Congestive Heart Failure Flashcards
What does cardiac muscle dysfunction lead to/impair?
Pulmonary edema
Impairs hearts ability to pump blood and/or the ventricles ability to accept blood
What is the most common cause of CHF?
Left Heart Failure. Usually L ventricle.
What is CHF the result of?
Increased fluid in many parts of the body, commonly causes congestion in the pulmonary circulation.
What causes R sided CHF?
R ventricle failure d/t pulmonary HTN, PE, R ventricle infart, L heart failure
Where does the fluid back up to with R-sided CHF
Fluid backs up to liver, abdomen, LE
Common S/S R CHF
May not eat much, weight gain DISTENDED JUGULAR VEINS. Fatigue. Dependent edema. Enlarged liver and spleen.
What is L sided CHF caused by? Where does the fluid back up?
L ventricle impairment, and fluid behind L ventricle.
Lungs, liver, abdomen, LE
What is the result on the heart of L CHF?
Decreased SV, EDV, EF, cardiac muscle hypertrophy
S/S L CHF
Pulmonary Sx (coughing, tacypnea, orthopnea, exertional dyspnea etc)
What is low output CHF frequently associated with?
L sided CHF
What is low output CHF the result of?
Low cardiac output at rest or during exertion
What does low output CHF cause?
Heart unable to pump the minimal amount of blood necessary to support the circulation.
What is High Output CHF?
Overload of fluid in the system. (less due to muscle dysfunction like in low output)
What is high output CHF usually the result of?
Renal system failure to filter off excess fluid (renal insufficiency or pregnancy). Still have reduced CO.
What is systolic heart failure?
Impaired contraction of the ventricles that produces an inefficient expulsion of blood
What is diastolic heart failure?
Ventricles unable to accept the blood ejected from the atria. (non compliant tissue, hypertrophy)
Things that might cause chronic CHF
CM, congenital, chronic renal insufficiency, aging
Things that might cause acute CHF
HTN, CAD, arrythmias, acute renal insufficiency, heart valve abnormalities, PE, pericardial effusion, SCI
Hypertrophic Cardiomyopathy (CM)
excessive L ventricle hypertrophy. Thickened myocardium less compliant to filling. Tends to be just on L.
Restrictive CM
Marked endocardial scarring of ventricles with impaired diastolic filling and contractile force during systole. Could be L or R.
Dilated CM
Ventricular dilation and cardiac muscle contractile dysfunction . “floppy muscle”
Ischemic CM
Decreased myocardial perfusion or the result of an MI.
What type of heart valve abnormality tends to cause R sided heart failure
Mitral valve stenosis
What lab value/medication would you expect from a person who has a mechanical valve replacement?
Anti-coagulant for the rest of life. 2.5-3.5x the normal value. (typically coumadin)
What is a pulmonary embolus?
Blood clot within the lung resulting in increased pulmonary artery pressures (bloods not flowing). Body increases HR to high rate to try to push out enough oxygenated blood.
how do age related changes relate to PT?
We need to lower intensity of activities, assess ability to tol activity and assess BP. HR is lower in older individuals.
How is the liver affected with CHF?
increased congestion in venous circulation, so inc. pressure at the portal vein damaging the liver. Prevents blood from LE from returning to the
How is the renal system affected with CHF?
Kidney read dec blood flow, retains more sodium and fluid, more fluid than the heart can handle goes to the heart.
How is CHF treated?
Dietary changes (less salt and fat) Drugs (control fluid, BP, or supp O2) Intra-aortic balloon pump Orthotopic heart transplant dialysis LVAD
What tests/labs might you look at with CHF?
CXR Proteinuria (inc BUN & creatinine) O2 sat dec & CO2 inc Electrolyte imbalance (in chronic) BNP (0-99 normal >100 = HF) Troponin I (cut off is .05)
What are some things you might ask about in the interview?
Orthopnea, PLOF, Onset of Sx
What might you observe?
Activity tolerance! peripheral edema, JVD*, RPE.
HR/Rhythm/Sounds (S3 hallmark)
Goals/decisions for D/C planning
Activity tolerance! (measurable), equipment, D/C location, Therapy recs.
What position do you want the pt in during exercise?
Erect. (standing/sitting) to reduce preload, but cant leave too long cuz peripheral edema
What kind of PT intervention for end stage LHF?
formal exercise can deteriorate function – typically do activity to tolerance, leg exercises, walking goal (here to bathroom rest come back) want them moving but not like 30 min/6x week (too much)
What kind of PT intervention for Mild to Moderate CHF?
Limited exercise tolerance.
Low intensity aerobic program.(walking program based on RPE) Maybe even just AROM, depending.
What are the important parts of education?
Weigh daily (> 2 pounds overnight or 5 lbs in week may be holding onto too much fluid), take meds, limit fluids (2L), limit Na+, 30 min aerobic activity per day.
What must the CHF be to be safe for aerobic training?
Compensated (medically managed)
With PT what must you be monitoring with the pt.
BP/HR/RR/O2 sat
Auscultation
