Heart Failure/(CAD)

Persons with left sided heart failure present with

Dyspnea/SOB Altered mental status /confusion Crackles and rales at the base of the lungs

NSTEMI

(non-ST segment Elevation MI) Troponin levels elevates

Crackles/rales

-Blood flow through the pulmonary artery into the lungs -increased blood flow causes Vaso dialtion of vessels -Increases permeability -blood seeping into pulmonary interstitium the extravasation -Alveoli: blood seeps Into air space

ACE inhibitors

-Dilates arteries and veins by blocking angiotensin -Promote renal excretion of sodium and water -Inhibits cardiac and vascular remodeling associated with chronic hypertension, heart failure and myocardial infarction

PERRL

"Pupils that are Equal, Round and Reactive to Light."

aldosterone

"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. na+ retention promotes water retention, which promotes a higher blood volume and pressure

ischemic

(Patient experiences pain) restriction in blood supply to tissues, causing a shortage of oxygen that is needed for cellular metabolism (to keep tissue alive). Ischemia is generally caused by problems with blood vessels, with resultant damage to or dysfunction of tissue.

STEMI

(ST segment elevation myocardial infarction) Almost 100% blockage of a major artery biggest risk for damage to the heart muscles which do not grow back Troponin levels elevate

DVT

(deep vein thrombosis) A blood clot that forms in a vein deep in the body. Most deep vein clots occur in the lower leg or thigh. If the vein swells, the condition is called thrombophlebitis. A deep vein thrombosis can break loose and cause a serious problem in the lung, called a pulmonary embolism. Acute swelling of a limb over a period of fewer than 72 hours is more characteristic of DVT

What factors lead to "silence chest pain?"

1. Diabetes: physiological conditions, neuropathy-losing feeling around the heart 2. Females especially above 50, genetics cause different symptoms for those experiencing a heart attack.

ACE inhibitors side effects

1. dry cough 2. angioedema 3. hyperkalemia 4. hypotension.

Diuretics Side Effects

1. hypokalemia 2. metabolic alkalosis 3. hypomagnesemia 4. hyperuricemia 5. Dehydration (hypovolemia), leading to hypotension 6. dose-related hearing loss (ototoxicity)

Beta Blockers Side effects

1. may mast hypoglycemia 2. Bronchonstriction 3. hypotension 4. blocks the effect of epinephrine 5. Contraindicated in patients with heart block

Side Effects 1.Aspirin 2.Beta-blocker 3.Morphine 4.Nitrate

1.Aspirin-----------bleeding 2.Beta-blocker----bronchoconstriction, bradycardia, and hypotension 3.Morphine--------respiratory depression 4.Nitrate.-----------headache, hypotension

CAD Treatment

1.Oxygen 2.Nitrates 3.Aspirin 4.Beta blockers 5.Morphine

Unstable Angina

1.Resting chest pain 2.New-onset chest pain 3.Chest pain that is longer in duration 4.Chest pain that is greater in intensity

Acute Coronary Syndrome

1.Unstable angina. 2. Acute MI. a. STEMI b. NSTEMI NO STABLE ANGINA

troponin

An elevated level of the enzyme troponin in general is concerning and is a sign of heart damage until proven otherwise. A chemical that is typically released when there is damage to the heart muscles.

Nitrates

Basal dilation increases: decreases venous flow, both Vassal the artery and the veins are dilated. The heart has to do less work.

Beta-blockers

Blocks beta-receptors and decreases the heart rate to decrease cardiac work. They block the effects of epinephrine and adrenaline. Heart beats slower and with less force.

Heaves

Blood flow you can feel flutter through your heart

Shortness of breath for the elderly is always considered ___________ until proven otherwise

Chest pain

Bilateral pitting edema on the dorsum

Cardiac edema starts at the foot, but must start at the dorsum of the foot

Beta Blockers can also cause

Cold hands and feet Fatigue Weight gain

Medical treatment of CHF

Diuretics ACE inhibitors Beta blockers Digitalis

Aspirin

Decreases platelets aggregation. Endothelial damage to the blood vessels the platelets will collect there and form a clot and causes Deep vein thrombosis. Unsuspecting moment it breaks off

A patient with _________ should not be given Diuretics.

Gout

What are the negative effects of too much potassium?

weak muscles, "flabby heart." Take Calcium to counteract

CAD

•May be asymptomatic •Stable angina •Unstable angina •Myocardial infarction •Sudden cardiac death

JVD

Jugular vein distention occurs when the pressure inside the vena cava increases and appears as a bulge running down the right side of a person's neck.

Myocardial infarction

MI: Heart attack

Myocarditis

Myocarditis is an inflammation of the heart muscle. It's most commonly caused by a virus and can lead to left-sided heart failure.

Right sided heart failure

Nocturia ---frequent urination at night due to increased venous return with elevation of legs. JVD Hepatomegaly and hepatojugular reflux Ascites Heaves

Morphine

Opiate and also analgesic: decreases blood flow

Pulmonary edema

Patient presents with cold clammy skin, spits up pink sputum, the capillaries rupture in the alveoli when they pull up that

Differences between L & R Hearl failure

RS signs LS symptoms

Non-medical treatment for heart failure

Sodium restriction, less than 4g/day Fluid restriction, 1-2 liters daily Weight loss Smoking cessation Restrict alcohol use Exercise as tolerated Annual influenza vaccine and pneumococcal vaccine are recommended

Pedaledema

Swelling of the foot. Occurs over many years as a result of heart failure. Must be bilateral.

