used to calculate CO, SVR, pulmonary art wdge pressure, SV, central venous pressure
What does pulmonary artery wedge pressure show?
function of L side of heart
Where is it & what does it show?
pulmonary artery catheter
sits in pulmonary artery & shows R-side pressure
How is central venous pressure measured?
What does it show?
can measure with a central line
shows fluid status (overload or dehydration) & gives info about why BP is decreased
Tx of decreased central venous pressure?
blood & fluids or if r/t heart not pumping can Tx with HF meds
volume coming back to heart
What occurs with preload in CHF?
it is increased
What meds are given for increased preload/CHF?
diuretics & vasodilators/BP meds
Nursing intervention that can decrease preload in CHF pt?
What AE can occur when placing central venous lines?
can go too far & hit ventricle --> arrhythmias
How would lasix affect preload?
How would vasodilation affect the preload?
3 goals of CHF Tx?
1. decrease preload
2. decrease afterload
3. increase CO
What is afterload?
What effect does lasix have on SVR?
Should CHF pt legs be elevated?
no - will drown them
What is CO? What is normal CO?
volume of blood pumped by heart in one minute
What is SVR? What does it indicate?
systemic vascular resistance - afterload
What is central venous pressure?
What does central venous pressure indicate?
R atrial pressure
What hemodynamic devices are used to measure R atrial pressure/CVP?
What do they also indicate?
Schwann Ganz or pulmonary wedge
fluid status, increased CVP, volume overload or R ventricular failure, decreased CVP, hypovolemia
What is reflected by pulmonary wedge pressure?
L ventricle preload (measures pulmonary capillary pressure & R atrial pressure)
What is indicated by an elevated PAWP?
heart failure/fluid overload
Counterregulatory mechanisms that occur in HF?
natriuretic peptides (ANP & BNP) are released by heart muscle & promote vasodilation to reduce afterload & preload
What will occur with systolic failure?
no forward BF, decreased EF & BP
Causes of systolic failure?
4. valvular heart disease
Hallmark of systolic failure?
ventricles do not fill during diastole --> decreased SV & CO
Swan-Ganz & pulmonary artery wedge are used to measure what?
CVP & R atrial pressure - shows functioning of the L side of the heart
Patho of diastolic failure?
high filling pressure in ventricles r/t noncompliance/stiffness --> venous engorgement in pulmonary & systemic systems --> pulmonary congestion, pulmonary HTN, ventricular hypertrophy, and normal EF
Cause of diastolic failure?
results from LV hypertrophy r/t chronic systemic HTN, aortic stenosis, or hypertrophic cardiomyopathy
How does dilation of the ventricles contribute to CHF?
Why does this occur?
muscles of heart stretch to increase CO & force of contractions --> enlarged heart will start to fail
What test can be used to distinguish CHF from lung problem?
elevated BNP indicates HF
What will happen to BNP with Tx of CHF?
How does hypertrophy of the ventricles contribute to heart failure?
How does SNS contribute to HF?
responds to decreased CO by releasing catecholemines (EPI & NE) to increase HR & contractility & vasoconstricts (increased preload) --> strains already failing heart
What is affected by L sided HF?
What diuretic cannot be given to CHF pt?
mannitol - pulls fluid from tissue into BV --> will stress overworked heart r/t increased BF
Important consideration with use of mannitol?
need IV filter
How does the neurohormonal response contribute to fluid retention during CHF?
decreased CO --> renin/angiotensin/aldosterone release --> retention of Na/water & vasoconstriction --> increased BP --> increased stress on heart
decreased CO also causes release of ADH
What type of CHF is usually seen first?
Patho of L-sided HF?
LV dysfunction --> blood backs up through L atrium into pulmonary veins --> increased pulmonary pressure --> fluid from pulmonary capillary bed shifts into interstitum & alveoli --> pulmonary congestion/edema
4 causes of L sided CHF?
CAD, HTN, cardiomyopathy, rheumatic heart disease
What may occur as a result of L sided CHF?
How may pulmonary congestion be monitored in L sided HF?
