Cardiac Pathologies: Cardiac Muscle Dysfunction and Failure Flashcards
What can be the cause of CMD?
CMD = Cardiac Muscle Dysfunction
Usually develops with some hidden dysfunction in the heart
- which can also have hidden problems
CMD is the most common cause of what?
Congestive heart failure
- most common manifestation from CMD
In a nutshell, how does CMD sx develop?
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
What is the prevalence of CHF and the risk factor?
5.7 million and accounting
- 1 in 5 over 40 can get it
- 85 and older annual rate of getting heart failure is 65%
How dangerous is CMD?
Causes the left ventricle to lose detriorate
- most fatal and severe
- most common diagnosis of patients over 65
How does hypertension cause CMD?
↑ arterial pressure = left ventricle hypertropy
- overstretched fibers and pump is less effective
Using ACE-inhibitors, CCB, diuretics, BB
How does CAD cause CMD?
second most cause (!!)
= bad left or/and right ventricle because of injury
How does cardiac arrhythmias cause CMD?
fast or slow HR = impair left and/or right ventricle function
How does renal insuffiency cause CMD?
acute or chronic problems = fluid buildup
Using dieuretics or dialysis to decrease reabsorption of fluid from kidney
How does cardiomyopathy cause CMD?
cardiac muscle fiber’s ability to contract and relax is broken frfr
- primary cause = pathological procress
- secondary cause = systemic disease
What is the leading cause of heart failure and transplants?
cardiomyopathy with 3 main types
What is dilated cardiomyopathy and it’s dysfunction?
BIG VENTRICLES
- systolic dysfunction
What is hypertrophic cardiomyopathy and it’s dysfunction?
WEIRD LEFT VENTRICLE WALL IS THICC
- diastolic dysfunction
What is restrictive cardiomyopathy and it’s dysfunction?
WEIRD LEFT VENTRICLE WALL IS STIFF
- diastolic dysfunction
What are the causes of cardiomyopathy?
Primary:
- inherited
- onset is younger
Secondary:
- medical issue
What are the sx of dilated cardiomyopathy?
- same sx as MI with ↓ ejection fraction
- S3 sounds and mitral valve regurgitation
- crackles and dull when listening
- image = big heart UwU
What are the sx of hypertrophic cardiomyopathy?
- 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
What are the sx of restrictive cardiomyopathy?
↓ CO
fatigue and ↓ exercise ability
systemic edema
Arrhythmias
How does heart valve weirdness and acquired heart disease cause cardiac muscle dysfunction?
weirdness = abnormal
blocked or incapable valves = needing heart to contract more
associated w/ myocardial dilation and hypertrophy
What are some common surgeries to assist with valve weirdness?
valve replacement
valvuloplasty
valvulotomy
commissurotomy
How does pulmonary hypertension cause CMD?
defined by mean pulmonary artery pressure
abnormal = greater than 25
- COPD = greater than 20
How does pulmonary embolism cause CMD?
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
How does age-related changes cause CMD?
↓ CO by changing contract and relax of heart muscle
higher chance of:
- heart disease
- hypertension
- other pathological processes
- congential heart disease - embryonic
How does contractility affect heart failure?
length and tension of cardiac muscle is curvelinear
- tension proportional to length
What is optimized during ventricular stretching regarding the myocardium stretch?
During filling, there needs to be overlap of the actin and myosin = increased cross bridging and more force
What are the normal limits of an intact heart?
- 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)
What is indicated by the frank-starling mechanism?
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
Why is the frank-starling law length dependent?
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
How does cardiac contractility affect heart failure?
when impaired - contraction is as problem (systolic problem)
- there is a reduction of muscle mass
- increase likelihood of cardiomyopathies
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
when there is an increase in afterload there is a contraction issue (systolic dysfunction)
- systemic/pulmonary HTN
- aortic or pulmonic valve stenosis = ventricular hypertrophy
What is the consequences of an increase in afterload?
