypertrophy, and neurohormonal response do not cause increased heart rate, increased myocardial contractility, and peripheral vasoconstriction.
pp. 739-740

Metoprolol, which is a β-adrenergic blocker, inhibits the sympathetic nervous system, causing a decrease in heart rate; therefore, this drug should be withheld and the primary health care provider notified. Diuretics, such as furosemide, are used to reduce edema, pulmonary venous pressure, and preload; pulse rate is not affected. Morphine is used to reduce pain and anxiety, and it also decreases preload and afterload; it may be given if the patient is in pain and has a heart rate of 45. Antihyperlipidemic drugs, such as rosuvastatin, are used to help control cholesterol in the patient; a heart rate of 45 does not indicate that it should be withheld. P. 745

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