Congestive Heart Failure CAT Flashcards
Why does CHF occur?
- The heart can no longer meet the metabolic demands of the body
- The heart can’t pump enough blood due to insufficient/defective cardiac filling or impaired contraction and emptying of the heart
How does the heart respond to loss of function?
It uses compensatory mechanisms which results in increased blood volume, cardiac filling pressure, heart rate, and cardiac muscle mass
Etiology of CHF
- Not an independent disease
- Symptom of pathology in the heart muscle or cardiac valves
Where does the injury to the heart take place in CHF?
Right-sided, left-sided, or both
What does the injury to heart tissue in CHF lead to?
Abnormal retention of fluids and diminished blood flow causes further stress and injury to the system
What pathologies contribute to CHF?
- Arrhythmia
- Pulmonary embolism
- Hypertension
- Valvular heart disease
- Myocarditis
- Unstable angina
- Renal failure
- Medication-induced problems
- High salt intake
- Severe anemia
Clinical presentation with CHF early on
- Tachycardia
- Venous congestion
- High catecholamine
- Impaired cardiac output
Clinical presentation for CHF (left-sided)
- Signs of pulmonary venous congestion
- Diagnoses such as left ventricular infarction, aortic or mitral valve disease, and hypertension create pulmonary congestion
Clinical presentation for CHF (right-sided)
Signs of systemic venous congestion
Lab values and imaging associated with CHF
- Urinalysis
- CBC count (electrolyte, thyroid stimulating hormone, blood urea nitrogen, serum creatinine levels)
- Chest x-ray
- ECG
- Electrocardiogram
Additional findings with CHF
- Fluid accumulation spreads
- Ankle edema, congestive hepatomegaly, ascites, and pleural effusion occur
- Leads to right-sided CHF
Later stages of CHF are characterized by __
Symptoms of low cardiac output
Medical management of CHF
- Based on the root cause of heart failure
- Use of diuretics, nitrates, cardiac glycosides, analgesics, and angiotensin-converting enzyme inhibitor agents
- Be aware of the potential side effects
Role of physical therapy in managing CHF
- Improve general conditioning and mobility
- Improve exercise tolerance
- Education on disease process
- Walking is common starting point
Long-term outcomes associated with CHF
- Can live w/ CHF, and can expect improved endurance and strength with PT
- PT will not cure CHF or its cause
Prognosis for CHF
- Poor
- Ability of the heart to contract and relax progressively worsens and eventually fails
Most significant predictors of mortality
- Decreasing left ventricular ejection fraction
- Worsening NYHA functional status
- Degree of hyponatremia
- Decreasing peak exercise oxygen uptake
- Decreasing hematocrit
- Widened QRS on ECG
- Chronic hypotension
- Resting tachycardia
- Renal insufficiency
- Intolerance to conventional therapy
- Refractory volume overload
Cor pulmonale
- Right sided heart failure
- Consequence of chronic obstructive pulmonary disease
- Sustained hypoxia –> increased pulmonary artery pressure –> R ventricular hypotrophy –> R-sided heart failure
- When R-sided failure occurs, L side does not get enough blood and cannot sustain cardiac output
- NOT CONGESTIVE IN NATURE, NO FLUID BUILDUP IN LUNGS
