Chronic Heart Failure

Question 1

What is chronic heart failure?

Answer 1

An underlying structural abnormality or cardiac dysfunction that impairs the ability of the ventricle to fill or eject with blood

Question 2

What two mechanisms occur following a major cardiac event like a heart attack?

Answer 2

• Walls stretch to hold more blood

- Walls thicken to pump more strongly

Question 3

List and describe the types of heart failure.

Answer 3

• Diastolic heart failure - inability to fill at a normal capacity, ejection fraction does not change
• Systolic heart failure - decreased ejection fraction
• Right sided heart failure - secondary to acute or chronic heart failure, right ventricle volume overloads, flattened septum, compressed left ventricle

Question 4

What are the main mechanisms for chronic heart failure?

Answer 4

CAD and atherosclerosis

Question 5

What are the two types of acute myocardial infarction?

Answer 5

STEMI - ST elevation myocardial infarction

NSTEMI - Non ST elevation myocardial infarction (ischemia)

Question 6

What are the three different types of causes of heart failure?

Answer 6

• Hypertrophic cardiomyopathy (increase wall thickening in LV)
• Dilated cardiomyopathy (Dilated LV, “balloon”)
• Restrictive cardiomyopathy (increase in thickening of LV and decrease in LV chamber) “stiff”

Question 7

What is Dilated cardiomyopathy specifically?

Answer 7

Enlargement of heart chambers, depressed systolic function

Question 8

What is hypertrophic cardiomyopathy specifically?

Answer 8

Excessive thickening of chambers, diastolic ability affected

Question 9

What is restrictive cardiomyopathy specifically?

Answer 9

Restricted ability to fill heart, due to stiffness (decreased diastolic)

Question 10

What is the NYHA classifications for heart failure?

Answer 10

• Class I, Mild HF – no limit on PA, ordinary PA does not cause discomfort, undue fatigue, palpitations, or shortness of breath
• Class II, Mild HF – slight limitations on PA, comfortable at rest but ordinary PA results in fatigue, palpitations, or SOB
• Class III, Moderate – marked limitations on PA, comfortable at rest but less than ordinary activity causes fatigue, heart palpitations or SOB
• Class IV, Severe HF – unable to carry on any PA, symptoms of CHF at rest

Question 11

What is abnormal ejection fraction in HF?

Answer 11

<40% (heart failure), 40-50% (heart damage but not failure)

Question 12

What are some symptoms of HF?

Answer 12

• SOB
• Ankle swelling (weight gain)
• Loss of appetite
• Tiredness
• Chest pain

Question 13

What are some common medications for this population?

Answer 13

• ACE inhibitors
• ARBs
• Calcium channel blockers
• Beta blockers
• Diuretics
• Nitrates
• Statin
• Anti-coagulants

Question 14

What is the best way to do an exercise stress test?

Answer 14

Ramp protocol, Naughton of modified Bruce

Question 15

True or false, building muscle will improve oxygen flow?

Answer 15

True! oxygen is starved in this population so building muscle will improve it’s flow

Question 16

What are contraindications to exercise in this population?

Answer 16

Relative contraindications
-1.5-2kg increase in weight over 3-5 days
-Abnormal response in BP
-NYHA IV
-Ventricular arrhythmia at rest
-Recent embolism
-Resting supine HR >100bpm
Absolute contraindications
-Unstable heart failure over 2-4 days
-Recent embolism
-Active pericarditis
-Third degree heart block