NURS230-CARE OF PATIENTS WITH CARDIAC
PROBLEMS EXAM GUIDE
1. Explain the pathophysiology of heart failure.
a. Definition of heart failure: general term for the inability of the heart to work
effectively as a pump; “pump failure”
b. Concepts
i. Ejection fraction: percentage of blood ejected from the heart during
diastole
ii. Cardiac output
iii. Stroke volume: amount of blood ejected by the left ventricle during each
heartbeat
1. Equivalent to Systolic B/P minus Diastolic B/P
iv. Preload
v. Afterload
c. Compensatory mechanisms: used when cardiac output is insufficient to meet the
demands of the body; many initially increase cardiac output, but eventually have
damaging effect on pump function
i. Sympathetic nervous system stimulation:
1. Increase in HR and B/P from vasoconstriction
2. Increased fluid retention
ii. Renin-angiotensin system (RAS) activation
iii. Other chemical responses:
1. BNP is positive
,NURS230-CARE OF PATIENTS WITH CARDIAC
PROBLEMS EXAM GUIDE
2. Positive troponin
iv. Myocardial hypertrophy:
1. Cells begin to get bigger
2. Boggy, insufficient heart
2. Compare and contrast types of heart failure.
a. Left-sided heart failure: inadequacy of the left ventricle of the heart to pump
accurately
i. Results in decreased tissue perfusion from cardiac output and
pulmonary congestion from increased pressure in the pulmonary vessels
ii. Typical causes:
1. Hypertension
2. Coronary artery disease (possible MI in the past)
3. Valvular disease (valve repair in the past or taking meds that
help with valves)
iii. Signs/symptoms:
1. Decreased cardiac output:
a. Fatigue
b. Weakness
c. Oliguria (day)
d. Nocturia (night)
e. Angina
f. Confusion
g. Restlessness
, NURS230-CARE OF PATIENTS WITH CARDIAC
PROBLEMS EXAM GUIDE
h. Dizziness
i. Tachycardia
j. Palpitations
k. Pallor
l. Weak peripheral pulses
m. Cool extremities
2. Pulmonary congestion:
a. Hacking cough (worse at night)
b. Dyspnea
c. Adventitious breath sounds (crackles/rales, wheezes)
d. Frothy, pink tinged sputum
e. Tachypnea
f. S3/S4 summation gallop
b. Right-sided heart failure: inability of the right ventricle to empty completely,
resulting in increased volume and pressure in the systemic veins and systemic
venous congestion with peripheral edema
i. Can be caused by:
1. Left ventricular failure
2. Right ventricular myocardial infarction (MI)
3. Pulmonary hypertension
ii. Signs/symptoms:
1. Systemic congestion:
a. Jugular vein distention
PROBLEMS EXAM GUIDE
1. Explain the pathophysiology of heart failure.
a. Definition of heart failure: general term for the inability of the heart to work
effectively as a pump; “pump failure”
b. Concepts
i. Ejection fraction: percentage of blood ejected from the heart during
diastole
ii. Cardiac output
iii. Stroke volume: amount of blood ejected by the left ventricle during each
heartbeat
1. Equivalent to Systolic B/P minus Diastolic B/P
iv. Preload
v. Afterload
c. Compensatory mechanisms: used when cardiac output is insufficient to meet the
demands of the body; many initially increase cardiac output, but eventually have
damaging effect on pump function
i. Sympathetic nervous system stimulation:
1. Increase in HR and B/P from vasoconstriction
2. Increased fluid retention
ii. Renin-angiotensin system (RAS) activation
iii. Other chemical responses:
1. BNP is positive
,NURS230-CARE OF PATIENTS WITH CARDIAC
PROBLEMS EXAM GUIDE
2. Positive troponin
iv. Myocardial hypertrophy:
1. Cells begin to get bigger
2. Boggy, insufficient heart
2. Compare and contrast types of heart failure.
a. Left-sided heart failure: inadequacy of the left ventricle of the heart to pump
accurately
i. Results in decreased tissue perfusion from cardiac output and
pulmonary congestion from increased pressure in the pulmonary vessels
ii. Typical causes:
1. Hypertension
2. Coronary artery disease (possible MI in the past)
3. Valvular disease (valve repair in the past or taking meds that
help with valves)
iii. Signs/symptoms:
1. Decreased cardiac output:
a. Fatigue
b. Weakness
c. Oliguria (day)
d. Nocturia (night)
e. Angina
f. Confusion
g. Restlessness
, NURS230-CARE OF PATIENTS WITH CARDIAC
PROBLEMS EXAM GUIDE
h. Dizziness
i. Tachycardia
j. Palpitations
k. Pallor
l. Weak peripheral pulses
m. Cool extremities
2. Pulmonary congestion:
a. Hacking cough (worse at night)
b. Dyspnea
c. Adventitious breath sounds (crackles/rales, wheezes)
d. Frothy, pink tinged sputum
e. Tachypnea
f. S3/S4 summation gallop
b. Right-sided heart failure: inability of the right ventricle to empty completely,
resulting in increased volume and pressure in the systemic veins and systemic
venous congestion with peripheral edema
i. Can be caused by:
1. Left ventricular failure
2. Right ventricular myocardial infarction (MI)
3. Pulmonary hypertension
ii. Signs/symptoms:
1. Systemic congestion:
a. Jugular vein distention
