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PHTH 536 - Body Systems > Cardiac Pathologies: Cardiac Muscle Dysfunction and Failure > Flashcards

Cardiac Pathologies: Cardiac Muscle Dysfunction and Failure Flashcards

1
Q

What can be the cause of CMD?

CMD = Cardiac Muscle Dysfunction

A

Usually develops with some hidden dysfunction in the heart
- which can also have hidden problems

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2
Q

CMD is the most common cause of what?

A

Congestive heart failure
- most common manifestation from CMD

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3
Q

In a nutshell, how does CMD sx develop?

A

when the heart can’t pump = can’t meet the demand
- CMD pt’s will have no sx at the start but develop as the heart can’t meet the demand

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4
Q

What is the prevalence of CHF and the risk factor?

A

5.7 million and accounting
- 1 in 5 over 40 can get it
- 85 and older annual rate of getting heart failure is 65%

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5
Q

How dangerous is CMD?

A

Causes the left ventricle to lose detriorate
- most fatal and severe
- most common diagnosis of patients over 65

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6
Q

How does hypertension cause CMD?

A

↑ arterial pressure = left ventricle hypertropy
- overstretched fibers and pump is less effective

Using ACE-inhibitors, CCB, diuretics, BB

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7
Q

How does CAD cause CMD?

A

second most cause (!!)
= bad left or/and right ventricle because of injury

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8
Q

How does cardiac arrhythmias cause CMD?

A

fast or slow HR = impair left and/or right ventricle function

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9
Q

How does renal insuffiency cause CMD?

A

acute or chronic problems = fluid buildup

Using dieuretics or dialysis to decrease reabsorption of fluid from kidney

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10
Q

How does cardiomyopathy cause CMD?

A

cardiac muscle fiber’s ability to contract and relax is broken frfr

  • primary cause = pathological procress
  • secondary cause = systemic disease
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11
Q

What is the leading cause of heart failure and transplants?

A

cardiomyopathy with 3 main types

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12
Q

What is dilated cardiomyopathy and it’s dysfunction?

A

BIG VENTRICLES
- systolic dysfunction

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13
Q

What is hypertrophic cardiomyopathy and it’s dysfunction?

A

WEIRD LEFT VENTRICLE WALL IS THICC
- diastolic dysfunction

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14
Q

What is restrictive cardiomyopathy and it’s dysfunction?

A

WEIRD LEFT VENTRICLE WALL IS STIFF
- diastolic dysfunction

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15
Q

What are the causes of cardiomyopathy?

A

Primary:
- inherited
- onset is younger

Secondary:
- medical issue

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16
Q

What are the sx of dilated cardiomyopathy?

A
  • same sx as MI with ↓ ejection fraction
  • S3 sounds and mitral valve regurgitation
  • crackles and dull when listening
  • image = big heart UwU
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17
Q

What are the sx of hypertrophic cardiomyopathy?

A
  • sx can vary
  • avg age of sx is 20
  • dyspnea and angina
  • arrhythmias and syncope
  • S4 heart sound

breathing hard = need more O2 because of THICC wall

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18
Q

What are the sx of restrictive cardiomyopathy?

A

↓ CO
fatigue and ↓ exercise ability
systemic edema
Arrhythmias

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19
Q

How does heart valve weirdness and acquired heart disease cause cardiac muscle dysfunction?

weirdness = abnormal

A

blocked or incapable valves = needing heart to contract more
associated w/ myocardial dilation and hypertrophy

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20
Q

What are some common surgeries to assist with valve weirdness?

A

valve replacement
valvuloplasty
valvulotomy
commissurotomy

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21
Q

How does pulmonary hypertension cause CMD?

A

defined by mean pulmonary artery pressure

abnormal = greater than 25
- COPD = greater than 20

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22
Q

How does pulmonary embolism cause CMD?

A

Dysfunction because of elevated pulmonary artery pressure = increase right ventricle WORK
- possibly life-threatening

medical management:
- rapidly acting fibronolytic agent
- sedative to decrease anxiety and pain
- O2
- Embolectomy

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23
Q

How does age-related changes cause CMD?

A

↓ CO by changing contract and relax of heart muscle
higher chance of:
- heart disease
- hypertension
- other pathological processes
- congential heart disease - embryonic

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24
Q

How does contractility affect heart failure?

A

length and tension of cardiac muscle is curvelinear
- tension proportional to length

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25
Q

What is optimized during ventricular stretching regarding the myocardium stretch?

A

During filling, there needs to be overlap of the actin and myosin = increased cross bridging and more force

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26
Q

What are the normal limits of an intact heart?