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
How does ventricular dysfunction affect heart failure?
becomes a relaxation dysfunction (diastolic)
- theres more stiffness and hypertrophy)
- mycocardial disease or even MI
- Mitral or tricuspid valve stenosis
- pericardial disease
Common contributing etiologies
Hypertension
Increase in arterial pressure
= L ventricular hypertrophy
= overstresed contractile fibers
= less effective pump
#1 cause
Common contributing etiologies
CAD/ischemia/MI
damange to the left ventricle
= less effective pump
#2 cause
Common contributing etiologies
Cardiac dysrhythmias
bad timing changes ventricular function and how it empties properly
Common contributing etiologies
Renal insufficiencies
Fluid overload
Common contributing etiologies
Valve abnormalities
leads to either:
increase in aterial pressure or increase EDV
Common contributing etiologies
Chronic pericardial effusion
heart wall can’t contract properly
Common contributing etiologies
Pulmonary embolism
increase pulmonary artery pressures
increased work right ventricle
Common contributing etiologies
Pulmonary HTN
chronic increase in pulmonary artery pressure
increased afterload right ventricle
How does a left ventricle pathology lead to HF?
What are the hallmark sx?
Decrease of CO and blood build up in the left atrium
= pulmonary and peripheral congestion
dyspnea and cough
How does a right ventricle pathology lead to HF?
What are the hallmark sx?
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)
How does biventricular pathology lead to HF?
What are the hallmark sx?
acute exacerbations are both ventricles
- left overloads = pulmonary edema
- right overload = systemic congestion
What is the functional pathology regarding heart failure with reduced ejection fraction on the left ventricle?
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
What does left sided failure tends to show?
show more pulmonary congestion
What does a HFpEF > 50% EF indicate?
Decreased ability to accomodate for the heart
= increase in HR and BP
What does a HFrEF < 40% EF indicate?
We see lower BP
What does right sided failure tend to show?
show more peripheral congestion
What is compensated heart failure?
who’s been diagnosed with HR but NO signs of pulmonary or peripheral congestion
- NYHA I-III
- ACC/AHA stages A-C
What is an acute uncompensated heart failure?
Presence of new or worsening sx/symptoms of dyspnea, fatigue or edema = hospitalization or unscheduled medical care
What are the signs of increased congestion?
edema
dyspnea
weight gain
angina
exercise tolerance
How is renal function affected by heart failure?
decreased CO = retention of fluids and sodium
- extra work load and poorly perfused with O2 blood
How is pulmonary function affected by heart failure?
more fluid in the lungs = impairment of gas exchange
- increase in pulmonary capillar wedge pressure = damage = global respiratory impairment
How is hepatic function affected by heart failure?
too much fluid clogs the hepatic vein
- bad perfusion to hepatic tissue = liver cirrhosis
How is skeletal muscle dysfunction affected by heart failure?
fluid overload = more weight on limbs
bad perfusion
type I & II atrophy
Poor exercise tolerance
How is pancreatic function affected by heart failure?
decreased blood flow to the pancreas
impairment of insulin secretion
decreased energy metabolism from glucose = heart needs to work = the worse cycle for it
What are some examples of managemeent for CHF?
Lifestyle changes
Pharmacologic
Mechanical management
surgical managemeent
dialysis for fluid management
What are some medicine possibly taken for CHF?
Diuretics
ACE inhibitors
MRAs
Beta-blockers
What are some mechanical management for CHF?
plantable defibrillators and/or pacemakers
cardiac resynchronization therapy
assisted circulation - IASP (intraaortic ballon pump)
LVAD and Impella
What are some surgical managment for CHF?
repairing or replacing faulty valves
transplant
CABG since CAD leads to CHF
What are we looking for in our PT exam?
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?
What are the effects of rehab that have heart failure?
Reduces hospitalizations and improve the quality of life
BUT has no effect on mortality
What is the recommended exercise prescription for heart failure patients?
Dosing (40-80% ; RPE 6-20)
Frequency (1-3x a week)
Mode (aerobic or aerobic and resistance)
Delivery (exercise only or comprehensive)
What are the benefits of exercise for HF?
Improved:
- exercise tolerance
- coronary artery flow and prevention from ischemia
- life in general
How are we able to keep HF patients safe during treatment?
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
How are we conducting resistance training for patients with HF?
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
What are the ACSM guidelines for heart failure?
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
What are the implications we are looking for with HF patients?
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
What is life’s simple 7?
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
What is indicated with a MID score for diet in LS7?
Associated with lower HF probability
What is indicated when trying to prevent HF in LS7 through clusters?
2 idea scores in:
- BMI and glucose
- smoking and glucose
- PA and smoking
= lower risk of HF
What is indicated when trying to prevent HF in LS7 through clusters of 3?
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
How much does an MID lifestyle in the LS7 affect the risk for HF?
HF risk reduction of 47%
What is added to LS7 to make it LS8?
Sleep was added
What are some examples to assist with education for patients with HF?
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