Angioedema

Swelling of the lips Swelling of the uvula and obstruction of the airway In order to phonate air needs to come down the vocal cords Change in voice raspy

Digitalis

The drug of choice is digoxin. It decreases heart rate and strengthens contractility. Makes it more efficient. Has so many side effects and therapeutic window is narrow

TIA

Transient ischemic attack kind of like a stroke that lasts only a few minutes. It happens when the blood supply to part of the brain is briefly blocked.

Signs it is not Heart failure

When I breathe it hurts not cardiac When you press on the chest it hurts When you move and then chest hurts not cardiac

hemochromatosis

a disorder where too much iron builds up in your body. Sometimes it's called "iron overload." Normally, your intestines absorb just the right amount of iron from the foods you eat. But in __________________, your body absorbs too much, and it has no way to get rid of it

renin-angiotensin-aldosterone system

a hormone cascade pathway that helps regulate blood pressure and blood volume can lead to the hypertension.

Angiotensin

a protein whose presence in the blood promotes aldosterone secretion and tends to raise blood pressure.

Which of the following is the most common cause of heart failure? a. Coronary artery disease b. Hypertension c. Diabetes d. Stroke.

a. Coronary artery disease

Which of the following is the most common cause of right-sided heart failure? a. Left-sided heart failure b. Diabetes c. Stroke d. Cigarette smoking.

a. Left sided heart failure

ascites

abnormal accumulation of fluid in the abdomen. Most likely caused by failure of the liver and albumin being low.

amyloidosis

an abnormal protein called amyloid builds up in your tissues and organs.

Paroxysmal nocturnal dyspnea

awakening from sleep with SOB and needing to be upright to achieve comfort

You arrived 5 minutes early for your OT/PT session with your patient. She has a history of cigarette smoking, stroke and hypertension. While talking with her she developed sudden onset of dyspnea without chest pain. This most likely represents: a.Acute myocardial infarction b.Acute systolic heart failure c.Right sided heart failure d.High output heart failure.

b. Acute systolic heart failure

Peter is a 54-year-old man with CHF. He states he has difficulty breathing when he lies flat. This condition is known as: a. Jugular venous distention b. Orthopnea c. Paroxysmal nocturnal dyspnea d. Hepatojugular reflux.

b. Orthopnea

Your patient arrived for her usual OT/PT session. She has a history of diabetes, hypertension and coronary artery disease. You noticed bilateral pedal edema and increased abdominal distention. Theses findings are consistent with: a. Left sided heart failure b. Right sided heart failure c. Systolic heart failure d. Diastolic heart failure.

b. Right sided heart failure

Which of the following is not a component of acute coronary syndrome? a. Non-ST segment elevation MI b. ST- segment elevation MI c. Stable angina d. Unstable angina.

c. Stable angina

During one of your OT/PT sessions your patient began coughing uncontrollably. She states that she has been having intermittent cough ever since her PCP changed her medication. She has a history of diabetes and hypertension. Which medication would you expect her to have? a. Beta blocker b. Calcium channel blocker c. Diuretics d. ACE inhibitor

d. ACE inhibitor

Which of the following is included in coronary artery disease? a. It may be asymptomatic b. Stable angina c. Sudden cardiac death d. All the above.

d. All the above.

After ending your OT/PT session with your patient he developed sudden onset of dyspnea with a productive cough of pink sputum. Which of the following is the most appropriate intervention? a. Reassure him that everything will be okay b. Call his PCP and discuss the condition c. Call his children and tell them to come to the house. d. Call an ambulance.

d. Call an ambulance.

Which of the following is the most effective means of providing symptomatic relief to patients with moderate to severe heart failure? a. ACE inhibitor b. Beta blocker c. Digoxin d. Diuretics.

d. Diuretics

Which of the following is caused by the constant use of diuretics? a. Hypermagnesemia b. Hypouricemia c. Metabolic acidosis d. Hypokalemia

d. Hypokalemia.

Which of the following is the recommended treatment for heart failure? a. Sodium restriction to 8g per day b. Increase alcohol intake c. Fluid restriction to 6 liters per day d. Weight reduction.

d. Weight reduction. (A is suppose to be 4g c. 1-2 liters a day)

Beta Blockers

decrease heart rate and dilate arteries by blocking beta receptors Only Carvidilol, Metoprolol and Bisoprolol have been proven.

analgesic drugs

drugs that produce relief from pain while the patient remains conscious

Hyperkalemia

excessive potassium in the blood

EOMI

extraocular movements intact.

Hepatojugular reflux occurs when:

mild pressure placed on the patient's liver further engorges the jugular veins.

orthopnia

results in dyspnea when lying flat measured by number of pillows needed to prop head

Contraindications of digloxin

should not be given to patients with hypokalemia should not be given to patients with WPW should not be given to patients with AV block

diaphoresis

sweating, especially to an unusual degree as a symptom of disease or a side effect of a drug.