PATHO Chapter 17: left and right heart failure

Question 5 of 5 Which of the following are expected in response to left ventricular failure? Select all that apply. Decreased heart rate Increased anti-diuretic hormone Increased angiotensin II Increased urine output Decreased sodium and water reabsorption

Increased anti-diuretic hormone Increased angiotensin II

Question 1 of 5 When left ventricular failure occurs, which of the following signs and symptoms relate to the backward effects of heart failure? Select all that apply. Hypertension Jugular vein distension Pulmonary edema Paroxysmal nocturnal dyspnea Peripheral edema

Pulmonary edema Paroxysmal nocturnal dyspnea

Question 2 of 5 In response to hypertension, the left ventricle may undergo hypertrophy, reducing filling volume of the left ventricle. This is an example of _____________. total heart failure systolic dysfunction backward effects diastolic dysfunction

diastolic dysfunction

Question 4 of 5 Baroreceptors detect ______________ and respond by increasing __________. high blood pressure, heart rate low blood pressure, heart rate decreased heart rate, blood pressure increased heart rate, blood pressure

low blood pressure, heart rate

Question 3 of 5 The backward effect of left heart failure may cause __________________. Select all that apply. hypertension pulmonary edema pulmonary crackles paroxysmal nocturnal dyspnea jugular vein distension

pulmonary edema pulmonary crackles paroxysmal nocturnal dyspnea

Question 1 of 5 Which of the following is incorrectly matched? High-output failure - Elevated demands on the heart Diastolic dysfunction - Difficulty ejecting blood Low-output failure - Decreased venous return Systolic dysfunction - Difficulty contracting and pumping effectively Backward effect - Blood backing up in circulatory system

Diastolic dysfunction - Difficulty ejecting blood

Question 4 of 5 Where would fluid accumulate in a patient due to the increased level of hydrostatic pressure caused by left ventricular failure? Alveoli Perihilar region Pleural cavity Pulmonary interstitial spaces Hepatic portal veins

Pulmonary interstitial spaces

Question 2 of 5 What are the causes of left ventricular failure? Select all that apply. Increased pressure within the venous system Decreased pulmonary arterial blood flow Reduced forward pumping strength of the ventricle muscle Increased stiffness of ventricle muscle Reduced relaxation of ventricle muscle

Reduced forward pumping strength of the ventricle muscle Increased stiffness of ventricle muscle Reduced relaxation of ventricle muscle

Question 1 of 6 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 pitting edema; and cool, pale extremities. Which of his signs and symptoms are associated with right-side heart failure? Select all that apply. Ascites Headache and memory loss Cyanosis Peripheral pitting edema Cool, pale extremities

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

Question 3 of 5 A patient presents with peripheral edema, hepatosplenomegaly, and jugular vein distention. What do these signs and symptoms represent? Select all that apply. Forward effects of right ventricular failure Forward effects of left ventricular failure Backward effects of right ventricular failure Backward effects of left ventricular failure Total heart failure

Backward effects of right ventricular failure Total heart failure

Question 5 of 5 Which of the following are classes of medications used in management of heart failure? Select all that apply. Diuretics ACE inhibitors Beta blockers Hormone replacement therapy Inotropic agents

Diuretics ACE inhibitors Beta blockers Inotropic agents

Question 3 of 6 Based on assessment findings and mixed signs and symptoms, you suspect total heart failure. Howard's symptoms are due to the body's attempt to compensate for the heart failure. As a clinician, you know compensation helps to a point, but eventually the compensation itself can be compounding the issues associated with heart failure. Which of the following are correct statements regarding the body's attempts to compensate for heart failure? Select all that apply. Heart rate elevates in response to parasympathetic activation. Fluid retention by the body is an attempt to increase blood pressure by increasing blood volume. Pale, cool extremities result from increased blood flow to the skin in attempt to divert excess blood away from the heart. Baroreceptors detect falling blood pressure and initiate increased heart rate to compensate. Peripheral vasodilation is the primary cause of the peripheral pitting edema.

Fluid retention by the body is an attempt to increase blood pressure by increasing blood volume. . Baroreceptors detect falling blood pressure and initiate 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 to compensate for the pressure loss. Another means by which the body attempts to compensate for heart failure is to retain fluid. An increase in blood volume results in an increase in pressure. However, excess fluid in the body increases the likelihood of edema.

Question 2 of 6 Which of his signs and symptoms are associated with left-side heart failure? Select all that apply. Headache and memory loss Orthopnea Paroxysmal nocturnal dyspnea Pulmonary crackles Pulmonary edema

Headache and memory loss Orthopnea Paroxysmal nocturnal dyspnea Pulmonary crackles Pulmonary edema Left-side heart failure results in fluid back up in the pulmonary system, as well as decreased perfusion of systemic tissues. Headache and memory loss can result from decreased perfusion of the brain. Orthopnea, paroxysmal nocturnal dyspnea, pulmonary crackles, and pulmonary edema are all signs of the left ventricle failing to pump the blood forward and the backward effects of fluid accumulation in the lungs developing.

Question 6 of 6 Howard undegoes further testing. Which of the following values may provide further evidence that Howard has left ventricular failure? Increased PCWP Decreased albumin Decreased PAP Increased JVD Increased CVP

Increased PCWP Pulmonary capillary wedge pressure (PCWP) 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 heartfailure.

Question 5 of 6 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? Select all that apply. Decreased ADH Increased aldosterone Decreased angiotensin Increased natriuretic peptide Increased renin

Increased aldosterone Increased renin Fluid retention results from the activation of the 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 reduced blood volume.

Question 4 of 6 Which of the following signs and symptoms, although not present in Howard's initial examination, are also associated with right-side heart failure? Select all that apply. Jugular vein distention Orthopnea Hepatosplenomegaly Crackles in the lungs Pulmonary edema

Jugular vein distention Hepatosplenomegaly Jugular vein distention (JVD) and hepatosplenomegaly are common signs of right-side heart failure, as blood backs up in the large veins delivering blood to the heart, causing the veins and organs to enlarge. The other answers listed are associated with left-side heart failure.