A
  • bigger ventricle volume during diastole (greater stretched)
  • pressure made depends on the load it has to contract against
  • contract is dependent on other factors (preload, afterload, chemicals or hormones)
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27
Q

What is indicated by the frank-starling mechanism?

A

greater venous return = greater SV
- ability of the heart to change how much it contracts = SV response to changes in venous return
- allows the heart to adjust quickly adjust preload so output is constant

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28
Q

Why is the frank-starling law length dependent?

A

An natural property of the myocardium which states that because of letting a bigger stretch = bigger contraction is possibe

i.e. controlling the eccentric load in a squat = greater force on the concentric contractability

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29
Q

How does cardiac contractility affect heart failure?

A

when impaired - contraction is as problem (systolic problem)
- there is a reduction of muscle mass
- increase likelihood of cardiomyopathies

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30
Q

How does afterload affect heart failure?

Reminder: afterload is the pressure the heart needs to have to eject the blood through aortic valve and push blood to the body

A

when there is an increase in afterload there is a contraction issue (systolic dysfunction)
- systemic/pulmonary HTN
- aortic or pulmonic valve stenosis = ventricular hypertrophy

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31
Q

What is the consequences of an increase in afterload?

A

decreases SV = since it takes longer for the tiny heart to get that next contraction in
- leads to increased pressure in the heart because decreased ejection fraction

32
Q

How does ventricular dysfunction affect heart failure?

A

becomes a relaxation dysfunction (diastolic)
- theres more stiffness and hypertrophy)
- mycocardial disease or even MI
- Mitral or tricuspid valve stenosis
- pericardial disease

33
Q

Common contributing etiologies

Hypertension

A

Increase in arterial pressure
= L ventricular hypertrophy
= overstresed contractile fibers
= less effective pump

#1 cause

34
Q

Common contributing etiologies

CAD/ischemia/MI

A

damange to the left ventricle
= less effective pump

#2 cause

35
Q

Common contributing etiologies

Cardiac dysrhythmias

A

bad timing changes ventricular function and how it empties properly

36
Q

Common contributing etiologies

Renal insufficiencies

A

Fluid overload

37
Q

Common contributing etiologies

Valve abnormalities

A

leads to either:
increase in aterial pressure or increase EDV

38
Q

Common contributing etiologies

Chronic pericardial effusion

A

heart wall can’t contract properly

39
Q

Common contributing etiologies

Pulmonary embolism

A

increase pulmonary artery pressures
increased work right ventricle

40
Q

Common contributing etiologies

Pulmonary HTN

A

chronic increase in pulmonary artery pressure
increased afterload right ventricle

41
Q

How does a left ventricle pathology lead to HF?

What are the hallmark sx?

A

Decrease of CO and blood build up in the left atrium
= pulmonary and peripheral congestion

dyspnea and cough

42
Q

How does a right ventricle pathology lead to HF?

What are the hallmark sx?

A

decreased right ventricle CO = venous congestion
- right heart failure - Cor Pulmonale

mostly due to pulmonary pathology or RCA infarct

JVD, peripheral edema, ascites, pleural effusion and weight gain (due to build up)

43
Q

How does biventricular pathology lead to HF?

What are the hallmark sx?

A

acute exacerbations are both ventricles
- left overloads = pulmonary edema
- right overload = systemic congestion

44
Q

What is the functional pathology regarding heart failure with reduced ejection fraction on the left ventricle?

A

has decreased ability to eject blood = worse contractility or due to pressure overload
- pump is either = too stretched / too damanged / too much pressure

Systolic dysfunction

45
Q

What does left sided failure tends to show?

A

show more pulmonary congestion

46
Q

What does a HFpEF > 50% EF indicate?

A

Decreased ability to accomodate for the heart
= increase in HR and BP

47
Q

What does a HFrEF < 40% EF indicate?

A

We see lower BP

48
Q

What does right sided failure tend to show?

A

show more peripheral congestion

49
Q

What is compensated heart failure?

A

who’s been diagnosed with HR but NO signs of pulmonary or peripheral congestion
- NYHA I-III
- ACC/AHA stages A-C

50
Q

What is an acute uncompensated heart failure?

A

Presence of new or worsening sx/symptoms of dyspnea, fatigue or edema = hospitalization or unscheduled medical care

51
Q

What are the signs of increased congestion?

A

edema
dyspnea
weight gain
angina
exercise tolerance

52
Q

How is renal function affected by heart failure?

