Cardiac Failure

Question 1

What is the prognosis?

Answer 1

50% of those diagnosed with HF die within 4 years

Question 2

What percent of HF cases also have HTN?

Answer 2

75%

Question 3

Increased length and decreased contractility lead to

Answer 3

decreased cardiac output

Question 4

What activates the renin-angiotensin system:

Answer 4

increased sympathetic activity (increased HR and contractility)

Question 5

What are the results of renin-angiotensin activation?

Answer 5

increased blood volume

LV hypertrophy

Question 6

What happens to the frank-starling curve in HF?

Answer 6

it plateaus

unable to further compensate

Question 7

Describe systolic HF:

Answer 7

“beach ball”
1. contractile dysfxn
2. inability of myocardium 3. to adequately contract to eject blood from LV
characterized by EF < 40%

Question 8

Describe diastolic HF:

Answer 8

“raquetball”

1. compliance dsyfxn
2. decreased ability of myocardium to fill during diastole
3. leads to decreased SV (and decreased CO)
4. EF within normal range

Question 9

After initial myocardial damage, what are the processes that cause altered mechanics?

Answer 9

1. weak area unable to withstand increased pressure
2. dilation occurs
3. scaring occurs
4. causes LV to change chape
5. ventricular mass/volume increase : slowly negatively impacts LV fxn

Question 10

What are the causes of diastolic HF?

Answer 10

1. chronic HTN with LV hypertrophy
2. hypertrophic CM
3. Aortic stenosis with normal LVEF
4. CAD
5. restrictive cardiomyopathy

Question 11

R HF can be due to pulmonary disease because:

Answer 11

chronic resistance in the lungs (pulmonary arterial system) means RV has to work harder

Question 12

With chronic increase in RV end diastolic pressure, what happens?

Answer 12

1. increased RA pressure
2. JVD
3. liver engorgement
4. ascites
5. peripheral edema

Question 13

Class I

Answer 13

no limitation

Question 14

Class II

Answer 14

light physical activity limitation

Question 15

Class III

Answer 15

marked limitation of physical activity, comfortable at rest

Question 16

Class IV

Answer 16

symptoms even at rest

Question 17

Stage A

Answer 17

high risk for CHF development

no structural issues

Question 18

Stage B

Answer 18

structural disorder of the heart

no symptoms

Question 19

Stage C

Answer 19

past/current CHF symptoms associated with underlying heart disease

Question 20

Stage D

Answer 20

end-stage disease

require specialized treatment strategies

Question 21

Acute “uncompensated” HF:

Answer 21

1. rapid failure of the heart
2. causes rapid shift of blood from cardiac to pulmonary systems
3. acute symptoms of dyspnea, edema, decreased activity

Question 22

Chronic “compensated” HF:

Answer 22

1. changes to RAAS: Na and H20 retention, inc. contractility
2. sympathetic stimulation
3. inc. peripheral 02 extraction
4. cardiac dilation to inc. SV

Question 23

What are the results of sympathetic stimulation?

Answer 23

inc. HR
inc. contractility
inc. rate of ventricular relaxation
arterial/venous constriction

Question 24

Auscultate for pulmonary edema. Expected sounds?

Answer 24

crackles

diminished breath sounds possible

Question 25

Describe the pathway of back flow:

Answer 25

1. LV 2. LA 3. Pulmonary system 4. RV 5. RA 6. Venous system in body

Question 26

Muscle changes in HF causes:

Answer 26

1. dec. blood flow 2. poor muscle nutrition/absorption 3. insulin resistance 4. inc. tumor necrosis factor (systemic inflammation) 5. abnormal skeletal muscle metabolism

Question 27

Results of muscle changes in HF:

Answer 27

1. dec. muscle mass 2. inc. muscle atrophy (type II fibers) 3. myopathy

Question 28

HF can lead to increased metabolic rate up to ___%.

Answer 28

70%

Question 29

Depression is present in ___% of HF patients.

Answer 29

43%

Question 30

B12 insufficiency is associated with:

Answer 30

neuropathy

Question 31

PT consideration for patients with hx of ventricular arrhythmias:

Answer 31

monitor with telemetry for first treatment during activity

Question 32

T or F: PT consideration should consider cognitive changes.

Answer 32

True. | Deficits are greater than that expected with normal aging in those patients with HF (25% to 74%)

Question 33

Signs of worsening HF:

Answer 33

``` Increased fatigue Increased dyspnea Reduced exercise tolerance Increased edema or ascites Weight gain Loss of appetite Orthopnea Dry cough Cyanosis Jugular vein distension Paroxysmal nocturnal dyspnea (PND) S3 heart sounds ```

Question 34

What is orthopnea?

Answer 34

inability to breathe well when lying flat; pt requires inc. # of pillows when sleeping

Question 35

What is paroxysmal nocturnal dyspnea (PND)?

Answer 35

sudden onset SOB when supine

Question 36

Pt needs to be in ______ HF to engage in exercise.

Answer 36

compensated

Question 37

Systemic effects of chronic HF contribute to ______.

Answer 37

myopathy | consider resisted exercise program

Question 38

3 main treatment options for HF:

Answer 38

meds lifestyle mods surgery

Question 39

HF surgical options:

Answer 39

``` Coronary Artery Bypass Graft Angioplasty Valve Replacement Defibrillator Implantation Myectomy and/or ventriculotomy Gene/Stem Cell Therapy Ventricular Assist Device (VAD) Heart Transplant ```

Question 40

HF drug options:

Answer 40

``` ACE inhibitor β-Blocker Electrolyte replacement: K+, Mg+ Diuretics Vasodilators Inotropes Vasopressors ```

Question 41

HF lifestyle changes:

Answer 41

``` Low-saturated-fat, low-sodium diet Exercise Smoking cessation Losing weight Avoiding alcohol  Avoiding or limiting caffeine Reducing stress Regular check ups with the doctor ```

Question 42

What data is usually monitored with telemonitoring?

Answer 42

1. BP, HR, SpO2 2. Weight 3. Blood sugar, HgA1C 4. Some systems allow for patient to enter subjective symptoms