Congestive Heart Failure CAT Flashcards

1
Q

Why does CHF occur?

A
  • 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
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2
Q

How does the heart respond to loss of function?

A

It uses compensatory mechanisms which results in increased blood volume, cardiac filling pressure, heart rate, and cardiac muscle mass

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3
Q

Etiology of CHF

A
  • Not an independent disease
  • Symptom of pathology in the heart muscle or cardiac valves
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4
Q

Where does the injury to the heart take place in CHF?

A

Right-sided, left-sided, or both

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5
Q

What does the injury to heart tissue in CHF lead to?

A

Abnormal retention of fluids and diminished blood flow causes further stress and injury to the system

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6
Q

What pathologies contribute to CHF?

A
  • Arrhythmia
  • Pulmonary embolism
  • Hypertension
  • Valvular heart disease
  • Myocarditis
  • Unstable angina
  • Renal failure
  • Medication-induced problems
  • High salt intake
  • Severe anemia
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7
Q

Clinical presentation with CHF early on

A
  • Tachycardia
  • Venous congestion
  • High catecholamine
  • Impaired cardiac output
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8
Q

Clinical presentation for CHF (left-sided)

A
  • Signs of pulmonary venous congestion
  • Diagnoses such as left ventricular infarction, aortic or mitral valve disease, and hypertension create pulmonary congestion
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9
Q

Clinical presentation for CHF (right-sided)

A

Signs of systemic venous congestion

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10
Q

Lab values and imaging associated with CHF

A
  • Urinalysis
  • CBC count (electrolyte, thyroid stimulating hormone, blood urea nitrogen, serum creatinine levels)
  • Chest x-ray
  • ECG
  • Electrocardiogram
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11
Q

Additional findings with CHF

A
  • Fluid accumulation spreads
  • Ankle edema, congestive hepatomegaly, ascites, and pleural effusion occur
  • Leads to right-sided CHF
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12
Q

Later stages of CHF are characterized by __

A

Symptoms of low cardiac output

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13
Q

Medical management of CHF

A
  • 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
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14
Q

Role of physical therapy in managing CHF

A
  • Improve general conditioning and mobility
  • Improve exercise tolerance
  • Education on disease process
  • Walking is common starting point
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15
Q

Long-term outcomes associated with CHF

A
  • Can live w/ CHF, and can expect improved endurance and strength with PT
  • PT will not cure CHF or its cause
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16
Q

Prognosis for CHF

A
  • Poor
  • Ability of the heart to contract and relax progressively worsens and eventually fails
17
Q

Most significant predictors of mortality

A
  • 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
18
Q

Cor pulmonale

A
  • 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