A

decreased CO = retention of fluids and sodium
- extra work load and poorly perfused with O2 blood

53
Q

How is pulmonary function affected by heart failure?

A

more fluid in the lungs = impairment of gas exchange
- increase in pulmonary capillar wedge pressure = damage = global respiratory impairment

54
Q

How is hepatic function affected by heart failure?

A

too much fluid clogs the hepatic vein
- bad perfusion to hepatic tissue = liver cirrhosis

55
Q

How is skeletal muscle dysfunction affected by heart failure?

A

fluid overload = more weight on limbs
bad perfusion
type I & II atrophy
Poor exercise tolerance

56
Q

How is pancreatic function affected by heart failure?

A

decreased blood flow to the pancreas
impairment of insulin secretion
decreased energy metabolism from glucose = heart needs to work = the worse cycle for it

57
Q

What are some examples of managemeent for CHF?

A

Lifestyle changes
Pharmacologic
Mechanical management
surgical managemeent
dialysis for fluid management

58
Q

What are some medicine possibly taken for CHF?

A

Diuretics
ACE inhibitors
MRAs
Beta-blockers

59
Q

What are some mechanical management for CHF?

A

plantable defibrillators and/or pacemakers
cardiac resynchronization therapy
assisted circulation - IASP (intraaortic ballon pump)
LVAD and Impella

60
Q

What are some surgical managment for CHF?

A

repairing or replacing faulty valves
transplant
CABG since CAD leads to CHF

61
Q

What are we looking for in our PT exam?

A

any vitals
breathing (dyspnea or tachypena w/ shallow)
orthopnea (how many pillows while laying down)
heart and lung sounds (S3 and rales)
peripheal edema (weight gain)
exercise tolerance
cognition
how are they eating?

62
Q

What are the effects of rehab that have heart failure?

A

Reduces hospitalizations and improve the quality of life
BUT has no effect on mortality

63
Q

What is the recommended exercise prescription for heart failure patients?

A

Dosing (40-80% ; RPE 6-20)
Frequency (1-3x a week)
Mode (aerobic or aerobic and resistance)
Delivery (exercise only or comprehensive)

64
Q

What are the benefits of exercise for HF?

A

Improved:
- exercise tolerance
- coronary artery flow and prevention from ischemia
- life in general

65
Q

How are we able to keep HF patients safe during treatment?

A

ability to monitor and decrease intensity if needed
- while taking account sudden cardiac death at higher efforts
- handle least fit group and possibility of MI
- TAKE CONTROL AND MONITOR

66
Q

How are we conducting resistance training for patients with HF?

A

Resistance exercises with light weights of 1-5lbs
- want to avoid valsva

avoiding valsva because we want to limit the increase in pressure in the blood

67
Q

What are the ACSM guidelines for heart failure?

A

light to mod exercise (@ 6-11)
up to 150 min per week (around 30-40 min @ 5-7 days per week)
choose aerobic over everything
Resistance training - LIGHTWEIGHT (40-60% of 10 RM)
Longer warm up and cool down

68
Q

What are the implications we are looking for with HF patients?

A

Look at vitals (!!)
Any heart and lung sounds (@ S3 / rales and crackles)
Slower with easier build up to get the heart to pump
Careful with edema and other signs not holding up well to exercise

Note: we want to focus on functional activities in the hospital and more community reintergration in rehab and OP

69
Q

What is life’s simple 7?

A

7 modifiable risk factor that can be changed:
- stop smoking
- diet
- glucose control
- BMI
- PA
- BP control
- decrease cholesterol

0-2 points each for a total of 14

70
Q

What is indicated with a MID score for diet in LS7?

A

Associated with lower HF probability

71
Q

What is indicated when trying to prevent HF in LS7 through clusters?

A

2 idea scores in:
- BMI and glucose
- smoking and glucose
- PA and smoking

= lower risk of HF

72
Q

What is indicated when trying to prevent HF in LS7 through clusters of 3?

A

3 ideal components to decrease together:
- BMI, BP and glucose
- BMI, glucose and smoking
- BP, glucose and smoking
- PA, glucose and smoking

= lower risk of HF

73
Q

How much does an MID lifestyle in the LS7 affect the risk for HF?

A

HF risk reduction of 47%

74
Q

What is added to LS7 to make it LS8?

A

Sleep was added

75
Q

What are some examples to assist with education for patients with HF?

A

Education about how to manage their disease:
- how exercise will increase their life happiness and avoid hospitals
- take meds
- be able to recognize any sx and when to call MD
- DIET (!!)
- emphasizing volume over intensity

PHTH 536 - Body Systems (5 decks)

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