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65 Cards in this Set
- Front
- Back
Heart failure, sometimes referred to as ______ _______, is a general term for the inability of the heart to work effectively as a pump.
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pump failure
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Most heart failure begins with failure of the ________ _______ and progresses to failure of _________ _______.
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1) left ventricle
2) both ventricles |
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Typical causes of left-sided heart (________) failure include hypertensive, _________ ______, and valvular disease involving the __________ or _________ valve.
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1) ventricular
2) coronary artery 3) mitral 4) aortic |
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Left-sided heart failure was formerly referred to as ________ _________ __________ (___); however, not all cases of LVF involve fluid accumulation.
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Congestive Heart Failure (CHF)
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Systolic heart failure (_______ ________ _______) results when the heart cannot contract forcefully enough during systole to _________ _______ _______ of blood into the circulation. Preload increases with decreased contractility, and afterload increases as a result of increased peripheral resistance.
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1) systolic ventricular dysfunction
2) eject adequate amounts |
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The _______ _______ (the percentage of blood ejected from the heart during systole) drops from a normal 50% to 70% to below 40% with _______ _______.
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1) ejection fraction
2) ventricular dilation |
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So what that ejection fraction drops to below 40%?
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As ejection fraction decreases, tissue perfusion diminishes and blood accumulates in the pulmonary vessels.
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In contrast, _______ _______ ________ (heart failure with preserved left ventricular function) occurs when the left ventricle _________ _______ adequately during diastole.
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1) diastolic heart failure
2) cannot relax |
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Inadequate relaxation or "______" prevents the ventricle from filling with sufficient blood to ensure an ________ ______ ____.
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1) stiffening
2) adequate cardiac output |
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_____-_____ ______ (_______) failure may be caused by left ventricular failure, right ventricular MI, or ________ ________.
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1) Right-sided heart (ventricular)
2) pulmonary hypertension |
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In Right-sided HF, the right ventricle cannot _______ ______. Increased volume and pressure develop in the _________ ________, and ________ ________ results.
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1) empty completely
2) venous system 3) peripheral edema |
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_____ - _____ ______ failure can occur when cardiac output remains _______ or ______ _______, unlike left- and right- sided heart failure, which are typically ______ - _______ states.
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1) High-output heart failure
2) normal 3) above normal 4) low-output |
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High-output failure is caused by increased ______ _______ or _________ conditions, such as septicemia (_____), _______, and ________. This type of heart failure is not as common as other types.
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1) metabolic needs
2) hyperkinetic 3) fever 4) anemia 5) hyperthyroidism |
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In HF, stimulation of _______ _______ _______ (i.e., increasing catecholamines) as a result of tissue ______ represents the most immediate compensatory mechanism.
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1) sympathetic nervous system
2) hypoxia |
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Stimulation of the adrenergic receptors causes an increase in heart rate ( ____ _____) and blood pressure from ____________ ( _______ ________ ).
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1) beta adrenergic
2) vasoconstiction 3) alpha adrenergic |
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Because cardiac output (CO) is the product of heart rate (HR) and stroke volume (SV), an increase in HR results in an immediate increase in ______ _______.
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cardiac output
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______ _______ is also improved by sympathetic stimulation. Sympathetic stimulation increases venous return to the heart, which further stretches the myocardial fibers causing dilation.
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Stroke Volume
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According to ______ _____, increased myocardial stretch results in more forceful contraction. More forceful contraction results in SV and CO. After a critical point is reached within the cardiac muscle, further volume and stretch reduce the force of contraction and cardiac output.
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Starling's law
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Sympathetic stimulation also results in _______ _______.
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arterial vasoconstriction
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Constriction of the arteries increases ________, the resistance against which the heart must pump. As it increases, the left ventricle requires more energy to eject its contents and SV may ________.
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1) afterload
2) decline |
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Reduced blood flow to the kidneys, a common occurrence in low-output states, results in activation of the _____ - ______ system.
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renin-angiotensin system (RAS)
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Vasoconstriction becomes more pronounced in response to __________, and ________ secretion causes sodium and water retention. _______ and ________ increase.
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1) angiotensin II
2) aldosterone 3) preload 4) afterload |
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Angiotensin II contributes to ________ ________ resulting in progressive myocyte ( _______ ) contractile dysfunction over time.
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1) ventricular remodeling
2) myocardial cell |
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In those who have had an MI, heart muscle cell injury causes an ________ ______.
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immune response
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Pro-inflammatory cytokines, such as ________ _______ _______ and interleukins ( ___ and ____ ), are released, especially with left-sided HF. These substances contribute to ventricular remodeling.
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1) tumor necrosis factor (TNF)
2) IL-1 and IL-6 |
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________ ________ are neurohormones that work to promote vasodilation and diuresis through sodium loss in the ______ ______.
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1) Natriuretic peptides
2) renal tubules |
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The _____ _____ ______ is produced and released by the ventricles when the patient has fluid overload as a result of HF.
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B-type natriuretic peptide (BNP)
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____ increases with age and has greater concentration in women. People who are ______ have lower levels of it compared with those who are not.
