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775 Quiz 2 > Chronic Heart Failure > Flashcards

Chronic Heart Failure Flashcards

1
Q

How does exercise training reduce peripheral resistance?

A
  • Decreases circulating catecholamine levels therefore causing an anti-inflammatory and antioxidative effect
  • Decreases natriuretic peptide concentrations therefore increasing shear stress and Nitric oxide formation
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2
Q

How could aerobic training increase LVEF?

A

Improve: preload, myocardial contractility and augmented vascular reserve

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3
Q

Is LV remodelling possible through exercise in stable HF patients?

A

Yes

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4
Q

What is a major problem in all HF patients when it comes to exercising?

A

Adherence

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5
Q

What mode is preferred in HF patients?

A

Cycling - because of the reproducible power output, the possible low workloads and reduced injury rate.

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6
Q

What is now accepted as the limit for prolonged aerobic exercise without additional risk for patients with HF?

A

VT - (65–90% of VO2peak)

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7
Q

True or False: HF patients with significantly reduced pre-training VO2peak and/or high exercise-related risks, aerobic training intensities as low as 40% of VO2peak is effective

A

True

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8
Q

True or False: The risk of a cardiovascular event is low after both high-intensity exercise and moderate-intensity exercise in a cardiovascular rehabilitation setting.

A

True

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9
Q

Why is sustained maximal isometric exercise contraindicated in HF patients?

A

Because of the excessive rise in blood pressure and the lowering of the stroke volume.

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10
Q

Patients with HF with preserved ejection fraction (HFPEF) present a combination of:

A

Systolic and diastolic abnormalities

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11
Q

HF with preserved ejection fraction is primarily due to:

A
  • Reduced cardiac output, secondary to an inability to increase the end-diastolic and stroke volume via the Frank–Starling mechanism
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12
Q

What 2 factors contribute significantly to the exercise intolerance in HF patients?

A
  1. Reduced arteriovenous oxygen difference

2. Reduced cardiac output

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13
Q

True or False:
The arteriovenous oxygen reserve is an independent predictor of VO2peak, which strongly suggests that peripheral factors at least partly determine the limited exercise tolerance in these patients

A

True

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14
Q

True or False:
Activities with pronounced arm–shoulder movements should be avoided, especially during the first 2 months after implantation of an ICD.

A

True

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15
Q

Exercise training attenuates:

A
  • Neurohormonal stimulation
  • Production of proinflammatory cytokines
  • Over-expression of natriuretic peptide
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16
Q

True or False:

Symptoms and disease progression in HF does NOT involve alteration of peripheral organs and neurohormonal activation

A

False - It does

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17
Q

What is the HR response in HF patients and what does this lead to?

A
  • Increased at rest, decreased at peak exercise

Leads to a reduction of the chronotropic reserve, because of desensitisation of b-adrenergic receptors.

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18
Q

True or False:

Exercise training has a beneficial effect on the sympathetic nervous system, even in patients receiving a beta-blocker

A

True

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19
Q

True or False:

In HF patients - SV during exercise, increases less than in healthy subjects or, more often, decreases.

A

True

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20
Q

True or False
Interval training programme is NOT associated with a greater improvement in LVEF than a continuous or steady-state programme

A

False - It is

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21
Q

What limits exercise the most in HF patients central or peripheral factors?

A

It is usually the periphery

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22
Q

How does HF affect ventilation?

A

Increase in dead space and Ve/VCO2 slope

Reduces ventilatory efficiency

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23
Q

How does HF contribute to myopathy?

A

Decreased: muscle mass and oxidative muscle metabolism

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24
Q

True or False:
When CO during exercise is increased in patients with severe HF, maximal VO2 increases minimally because arteriovenous oxygen difference does not increase in parallel

A

True

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25
Q

What are the key phenomenon in the blunted vasodilatory response to exercise in CHF patients

A

Abnormalities in endothelium- and flow-dependent vasodilatation

26
Q

How does exercise training reduce peripheral resistance in HF patients?

A

Improves both basal endothelial nitric oxide formation and agonist-mediated endothelium-dependent vasodilation

27
Q

Muscle atrophy occurs because of:

A

Malnutrition, deconditioning

and the toxic action of cytokines

28
Q

How does exercise training increase muscle capacity?

A

By increases in:

  • myofibril cross-sectional area
  • mitochondrial density
  • volume density of cytochrome c oxidase-positive mitochondria
  • capillary density
29
Q

True or false:
A higher intensity level of exercise training (70% of peak VO2 ) seems to be necessary to obtain a significant reshift to type I fibre, with a
significant increase in type I fibre and a significant decrease
in type II fibre.

A

True

30
Q

True or false:
The slope relating ventilation to oxygen uptake (VE/VCO2 slope) is decreased
in chronic HF patients and is a potent prognostic factor.

A

False - It is increased

31
Q

True of false:

Both interval training and continuous training is associated with reverse left ventricular remodelling

A

False - Just interval training had significant LV remodelling

32
Q

CHF is characterised by:

A

Inability of the heart to deliver oxygen to the working tissues (due to systolic and/or diastolic dysfunction)

33
Q

Systolic Dysfunction:

A

Impaired ventricular CONTRACTION because of the loss of myocardium (from infarction) or loss of CONTRACTILITY.

