CP Exam 3: CHF

Question 1

What is congestive heart failure?

Answer 1

inability of heart to supply the organs and tissues of the body with sufficient amount of blood

most commonly leading to dyspnea and fatigue

Question 2

What is the major concept behind CHF?

Answer 2

you have a decreased CO that is less than the normal of 4 ml/min

Question 3

What is the more accepted AHA/ACC stages of CHF?

Answer 3

A. pt at high risk for CHF but no structural damage

B. structural damage but no sx

C. Structural damage and DOE like sx but controlled by meds

D. advanced disease requiring in hospital assistance, VAD or cardiac transplant

Question 4

What is NYHA stages of CHF?

Answer 4

Stage 1: no fn. limitations or sx w/ normal activity

2: pt w/ slight sx with ordinary fnxl , comfortable at rest
3: marked limitation w/ any activity, only comfortable at rest
4: any activity brings discomfort and pt has sx at rest

Question 5

What is the most common etiology of CHF?

Answer 5

MI/CAD

not common but can also be idiopathic

Question 6

What is the basics of systolic CHF?

Answer 6

inability of the heart to squeeze out

Question 7

What are the four areas that can cause systolic HF?

Answer 7

1. preload- EDV and fiber length prior to contraction
2. afterload- resistance of flow to ventricular ejection
3. contractility- contractile strength of myocardium
4. chronotropy- rate of contraction, ability to maintain HR

Question 8

What is a hallmark characteristic of SHF?

Answer 8

a dilation or over stretching heart of the left ventricle leading to less contractile force (length tension curve)

Question 9

What does this lead to?

Answer 9

this leads to increased EDV and poor contractility

Question 10

What does EF have to be below to be considered SHF?

Answer 10

below 45%

Question 11

As a result of increased EDV where does the back up blood go into?

Answer 11

1. Lungs (w/left sided)- which decreases BP in systolic, Sx include-fine crackles, DOE, pink sputum, orthopnea
2. Periphery- (right sided)- peripheral edema, jugular venous distension, acites

Question 12

What else can SHF lead to?

Answer 12

1. increased LV pressure- S3 sound

2. decreased resting and exercising SBP

Question 13

What can also happen as a result to SHF that creates a vicious cycle?

Answer 13

baroreceptors at nephron sense low BP and activate RAAS which leads to more water retention, this will then increase preload further stretching the heart and worsening SHF

Question 14

What is diastolic heart failure characterized by?

Answer 14

LV is stiff, decreased compliance of the ventricle

Question 15

What happens as a result of a stiff LV?

Answer 15

inability of ventricle to relax and decrease diastole, decreases space for volume in LV

this leads to loss of SV and CO

Question 16

What are the sx for DHF?

Answer 16

same as SHF but harder to diagnose

Question 17

What is EF with DHF?

Answer 17

EF is preserved b/c you are getting less volume in but you are getting less volume out so percentage stays the same

Question 18

What are characteristics of left CHF?

Answer 18

pressure backs up towards lungs, orthopnea, dyspnea, exercise intolerance, LVEF affected only with systolic

Question 19

In left sided CHF what happens with exercise?

Answer 19

CO may be flat or dropping with increasing activity

Question 20

What are characteristics of right CHF?

Answer 20

pressure backs up toward periphery, JVD, peripheral edema, ascities, dyspnea, same exercise tolerance, RVEF affected

Question 21

What is B-type Natriuretic peptide? BNP

Answer 21

amino acid that is leaked out of ventricles or atriums when muscle fibers are overstretched in both SHF and DHF

Question 22

What is the lowest and highest BNP normal values?

Answer 22

below 100 no HF, above 900 severe HF

need to be above 400-500 to have HF

Question 23

What is orthopnea?

Answer 23

due to back flow of blood and fluid into alveoli pt is unable to lay flat b/c laying flat causes increased pulm capillary pressure

measured in pillows

Question 24

Where will blood back up into first in RCHF?

Answer 24

juglar vein and liver, portal HTN

Question 25

Why can LCHF cause peripheral edema?

Answer 25

lack of blood flow will trigger receptors to activate RAAS and will lead to retained fluid

Question 26

What is a clinically significant number for weight gain?

Answer 26

more than 2 pounds in a day

Question 27

What is very important to remember about pts with peripheral edema in CHF?

Answer 27

do not massage this fluid, use meds and diuresis to relieve sx, also don’t elevate legs above heart

pitting edema measurements used

Question 28

How does MI/CAD cause CHF?

Answer 28

damage to myocardium impairs contractility, this and remolding leads to dilation of heart, leads to increased EDV and stretching

Question 29

How can uncontrolled HTN lead to CHF?

Answer 29

leads to LV hypertrophy, overtime the pressure leads to EDV, leading to poor contractility

Question 30

What type of left sided valve dysfunction causes SHF?

Answer 30

1. aortic stenosis- similar to HTN
2. aortic insufficiency- increased EDV due to back flow
3. mitral valve insufficiency- inability to push EDV out efficiently

Question 31

What is tx of CHF?

Answer 31

1. usually lifestyle mods- decrease salt intake, nutrition big factor- not making prepared foods
2. meds- diuretics, ACE I, ARB, BB, digoxin
3. PT
4. surgical options

Question 32

How does the valsalva maneuver affect CHF?

Answer 32

when you take a deep breath in it increases intra thoracic pressure, this unloads left side of heart decreasing EDV resulting in a more favorable length tension curve leading to flat BP response

Question 33

How is this diff in pts with non CHF?

Answer 33

normally this would increase BP then reduce it

Question 34

How does CHF affect skeletal muscle?

Answer 34

due to consistent lack of blood flow it will decrease fiber diameter, number of mitochondria, cell acidosis

leading to impaired strength/endurance or deconditioning

Question 35

What is important to remember about interval training with CHF pts?

Answer 35

they may never progress out of this and that is okay

Question 36

Why do CHF need IMT?

Answer 36

even in normal MIP it can decrease DOE and help endurance

duration- 15-30 mins per day at intensity of 15-60% max MIP for 2-3 months