Congestive Heart Failure

Question 1

What does cardiac muscle dysfunction lead to/impair?

Answer 1

Pulmonary edema

Impairs hearts ability to pump blood and/or the ventricles ability to accept blood

Question 2

What is the most common cause of CHF?

Answer 2

Left Heart Failure. Usually L ventricle.

Question 3

What is CHF the result of?

Answer 3

Increased fluid in many parts of the body, commonly causes congestion in the pulmonary circulation.

Question 4

What causes R sided CHF?

Answer 4

R ventricle failure d/t pulmonary HTN, PE, R ventricle infart, L heart failure

Question 5

Where does the fluid back up to with R-sided CHF

Answer 5

Fluid backs up to liver, abdomen, LE

Question 6

Common S/S R CHF

Answer 6

May not eat much, weight gain
DISTENDED JUGULAR VEINS. 
Fatigue. 
Dependent edema.
Enlarged liver and spleen.

Question 7

What is L sided CHF caused by? Where does the fluid back up?

Answer 7

L ventricle impairment, and fluid behind L ventricle.

Lungs, liver, abdomen, LE

Question 8

What is the result on the heart of L CHF?

Answer 8

Decreased SV, EDV, EF, cardiac muscle hypertrophy

Question 9

S/S L CHF

Answer 9

Pulmonary Sx (coughing, tacypnea, orthopnea, exertional dyspnea etc)

Question 10

What is low output CHF frequently associated with?

Answer 10

L sided CHF

Question 11

What is low output CHF the result of?

Answer 11

Low cardiac output at rest or during exertion

Question 12

What does low output CHF cause?

Answer 12

Heart unable to pump the minimal amount of blood necessary to support the circulation.

Question 13

What is High Output CHF?

Answer 13

Overload of fluid in the system. (less due to muscle dysfunction like in low output)

Question 14

What is high output CHF usually the result of?

Answer 14

Renal system failure to filter off excess fluid (renal insufficiency or pregnancy). Still have reduced CO.

Question 15

What is systolic heart failure?

Answer 15

Impaired contraction of the ventricles that produces an inefficient expulsion of blood

Question 16

What is diastolic heart failure?

Answer 16

Ventricles unable to accept the blood ejected from the atria. (non compliant tissue, hypertrophy)

Question 17

Things that might cause chronic CHF

Answer 17

CM, congenital, chronic renal insufficiency, aging

Question 18

Things that might cause acute CHF

Answer 18

HTN, CAD, arrythmias, acute renal insufficiency, heart valve abnormalities, PE, pericardial effusion, SCI

Question 19

Hypertrophic Cardiomyopathy (CM)

Answer 19

excessive L ventricle hypertrophy. Thickened myocardium less compliant to filling. Tends to be just on L.

Question 20

Restrictive CM

Answer 20

Marked endocardial scarring of ventricles with impaired diastolic filling and contractile force during systole. Could be L or R.

Question 21

Dilated CM

Answer 21

Ventricular dilation and cardiac muscle contractile dysfunction . “floppy muscle”

Question 22

Ischemic CM

Answer 22

Decreased myocardial perfusion or the result of an MI.

Question 23

What type of heart valve abnormality tends to cause R sided heart failure

Answer 23

Mitral valve stenosis

Question 24

What lab value/medication would you expect from a person who has a mechanical valve replacement?

Answer 24

Anti-coagulant for the rest of life. 2.5-3.5x the normal value. (typically coumadin)

Question 25

What is a pulmonary embolus?

Answer 25

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.

Question 26

how do age related changes relate to PT?

Answer 26

We need to lower intensity of activities, assess ability to tol activity and assess BP. HR is lower in older individuals.

Question 27

How is the liver affected with CHF?

Answer 27

increased congestion in venous circulation, so inc. pressure at the portal vein damaging the liver. Prevents blood from LE from returning to the

Question 28

How is the renal system affected with CHF?

Answer 28

Kidney read dec blood flow, retains more sodium and fluid, more fluid than the heart can handle goes to the heart.

Question 29

How is CHF treated?

Answer 29

Dietary changes (less salt and fat)
Drugs (control fluid, BP, or supp O2)
Intra-aortic balloon pump
Orthotopic heart transplant
dialysis
LVAD

Question 30

What tests/labs might you look at with CHF?

Answer 30

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)

Question 31

What are some things you might ask about in the interview?

Answer 31

Orthopnea, PLOF, Onset of Sx

Question 32

What might you observe?

Answer 32

Activity tolerance! peripheral edema, JVD*, RPE.

HR/Rhythm/Sounds (S3 hallmark)

Question 33

Goals/decisions for D/C planning

Answer 33

Activity tolerance! (measurable), equipment, D/C location, Therapy recs.

Question 34

What position do you want the pt in during exercise?

Answer 34

Erect. (standing/sitting) to reduce preload, but cant leave too long cuz peripheral edema

Question 35

What kind of PT intervention for end stage LHF?

Answer 35

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)

Question 36

What kind of PT intervention for Mild to Moderate CHF?

Answer 36

Limited exercise tolerance.

Low intensity aerobic program.(walking program based on RPE) Maybe even just AROM, depending.

Question 37

What are the important parts of education?

Answer 37

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.

Question 38

What must the CHF be to be safe for aerobic training?

Answer 38

Compensated (medically managed)

Question 39

With PT what must you be monitoring with the pt.

Answer 39

BP/HR/RR/O2 sat

Auscultation