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KIN 187 Clinical Exercise Physiology > Chap 5. Chronic Heart Failure > Flashcards

Chap 5. Chronic Heart Failure Flashcards

1
Q

Exercise response to chronic heart failure

A

Alterations in central/peripheral and ventilatory abnormalities

  • reduction of cardiac output
  • leg fatigue due to inadequate blood flow
  • altered catecholamine levels
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2
Q

Central abnormalities

A
  • systolic dysfuction
  • pulmonary hemodynamics
  • diastolic dysfunction
  • neurohumoral mechanisms
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3
Q

Peripheral Abnormality

A
  • Blood flow abnormalities
  • vasodilatory capacity
  • skeletal muscle biochemistry
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4
Q

Ventilatory Abnormality

A 
Pulmonary pressure 
Physiologic dead space
Ventilation-perfusion mismatch 
Respiratory contro 
Breathing patterns
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5
Q

Ventilatory Inefficiency

A 
VE/VCO2 slope 
V02 Kinetics 
Ventilatory Threshold
VO2 in recovery 
Exercise periodic (oscillatory) breathing during exercise
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6
Q

An increase in VCO2

A 
Ventilatory/perfusion mismatching
Early lactate accumulation
Deconditioning
Hyperventilation
CHF patients have a higher slope (VE/VCO2) than normal subjects
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7
Q

Exercise Testing considerations for CHF (VE/CO2)

A

VE/VCO2 slope ≥34 indicates poor prognosis

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8
Q

HR (exercise test conditions)

A

20-30% of CHF patients have chronotropic incompetence
it is associated with decreased myocardial beta receptor sensitivity (HRpeak should exceed ≥80% of age predicted HRreserve)

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9
Q

BP (exercise test conditions)

A

may be low or fail to rise due to LV dysfunction, afterload reducing medications or both

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10
Q

VO2peak (exercise test conditions)

A

inversely related to mortality <18ml/kg/min or significant drop with testing is a concern

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11
Q

Other exercise testing conditions

A
  • Atrial/ventricular arrhythmias, bundle branch block

- Left ventricular hypertrophy

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12
Q

Exercise Programming (CHF)

A
  • Referral to cardiac rehabilitation
  • Follow basic recommendations
  • Re-evaluate frequently
  • Pro-long warm-up and cool-down
  • Perceived exertion and dyspnea scales should take precedence over heart rate targets
  • Isometric exercises should be avoided
  • Electrocardiogram monitoring is required for persons with a history of ventricular tachycardia, cardiac arrest (sudden cardiac death), and exertional hypotension
  • resistance training appears safe in persons with HRrEF
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13
Q

Systolic Heart Failure

A
  • Less blood pumped out of ventricles

- Weakened heart muscle can’t squeeze as well

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14
Q

Diastolic Heart Failure

A

Less blood fills the ventricles

Stiff heart muscle can’t relax normally

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15
Q

Left Side Heart Failure

A

Failure to properly pump out blood to the body (Systolic and diastolic fall under this category)

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16
Q

Right Side Heart Failure

A

back-ups in the area that collects ‘used’ blood

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17
Q

CHF occurs when

A 
cardiac output is reduced 
systolic dysfunction (impairment of left ventricle)
diastolic dysfunction (due to resistance to filling of one or both ventricles)
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18
Q

Most common cause of CHF

A

coronary artery disease, HTN and myocardial infarction

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19
Q

Pathophysiology of Heart Failure

A

Impaired Contractility
Increased afterload
both lead to reduced ejection fraction then heart failure

Impaired diastolic filling leads to preserved ejection fraction

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20
Q

Heart failure with preserved ejection fraction

A

aortic stenosis

hypertension due to increased diastolic filling and compensatory ventricular hypertrophy

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21
Q

Pathophysiology of CHF

A

Myocardial Injury –>reduced Cardiac Output—->decrease in carotid baroreceptor stimulation, decrease in renal perfusion—> activation of the SNS and the RAAS—

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22
Q

BNP

A

secreted by the ventricles in response to excessive stretching of cardiomyocytes
decrease TPR and central venous pressure

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23
Q

ANP

A

Secreted by atria in response to high blood volume

decrease TPR and central venous pressure

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24
Q

Vasoconstriction increases

A

afterload

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25
Q

Hemodynamic alterations increases

A

preload

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26
Q

SNA

A

has do to with SV and TVC

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27
Q

PNA

A

has to do with HR

28
Q

Adrenal Gland cortex

A

releases aldosterone

29
Q

Angiotension>Angiotension 1

A

Renin

30
Q

Angiotension1>Angiotension2

A

ACE

31
Q

Pituitary Gland

A

ADH secretion (vassopressin)

32
Q

Regulation of Stroke Volume

A

EDV
Aortic Blood Pressure
Contractility

33
Q

Contractility refers to

A

the strength of the ventricular contraction

34
Q

Stroke Volume vs afterload

A

decreasing graph

35
Q

Stoke volume vs EDV

A

increasing

Higher values of EDV if there is greater contractility

36
Q

Coronary Artery Disease

A

CAD
Build up of plaque in the coronary arteries
Leads to ischemia and heart attack
The most common cause of death

