Left and right heart failure

Howard, age 58, presents to the emergency department with a variety of signs and symptoms. Howard has a history of cardiac difficulties, including a myocardial infarction 5 years ago. Since that time, Howard has continued to struggle with lifestyle modifications, such as diet and exercise, to reduce his risk of future cardiac events. As the first clinician to see Howard, you record the following signs and symptoms: headache and memory loss; cyanosis; heart rate of 100 bpm; BP of 100/70 mm Hg; ascites; orthopnea; paroxysmal nocturnal dyspnea; pulmonary crackles and edema; peripheral edema; and cool, pale extremities. Which of his signs and symptoms are associated with right-sided heart failure?

-Ascites -Peripheral edema -When the right side of the heart fails, fluid backs up into the systemic venous system. -Ascites and peripheral edema occur, as the fluid in the capillaries increases. -The other signs and symptoms listed are not specific to right-side heart failure.

Given Howard's current health status, what are some medication options?

-Diuretics -Beta blockers -Positive inotropic agents -Diuretics reduce the fluid overload that occurs in heart failure, while beta blockers reduce the work load of the heart. -Positive inotropic agents stimulate more effective heart contractility. -Agents to reduce heart contractility would be determinantal in someone suffering heart failure, as would ACE agonists. -ACE inhibitors are usually prescribed to reduce fluid overload and vasoconstriction.

Based on assessment findings and mixed signs and symptoms, you suspect total heart failure. Which of the following are correct statements regarding the body's attempts to compensate for heart failure?

-Fluid retention by the body is an attempt to increase blood pressure by increasing blood volume -Baroreceptors detect falling blood pressure and initial increased heart rate to compensate -Left-side heart failure results in a fall in blood pressure that is detected by the baroreceptors. -These receptors activate the sympathetic nervous system to increase heart rate and compensate for the pressure loss. -The body also retains fluid to compensate for heart failure. -An increase in blood volume results in an increase in pressure. -However, excess fluid in the body increases the likelihood of edema.

The edema present in Howard's lungs and extremities indicates the presence of excess fluid in the body. Which of the following signals are associated with retention of fluid?

-Increased aldosterone -Increased renin -Fluid retention results from the activation of the renin-angiotensin-aldosterone system (RAAS) and the release of ADH. -Thus, increased renin, increased angiotensin, and increased aldosterone either directly or indirectly contribute to fluid retention. -Natriuretic peptide increases urine output and reduces blood volume

Which of the following signs and symptoms, although not present in Howard's initial examination, are also associated with right-side heart failure?

-Jugular vein distention -Enlarged liver and/or spleen -Jugular vein distention (JVD) and hepatosplenomegaly (enlarged liver or spleen) are common signs of right-side heart failure. -With this condition, blood backs up in the large veins that deliver blood to the heart, causing the veins and organs to enlarge. -The other answers listed are associated with left-side heart failure.

The backward effect of total heart failure may cause __________________

-Paroxysmal nocturnal dyspnea -Pulmonary edema -Jugular vein distention -pulmonary crackles

When left ventricular failure occurs, which of the following signs and symptoms relate to the backward effects of heart failure?

-Pulmonary edema -Paroxysmal nocturnal dyspnea

Which of his signs and symptoms are associated with the forward effects of left-side heart failure?

-headache -decreased blood pressure -Increased heart rate -Forward effects of left-side heart failure result from an inability of ventricle to adequately pump blood into systemic circulation, resulting in decreased blood pressure and increased heart rate to compensate. -Headache may occur due to poor perfusion of the brain. -Pulmonary crackles and pulmonary edema are due to backward effects of LV failure.

Which of the following are expected in response to left ventricular failure?

-increased Antidiuretic hormone -Increased angiotensin II

What are the causes of left ventricular failure?

-increased stiffness of ventricle msucle -reduced relaxation of ventricle muscle -reduced forward pumping strength of the ventricle muscle

Which of his signs and symptoms are associated with the backward effects of left-side heart failure?

-orthopnea -Paroxysmal nocturnal dyspnea -Pulmonary crackles -pulmonary edema -Backward effects of left-side heart failure results in fluid back up on the pulmonary system. -Orthopnea, paroxysmal nocturnal dyspnea, pulmonary crackles, and pulmonary edema are all signs of the left ventricle failing to pump blood forward and backward effects of fluid accumulation in the lungs developing.

A patient presents with peripheral edema, hepatosplenomegaly, and jugular vein distention. What do these signs and symptoms represent?

Backward effects of right ventricular failure

In response to hypertension, the left ventricle may undergo hypertrophy, reducing filling volume of the left ventricle. This is an example of _____________

Diastolic dysfunction

Which of the following pairs are incorrectly matched?

Diastolic dysfunction - difficulty ejecting blood

Which of the following are classes of medications used in management of heart failure?

Diuretics Beta blockers Inotropic agents ACE inhbitors

Howard undergoes further testing. Which value may provide further evidence that Howard has left ventricular failure?

Increased pulmonary capillary wedge pressure (PCWP) -Pulmonary capillary wedge pressure (PCWP) testing estimates the pressure in the left atria. -In left ventricular pressure, as fluid backs up in the left side of the heart, PCWP increases. -Increased CVP, or central venous pressure, is the measurement used to evaluate right-side heart failure.

Baroreceptors detect ______________ and respond by increasing __________.

Low blood pressure, heart rate

Where would fluid accumulate in a patient due to the increased level of hydrostatic pressure caused by left ventricular failure?

Pulmonary interstitial spaces