34
Q

Diastolic Dysfunction:

A

Impaired ventricular FILLING, increased diastolic pressure and reduced COMPLIANCE

35
Q

4 main central haemodynamic changes in CHF include:

A
  1. Decreased CO during exercise or rest
  2. High LV diastolic pressure
  3. Ventricular volume overload
  4. Elevated pulmonary and central venous pressure
36
Q

Hallmark signs and symptoms of CHF:

A

Fatigue, dyspnea and reduced exercise tolerance

37
Q

Hyperventilation and early onset of fatigue in individuals with CHF is largely due to:

A

Inadequate BF to the working muscles as well as an early accumulation of lactate in the blood at low work rates

38
Q

Contractility is reduced in CHF because:

A

Elevated levels of catecholomines and less sensitive beta-adernergic receptors alter normal inotropic regulation of the heart.

39
Q

How is exercise capacity affected by abnormal skeletal muscle abnormalities?

A
  • Reduced mitochondrial enzyme activities
  • Reduced Type 1 aerobic fibres, more Type 2 fibres
    These cause glycolysis, reduced oxidative phosphorylation and greater metabolic acidosis
40
Q

True or False:

Improvements in exercise capacity are due to cardiac changes not peripheral adaptations in patients with CHF?

A

False - Mainly because of peripheral adaptations ( improvements in muscle metabolism, endothelial function, vasodilation capacity and CO)

41
Q

CHF is managed in two ways:

A

1: Identify cause (eg stenosis, HTN)
2: Reduce overload with drugs

42
Q

Why are diuretics prescribed for CHF patients?

A

To reduce salt and water retention

43
Q

What drugs would reduce after-load?

A

ACE inhibitors and Vasodilators

44
Q

How do B-Blockers help patients with CHF?

A

Slows the sympathetic system therefore reduces the risk of damage to the failing heart due to adernergic stimulation

45
Q

How does medication differ between diastolic and systolic dysfunction?

A

Diastolic doesn’t need positive inotropic drugs, but CCB’s help with ventricular realxation and increase EDV, therefore increase functional capacity.

46
Q

ICD’s and CRT are used in CHF to:

A

Synchronise left and right ventricular contraction (to increase CO)

47
Q

Why is the CPX information more helpful compared to the ECG during testing?

A
  • Can see gas exchange in response to exercise
  • quantify exercise tolerance
  • may be able to identify pathophysiological abnormalities that limit exercise capacity
48
Q

How are CPx values different during exericse in CHF patients compared to healthy people?

A 
Lower CO
Peripheral vascular resistance is high 
High ventilation
Decreased EF, SV 
Exertional hypotension
49
Q

Considerations to exercise testing in CHF:

A

Symptoms come on at lower MET levels (usually

50
Q

True or False:

Target HR should be used as a criteria to terminate exercise testing

A

False - Should focus on haemodynamic responses and standard termination criteria

51
Q

Modes of testing recommended in CHF:

A

Cycle (ramp - 10-15 W increments)
6MWT
Functional test similar to ADL’s

52
Q

Exercise Recommendations for CHF:

A

Aerobic:
Large muscle activities 40-70% VO2peak, 4-7 days/week, 20-60min a session or broken up in smaller bouts

RT:
Circuit, High reps low weight

Flexibility:
2-3 days/week

Functional:
Activity specific

53
Q

What causes HF?

A

It develops after other conditions have damaged or weakened your heart. It can also occur if the heart becomes too stiff.

54
Q

Ejection Fraction is:

A

An important measurement of how well your heart is pumping and is used to help classify heart failure and guide treatment.

55
Q

What is the Ejection Fraction in a healthy heart?

A

50% or more (This means that 50 percent of the blood in the heart is pumped out with each beat)

56
Q

Describe Left-sided heart failure:

A

Fluid may back up in your lungs, causing shortness of breath.

57
Q

Describe Right-sided heart failure

A

Fluid may back up into your abdomen, legs and feet, causing swelling.

58
Q

Systolic heart failure:

A

The left ventricle can’t contract vigorously, indicating a pumping problem.

59
Q

Diastolic heart failure:

A

(also called heart failure with preserved ejection fraction) The left ventricle can’t relax or fill fully, indicating a filling problem.

60
Q

How can CAD lead to HF?

A

A heart attack occurs if plaques formed by the fatty deposits in your arteries rupture. This causes a blood clot to form, which may block blood flow to an area of the heart muscle, weakening the heart’s pumping ability and leaving permanent damage.

61
Q

How can HTN lead to HF?

A

If your blood pressure is high, your heart has to work harder than it should to circulate blood throughout your body.

Over time, the heart muscle may become thicker to compensate for the extra work it must perform. Eventually, your heart muscle may become either too stiff or too weak to effectively pump blood.

62
Q

How can abnormal heart rhythms (heart arrhythmias) lead to HF?

A

It may cause your heart to beat too fast, which creates extra work for your heart. Over time, your heart may weaken, leading to heart failure. A slow heartbeat may prevent your heart from getting enough blood out to the body and may also lead to heart failure.

775 Quiz 2 (5 decks)

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