Chronic Heart Failure

Question 1

NYHA stands for?

Answer 1

New York Heart Association

Question 2

NYHA Class I (Limitation, symptoms, VO2, MET & W)

Answer 2

Patients without limitation of physical activity. Ordinary activity does not cause symptoms.
- VO2max >20 mL/kg/min
- MET >6
- Intensity >100 W

Question 3

NYHA Class II (Limitation, symptoms, VO2, MET & W)

Answer 3

Patients with slight limitation of physical activity. Comfortable at rest, but symptoms during moderate physical activitiy.
- VO2max 15-20 mL/kg/min
- MET 4-6
- Intensity 60-100 W

Question 4

NYHA Class III (Limitation, symptoms, VO2, MET & W)

Answer 4

Patients with marked limitation of physical activity. Minor activities result in symptoms.
- VO2max 10-15 mL/kg/min
- MET 3-4
- Intensity 30-60 W

Question 5

NYHA Class IV (Limitation, symptoms, VO2, MET & W)

Answer 5

Patients with severe limitations of physical activties, Symptoms present at rest.
- VO2max <10 mL/kg/min
- MET <3
- Intensity <30 W

Question 6

For who is the CHF guidelines? (4)

Answer 6

• Patients referred by the cardiologist
• Patients who have been hemodynamically stable for 3 weeks (BP + HR)
• NYHA class II & III
• Patients with optimized medication regime

Question 7

What are contra-indications for participation in training program? (10 out of 19)

Answer 7

• Progressive increase in heart failure symptoms
• Severe ischemia of the cardiac muscle upon exertion
• Dyspnea while speaking
• Respiratory frequency >30 breaths per min
• HR at rest >110 bpm
• VO2max <10 mL/kg/min
• Ventricular tachycardia upon increasing exertion
• Poorly controlled DM (in consult with internal medicine specialist)
• Fever
• Acute systemic diseases

Question 8

What are contra-indications for participation in training program? (9 out of 19)

Answer 8

• Recent pulmonary embolism (<3 months ago) causing severe hemodynamic strain
• Thrombophlebitis
• Acute pericarditis or myocarditis
• Hemodynamically serious aortic stenosis or mitral valve stenosis
• Heart valve failure constituting an indication for surgical intervention
• Myocardial infarction <3 weeks before training
• Atrial fibrillation with rapid ventricular response at rest >100 bpm
• Serious cognitive problems (memory, attention and concentration)
• Weight gain of >3 kg within a ew days, with or w/o increase dyspnea at rest

Question 9

Physical therapist should keep an eye on?

Answer 9

• The patient’s training intensity
• Observe their individual response
• The way they tolerate the exercise load
• Their clinical stability
• Check whether the patient shows any signs of excessive strain (monitoring)

Question 10

What needs to measured in all patients before, during and after the training program?

Answer 10

• Blood pressure
• Fatigue (Borg RPE scale 6-20)
• Heart rate (and heart rhythm)

Question 11

The exercise session should be terminated when..

Answer 11

..severe fatigue or dyspnea out of proportion to the level of exertion occurs
..increase in breathing rate out of proportion to the level of exertion occurs
..low pulse pressure (<10 mmHg) occurs
..reduction of systolic blood pressure during exercise (>10 mmHg)
..increasing ventricular or supraventricular arrhythmias
..angina
..vegetative reactions like dizziness or nausea