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CardioPulm > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

What is the prognosis?

A

50% of those diagnosed with HF die within 4 years

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2
Q

What percent of HF cases also have HTN?

A

75%

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3
Q

Increased length and decreased contractility lead to

A

decreased cardiac output

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4
Q

What activates the renin-angiotensin system:

A

increased sympathetic activity (increased HR and contractility)

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5
Q

What are the results of renin-angiotensin activation?

A

increased blood volume

LV hypertrophy

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6
Q

What happens to the frank-starling curve in HF?

A

it plateaus

unable to further compensate

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7
Q

Describe systolic HF:

A

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

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8
Q

Describe diastolic HF:

A

“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
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9
Q

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

A
  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
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10
Q

What are the causes of diastolic HF?

A
  1. chronic HTN with LV hypertrophy
  2. hypertrophic CM
  3. Aortic stenosis with normal LVEF
  4. CAD
  5. restrictive cardiomyopathy
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11
Q

R HF can be due to pulmonary disease because:

A

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

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12
Q

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

A
  1. increased RA pressure
  2. JVD
  3. liver engorgement
  4. ascites
  5. peripheral edema
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13
Q

Class I

A

no limitation

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14
Q

Class II

A

light physical activity limitation

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15
Q

Class III

A

marked limitation of physical activity, comfortable at rest

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16
Q

Class IV

A

symptoms even at rest

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17
Q

Stage A

A

high risk for CHF development

no structural issues

18
Q

Stage B

A

structural disorder of the heart

no symptoms

19
Q

Stage C

A

past/current CHF symptoms associated with underlying heart disease

20
Q

Stage D

A

end-stage disease

require specialized treatment strategies

21
Q

Acute “uncompensated” HF:

A
  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
22
Q

Chronic “compensated” HF:

A
  1. changes to RAAS: Na and H20 retention, inc. contractility
  2. sympathetic stimulation
  3. inc. peripheral 02 extraction
  4. cardiac dilation to inc. SV
23
Q

What are the results of sympathetic stimulation?

A

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

24
Q

Auscultate for pulmonary edema. Expected sounds?

A

crackles

diminished breath sounds possible

25
Q

Describe the pathway of back flow:

A
  1. LV
  2. LA
  3. Pulmonary system
  4. RV
  5. RA
  6. Venous system in body
26
Q

Muscle changes in HF causes:

A
  1. dec. blood flow
  2. poor muscle nutrition/absorption
  3. insulin resistance
  4. inc. tumor necrosis factor (systemic inflammation)
  5. abnormal skeletal muscle metabolism
27
Q

Results of muscle changes in HF:

A
  1. dec. muscle mass
  2. inc. muscle atrophy (type II fibers)
  3. myopathy
28
Q

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

A

70%

29
Q

Depression is present in ___% of HF patients.

A

43%

30
Q

B12 insufficiency is associated with:

A

neuropathy

31
Q

PT consideration for patients with hx of ventricular arrhythmias:

A

monitor with telemetry for first treatment during activity

32
Q

T or F: PT consideration should consider cognitive changes.

A

True.

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

33
Q

Signs of worsening HF:

A 
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
34
Q

What is orthopnea?

A

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

35
Q

What is paroxysmal nocturnal dyspnea (PND)?

A

sudden onset SOB when supine

36
Q

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

A

compensated

37
Q

Systemic effects of chronic HF contribute to ______.

A

myopathy

consider resisted exercise program

38
Q

3 main treatment options for HF:

A

meds
lifestyle mods
surgery

39
Q

HF surgical options:

A 
Coronary Artery Bypass Graft
Angioplasty
Valve Replacement
Defibrillator Implantation
Myectomy and/or ventriculotomy
Gene/Stem Cell Therapy
Ventricular Assist Device (VAD)
Heart Transplant
40
Q

HF drug options:

A 
ACE inhibitor
β-Blocker
Electrolyte replacement: K+, Mg+
Diuretics
Vasodilators
Inotropes
Vasopressors
41
Q

HF lifestyle changes:

A 
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
42
Q

What data is usually monitored with telemonitoring?

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

CardioPulm (13 decks)

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