CXR will show decreased fluid in the lungs
R-sided failure patho?
backflow to R atrium & venous circulation --> venous congestion --> peripheral edema, hepatomegaly, splenomegaly, vascular congestion of GI, JVD
Med that may be given to increase BP & decrease peripheral edema in R sided HF?
5 causes of R sided HF?
1. L sided dysfunction
2. chronic pulmonary HTN/cor pulmonale
4. pulmonary emboli
What occurs in ADHF/acute decompensated HF?
lung alveoli filled with fluid - manifests as pulmonary edema
12 S/S of acute decompensated HF? (ADHF)
3. may be cyanotic
4. skin clammy & cold
6. RR >30
7. orthopnea: feel like drowning when lay flat
9. frothy blood-tinged sputum
10. bubbling crackles
11. pulmonary edema
12. enlarged heart on CXR
13. paroxysmal nocturnal dyspnea
What usually occurs with chronic CHF?
usually have biventricular failure
4. behavioral changes: r/t hypoxia
5. skin changes
6. weight changes
7. chest pain
10. orthopnea: orthopnea X5 - sleep with 5 pillows
What could be 1st s/s of CHF exacerbation?
dry hacking cough
Why may anemia occur with HF?
poor nutrition, renal disease, or durg therapy (ACE)
dyspnea when in supine position
Paroxysmal nocturnal dyspnea?
pt wakes in panic with feelings of suffocation & has strong desire to sit up for relief
L or R sided HF cause skin open with seeping fluids?
Why may tachycardia not be evident in a pt with CHF?
if taking beta blockers
Where may edema occur with CHF?
peripheral, lungs, liver(hepatomegaly), dependent areas, abd cavity (ascites)
What is the cause of dyspnea with CHF?
increased pulmonary pressures
Why does pt with CHF have nocturia?
daytime UO is decreased by decreased CO & fluid in interstitial areas
at night fluid shifts back into BF
What skin changes occur with CHF?
2. cool & damp/diaphoretic
3. LE shiny & swollen with diminished or absent hair growth
4. pigment changes r/t chronic selling
5. brown or brawny ankles & lower legs
What behavioral changes may occur with CHF?
unusual behavior: restlessness, confusion, decreased att. span or memory
caused by decreased CO --> decreased BF to brain & hypoxia
Why may chest pain occur with CHF?
decreased CO --> decreased coronary circulation
Weight changes that occur with CHF?
may initially gain r/t fluid retention
eventually will lose weight b/c of anorexia & N: loss of muscle & fat
Why may pt muscle & fat loss with CHF go unnoticed?
may be masked by fluid retention & edema
5 complications of CHF?
1. pleural effusions
2. arrhythmias: high risk for fatal
3. L ventricular thrombus
5. renal failure
What causes pleural effusion r/t CHF?
Where effusion usually seen?
increase pressure in pleural capillaries --> fluid into pleural space
in R lower lobe
What is the cause of nearly 1/2 of sudden cardiac death in CHF?
What arrhythmias may occur with CHF?
tachyarrhythmias & afib
2 causes of arrhythmias with CHF?
low EF increases risk
lasix & other drugs that alter K
2 risks associated with low EF?
2. formation of clots in L ventricle r/t blood pooling
How may clots be prevented with CHF?
may be on heparin
What may occur is thrombus forms in L ventricle r/t decreased EF & CHF?
can further decrease CO & can cause embolism
When is hepatomegaly most likely to occur with CHF?
What can it lead to?
more likely with R-sided failure
can lead to liver failure & cirrhosis
Why may renal failure occur with CHF?
decreased perfusion of the kidneys
Acronym to remeber s/s of CHF?
Shortness of breath
How is CHF classified?
based on tolerance of physical activity
Class I CHF?
no limitation of activity
Class II CHF?
slight limitation of activity: no s/s at rest
ordinary activity causes fatigue, dyspnea, palpitations, or pain
Class III CHF?
marked limitation of activity: usually comfortable at rest & some s/s with activity
Class IV CHF?
inability to carry on anyphysical activity without discomfort
s/s of cardiac insufficiency or anigna may be present even at rest