Cardiac Muscle Dysfunction- CHF

Question 1

What is the best indicator for cardiac function and what is the normal range?

Answer 1

ejection fraction, 60-70%

Question 2

What term describes the ratio of the blood volume ejected out of the ventricles relative to the blood volume received by the ventricles before contraction?

Answer 2

ejection fraction

Question 3

What are the four types of CHF?

Answer 3

left side, right side, diastolic, systolic

Question 4

You have a pt showing signs of pleural effusion and pulmonary edema. They have SOB, decreased breath sounds, fatigue, increased BP and resting HR, cough and chest pain, which type of CHF do you think they might have?

Answer 4

left side heart failure

Question 5

You go into a pts room and notice they have bilateral pitting edema, ascites on their abdomen, and notice jugular vein distension. Which type of CHF do you think they have?

Answer 5

right side heart failure/cor pulmonale

Question 6

You tell your pt with right sided CHF that they should be weighing themselves daily, what do you tell them to look out for?

Answer 6

3lb weight gain in 24 hours is a concern and should call their doctor immediately

Question 7

Which term is when increased arterial pressure leads to increased L ventricular hypertrophy?

Answer 7

hypertension

Question 8

Which term is when there is dysfunction of the L or R ventricle due to myocardial ischemia or injury?

Answer 8

CAD

Question 9

Which term describes very rapid or very slow heart rates that can impair the function of the ventricles?

Answer 9

cardiac dysrhythmias

Question 10

Which term causes fluid overload which can in turn cause heart to have to work more due to increased fluid it has to move?

Answer 10

renal insufficiency

Question 11

Which term describes when the contraction and relaxation of cardiac muscle is impaired?

Answer 11

cardiomyopathy

Question 12

Which term describes valvular stenosis or incompetent valves that cause ventricles to become distended and impact blood flow?

Answer 12

heart valve abnormalities

Question 13

Which term describes injury to the pericardium or pericarditis and leads to inflammation and fluid to accumulate and compress the heart?

Answer 13

pericardial effusion

Question 14

Which term results in severe hypoxemia, increased pulmonary artery pressure and increases the work of the right ventricle?

Answer 14

PE

Question 15

Which term describes elevated pressures in the pulmonary artery increase the after load in the R ventricle and lead to failure?

Answer 15

pulmonary HTN

Question 16

What are risk factors for CHF?

Answer 16

smoking, diabetes, anemia, psychological stress, alcohol and drug abuse

Question 17

What type of CHF occurs when there is impaired contraction of the ventricles during systole and produces insufficient expulsion of the blood. This causes decreased stroke volume and decreased ejection fraction?

Answer 17

systolic heart failure

Question 18

Which CHF is the inability of the ventricles to accept blood ejected from the atria during rest of diastole?

Answer 18

diastolic CHF

Question 19

t/f, ejection fraction cannot be preserved in diastolic heart failure

Answer 19

false, it CAN be preserved

Question 20

What body areas can CHF affect?

Answer 20

cardiovascular, pulmonary, hepatic (can lead to cirrhosis), pancreatic (can possibly impair insulin secretion and glucose intolerance), hematolic (abnormal blood cell function), MSK (dec exercise tolerance), renal (sodium and fluid retention because of inadequate cardiac output), nutritional (anorexia, protein calorie deficiency is common)

Question 21

Which type of dyspnea leads to unexplained episodes of SOB when pt assumes a more supine position?

Answer 21

paroxysmal nocturnal dyspnea

Question 22

Which type of dyspnea occurs in a recumbent position and is described by how many pillows they use at night?

Answer 22

orthopnea

Question 23

What is the hallmark sign of CHF and what does it indicate?

Answer 23

S3 heart sound, indicates a noncompliant L ventricle and occurs during early in diastole when the ventricle is filling

Question 24

Briefly describe the stages of heart failure (NYHA classification)

Answer 24

Class I (mild)- no limitation of physical activity
Class II (mild)- slight limitation of physical activity
Class III (moderate)- marked limitation of physical activity
Class IV: unable to carry out physical activity without discomfort

Question 25

Which lab value is useful to differentiate SOB due to CHF versus pulmonary in nature, and measures the hormone released from the heart when the ventricle is distended due to increased volume and pressure? What are the abnormal values?

Answer 25

BNP (B-type natriuretic peptide), greater than 450 indicates unstable heart function for those under 50, greater than 900 indicates unstable heart function for those over 50

Question 26

How can you diagnose CHF?

Answer 26

Echocardiogram is most commonly used, chest x ray, cardiac catherizations, EKG, cardiac MRI, doppler ultrasound

Question 27

Briefly describe the edema scale

Answer 27

1+ : barely noticeable pit
2+ : skin rebounds within 15 secs
3+ : skin rebounds within 15-30 secs
4+ : skin rebound takes longer than 30 secs

Question 28

What are some dietary recommendations for a pt with CHF?

Answer 28

decrease sodium intake (less than 2000mg/day: less than one teaspoon of salt), fluid restrictions

Question 29

Describe contraindications to exercise with CHF?

Answer 29

resting HR greater than 100bpm, resting HR less than 50, resting systolic BP greater than 200 or less than 90, resting diastolic greater than 110, o2 less than 90, class IV CHF, S3 heart sound, dyspnea worsening over 1-3 days, cyanosis, edema with greater than 3 lb weight gain

Question 30

You have a pt that is exercising, what would be abnormal exercise responses?

Answer 30

systolic drops more than 20 from upright resting BP, HR increases to rapidly, does not increase or decreases with exercise, systolic greater than 210 mmg, diastolic greater than 110 mmHg, severe leg claudication

Question 31

Which CHF treatment only allows the patient to do breathing exercises and gentle exercises with UEs and noncatherized leg?

Answer 31

intraaortic ballon pump (IABP)

Question 32

t/f, a patient with LVAD has complete exercise freedom

Answer 32

true!