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1) BNP
2) obese |
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Low cardiac output (CO) causes decreased ________ _______. As a result, the posterior pituitary gland secretes _______ (antidiuretic hormone [ADH]).
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1) cerebral perfusion
2) vasopressin |
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_________ hormone causes vasoconstriction and fluid retention, which worsen HF.
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antidiuretic hormone or vasopressin
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________ is secreted by endothelial cells when they are stretched.
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Endothelin
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As the myocardial fibers are stretched in patients with HF, _______ (a potent vasoconstrictor) is released, which increases peripheral resistance and hypertension. HF worsens as a result of these actions.
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Endothelin
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________ _______ (enlargement of the myocardium), with or without _______ _______, is another compensatory mechanism.
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1) myocardial hypertrophy
2) chamber dilation |
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The walls of the heart thicken to provide more ______ _____, which results in more forceful contractions, further increasing ________ _______.
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1) muscle mass
2) cardiac output |
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Cardiac muscle, however, may hypertrophy more rapidly than _______ _______ can provide adequate blood supply to the muscle. Often hypertrophied heart is slightly _______ deprived.
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1) collateral circulation
2) oxygen |
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As HF becomes very severe, patient may begin expectorating _____, _____ ______ - a sign of life-threatening pulmonary edema.
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frothy, pink sputum
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As ______ ______ develops, the patient often stops previously tolerated levels of activity because of ________ of _______.
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1) exertional dyspnea
2) shortness of breath |
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Dyspnea at rest in recumbent (lying flat) position is know as _________.
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orthopnea
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Patients who describe sudden awakening with a feeling of breathlessness 2 to 5 hours after falling asleep have ______ ________ _________.
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paroxysmal nocturnal dyspnea
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In advanced right-sided HF, ________ and an increased ______ _______ may develop from the pronounced liver congestion.
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1) ascites
2) abdominal girth |
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Define formula for measuring proportional pulse pressure?
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Systolic BP - Diastolic BP and all that over Systolic BP
- if result is less than 25% it means severely compromised cardiac output |
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The pulse may be tachycardic, or it may alternate in strength - what is it called?
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pulsus alternans
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A third heart sound, (S3) _______, an early diastolic filling sound indicating an increase in left ventricular pressure, may be heard on auscultation.
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gallop
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S4 is not necessarily a sign of heart failure, but is a reflection of _________ ________ _________.
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decreased ventricular compliance.
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What is an unreliable sign of HF?
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Edema
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What is a more reliable sign of HF than edema?
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accurate daily weights to document fluid retention or loss
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What serum electrolytes you should check for HF?
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- sodium
- potassium - magnesium - calcium - chloride |
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Any impairment of renal function resulting from inadequate perfussion causes elevated blood _______ _______ and serum _______ and decreased ________ _________ levels.
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1) urea nitrogen
2) creatinine 3) creatinine clearance |
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In HF urinalysis may reveal proteinuria and high _______ _______.
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specific gravity
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________ and _______ tests should be performed to identify HF resulting from anemia.
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1) Hemoglobin
2) hematocrit |
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__-_______ _______ ______ is used for diagnosing HF (in particular, diastolic HF) in patients with acute dyspnea.
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B-type natriuretic peptide (BNP)
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__________ is an early indicator of decreased compliance of the heart and occurs before the BNP rises.
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Microalbuminuria
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______ ______ ______ values often reveal hypoxia (low oxygen level) because oxygen does not diffuse easily through fluid-filled alveoli.
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Arterial Blood Gas (ABG)
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Respiratory alkalosis may occur due to ________?
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hyperventilation
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Respiratory acidosis may occur due to ________?
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carbon dioxide retention
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What is the best tool for diagnosing heart failure?
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EKG
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Which test may reveal enlargement of the heart?
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Chest x-ray
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_______ ______ (thallium imaging or technetium pyrophosphate scanning) can also indicate the presence and cause of HF.
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Radionuclide studies
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_________ ________ scans provide information about left ventricular ejection fraction and velocity, which are typically low in patients with HF.
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Multigated angiographic (MUGA)
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________ ________ ______ allow the assessment of cardiac function and volume status in acutely ill patients.
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Pulmonary artery catheters
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What's ACE?
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angiotensin-converting enzyme
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What's ARB?
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angiotensin receptor blocker
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ACE inhibitors and ARBs are started ________ and _______. The first dose may be associated with a rapid drop in BP. Patients at risk for hypotension usually have an initial systolic BP less than ______, are ______ than 75 years, have a serum _____ level less than 137 mEq/L, or are volume depleted. Monitor BP for several hours after the initial dose and each time the dose is increased.
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1) slowly and cautiously
2) 100 mm Hg 3) sodium |
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The clinical manifestations of ______ _______ are often vague and nonspecific and include _______, ______, and changes in _______ ______, especially in older adults.
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1) digitalis toxicity
2) anorexia 3) fatigue 4) mental status |
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Digitalis toxicity may cause nearly any dysrhythmia, but _____ are most commonly noted.
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premature ventricular complexes
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