37
Q

Ischemia

A

limited blood flow to the heart

38
Q

Risk factors of CAD

A

High LDL, Low HDL, Hypertension, family history, diabetes, smoking, obesity, etc

39
Q

Medical treatment for CAD

A

Angioplasty/coronary stent
Coronary bypass grafting
Medicines: beta-blockers, anti platelet drugs, calcium channel blockers, statins (lower cholesterol)

40
Q

Balloon Angioplasty

A

minimally invasive,

widens the arteries, deflated balloon goes through catheter and then you inflate it

41
Q

Coronary Stent

A

stent uses balloon to widen the artery and compress the plaque

42
Q

Myocardial Infarction

A

Occurs when the blood flow stops to a part of the heart causing damage to the cardiac muscle
Most commonly happens due to CAD

43
Q

Pathophysiology of MI

A

Atherosclerotic plaque
Inflammation: high sensitivity C-reactive protein (hs-CRP), calcification from calcium deposit as a part of plaque formation (can see this in CT scans)

44
Q

Elevated CRP

A

predicts the risk of MI and stroke

45
Q

CRP

A

c reactive protein

synthesized by the liver in response to factors released by macrophages and adipocytes

46
Q

A heart (CT) scan

A

can show calcification (bright white spots on the CT scan)

47
Q

Signs of a myocardial infarction

A

Discomfort in the center of the chest that lasts more than a few minutes (or goes away and comes back)
Uncomfortable pressure, squeezing, fullness or pain
pain/discomfort in arms, back, neck, jaw or stomach
Shortness of breath with or without chest discomfort
Breaking out in cold sweat, nausea or lightheadedness

48
Q

True positive

A

positive exercise test and CVD

49
Q

False Negative

A

negative exercise test and CVD

50
Q

False Positive

A

Positive exercise test and no CVD

51
Q

True Negative

A

Negative exercise test and no CVD

52
Q

Alpha receptor blockers (exercise)

A

significantly lower BP

Minimal effects on HR and metabolic responses to exercise

53
Q

CNS active drugs (exercise)

A

ex. clonidine, guanfacine, guanabenz

attenuating effects on HR and BP during exercise

54
Q

Calcium Channel Blockers (exercise)

A

some may decrease HR response at rest and during exercise

55
Q

Vasodilators, ACE inhibitors and angiotensin receptor blockers (exercise)

A

do not effect HR response

patients might experience hypotension

56
Q

Beta-Blockers (exercise)

A

decreased submax and max hr

sometimes decreased exercise capacity

57
Q

In Patient aerobic prescription (CAD and MI)

A

first 2-4 times/day for the 1st 3 days in the hospital
then 2 times/day beginning day 4 in hospital
to tolerance of intensity if they are asymptomatic (RPE ≤13 on 6 - 20 scale)
Post-MI/CHF: HR ≤120 bpm or HRrest +20 bpm
Postsurgery: HRrest +30 bpm
bouts of 3-5 min
rest=slower walk
2:1 exercise/rest ratio
progress to 10-15 min

58
Q

Aerobic Prescription (CAD and MI)

A 
4-7 days/wk
multiple short bouts of 1-10 min
RPE 11 to 16 (6 – 20 scale)
40 to 80% HRR or VO2R
HR below ischemic threshold
Warm up 5-10 min and then 20-60 min workout 
to toleration
59
Q

Muscular Strength/endurance prescription(CAD and MI)

A

3-4 days /wk
2-4 sets; 12-15 reps; 8-10 various exercises
take as much time as needed
functional movements, circuit training, avoid straining and holding breath

60
Q

Effects of exercise training

A

increased maximal oxygen consumption
improved ventilatory response
improved anaerobic and ventilatory threshold
relief of angina
modest decreases in bw, fat stores, bp, total cholesterol, serum triglycerides and LDL
Increases in HDL
Improved psychosocial well-being and self-efficacy
Protection against triggering MI by vigorous physical exertion
Decreased coronary inflammatory markers
increases numbers of endothelial progenitor cells and cells that promote angiogensis and vascular regeneration
Increased vagal tone and decreases adrenergic activity

61
Q

Neurohumoral effects of exercise

A

decrease in norepinephrine, decrease in vasopressin, decrease in ang 2, decrease in aldostersone

62
Q

Musculature effects of exercise

A

increase oxidative enzymes, increase mitochondria content, increase IGF-1. decrease proinflammatory cytokines, decrease oxidative stress

63
Q

Inflammatory response of exercise

A

decrease in iNOS, TNF, IL-1B, IL-6, IL-10, CD4OL, P-selectin, GM-CSF, MCP-1, ICAM-1, VCAM-1

64
Q

Cardiac Function effects of exercise

A

Increase Ca2+ sensititvity

Decrease myocyte contractility, improved hemodynamic, restoration of IP

65
Q

Vasculature effects of exercise

A

increase in eNOS, NO, SOD, Endothelial function

Decrease in ROS, Oxidative Stress

66
Q

Vascular reflex effects of exercise

A

increase of arterial baroreceptors, decrease in chemoreceptors

67
Q

Nervous System effects of exercise

A

Decrease in Ang 2, decrease in AT1, decrease in ROS, increase in NO, decrease SNA, Increase in vagal activity

KIN 187 Clinical Exercise Physiology (16 decks)

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