EXAM 2 MEDICAL SURGICAL STUDY GUIDE

HEART FAILURE Assessment of left and right CAD: lab test Hct and LDL Left Sided Heart Failure (think about s/s of Pulmonary disorders)  Most common  Prevents normal forward flowing blood  Blood backs up into the left atrium, and then to the pulmonary vein o Pressure increases, fluid leaks from the pulmonary capillary bed into the interstitium and then the alveoli o Results in pulmonary congestion and edema  Signs o LV heaves o Pleural effusion o Alternating pulses (strong, weak): o Changes in mental status, o Increased HR restlessness, confusion o Decreased PaO2, slight increase o Orthopnea, shallow respirations, dry PaCO2 (result poor oxygen hacking cough exchange) o Nocturia o Crackles (pulmonary edema) o **Frothy, pink-tinged sputum o S3/S4 sounds (advanced pulmonary edema) Right Sided Heart Failure  RV fails to contract effectively  Backup of blood into the right atrium, and then venous circulation  Venous congestion in systemic circulation results in o JVD o Hepatomegaly o Splenomegaly o Vascular congestion of GI tract o Peripheral edema: blood returning is blocked/backed up  Can result from acute conditions such as RIGHT VENTRICULAR INFARCTION or P.E.  CorPulmonale: right ventricular dilation and hypertrophy caused by pulmonary disease  Primary cause: Left-sided HF o Left side HF results in pulmonary congestion, increased pressure in the blood vessels of lungs (pulmonary HTN) o Chronic pulmonary HTN puts increased right ventricular afterload and results in right-sided hypertrophy and HF  Signs/Symptoms oooooRV heaves, murmurs JVD: 30-45 degree angle to be able to see Edema (pedal, scrotum, sacrum) Weight gain Increased HR ooooAscites: abdomen Anasarca (massive generalized body edema): 2+ everywhere Hepatomegaly (liver enlargement): RUQ pain, anorexia, GI bloating 1