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Kin 187 > CVD - Chronic heart failure > Flashcards

CVD - Chronic heart failure Flashcards

1
Q

What is Chronic Heart Failure (CHF)

A

Syndrome of the inability of the heart to deliver adequate blood/oxygen to the body

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2
Q

What are the different heart failure (HF) - for each side

A

Left sided HF = failure to properly pump blood out to the body - systolic and diastolic failure

Right sided HF = back ups in the area that collects used blood

Congestive heart failure

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3
Q

Systolic HF is

A

Less blood pumped out of ventricles

Weakened heart muscle cant squeeze as well

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4
Q

Diastolic HF is

A

Less blood fills the ventricles

Stiff heart muscle cant relax normally

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5
Q

When does CHF occur

A

When heart is unable to pump sufficiently to maintain blood flow to meet body demands

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6
Q

What is affected by CHF

A

Reduced cardiac output - due to left/right ventricular dysfunction

Systolic dysfunction - due to impairment of left ventricle

Diastolic dysfunction - due to resistance to filling of one or both ventricles

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7
Q

Systolic dysfunction is when

A

The ventricles fill with blood and then can only pump out less than 40-50% of the blood

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8
Q

Diastolic dysfunction is when

A

The stiff ventricles fill with less blood

The ventricles then only can pump out 60% of the blood

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9
Q

What are the most common causes of CHF (3)

A

Conornary artery disease

Hypertension

Myocardial infarction

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10
Q

What causes systolic dysfunction (reduced ejection fraction)

A

Afterload

Impaired contractility

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11
Q

What is Afterload

What causes it

A

Chronic pressure overload

Advanced aortic stenosis
Uncontrolled severe hyptertension

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12
Q

What causes impaired contractility

A

Cononary artery disease

Chronic volume overload

Dilated cardiomyopathies

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13
Q

What causes diastolic dysfunction (preserved ejection fraction)

A

Impaired diastolic filling

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14
Q

Myocardial injury results in

A

Reduced cardiac output

Decreased carotid baroreceptor stimulation

Decreased renal perfusion

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15
Q

Reduced carotid BR stimulation and Renal perfusion results in

A

Activation of SNS and renin angiotensin aldosterone system (RAAS)

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16
Q

Activation of the SNS (from reduced carotid BR stimulation and Renal perfusion) results in

A

Increase HR and inotropy (contraction/force of muscle)

Myocardial toxicity

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17
Q

Activation of the RAAS results in

A

B type natriuretic peptides (BNP) released

A type natriuretic peptides (ANP) released

Vasconstriction - increases Afterload

Hemodynamic alterations - increases Preload

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18
Q

What causes vasoconstriction

A

Increased angiotensin 2

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19
Q

What causes hemodynamic alterations

A

Increased aldosterone

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20
Q

What does BNP and ANP both do

A

Decrease TPR and Central venous pressure

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21
Q

Where is BNP secreted and in response to what

A

By the ventricles in response to excessive stretching of cardiomyocytes

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22
Q

Where is ANP secreted and in response to what

A

By atria in response to high blood volume

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23
Q

What is the SNS then inhibited by

Which results in

A

Beta blockers

Negative remodeling

Worsened LV function

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24
Q

What is the RAAS inhibited by

A

ACE inhibitors

Angiotensin receptor blockers

Aldosterone antagonists

ADH antagonists

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25
Q

Negative remodeling and worsened LV function result in

A

Symptoms of HF

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26
Q

During exercise the neural pathway consists of

A

Arterial baroreceptors and skeletal muscle mechano receptors go brain

Brain creates sympathetic or parasympathetic to change HR and SV, also vasculature in muscle

Changes cardiac output

Changes in total vascular conductance

Resets BP

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27
Q

The rein angiotensin aldosterone system is made up of

A

Liver

Kidneys

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28
Q

Liver produces

A

Angiotensinogen

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29
Q

Kidney produces

A

Renin when there is a decrease in renal perfusion

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30
Q

Angiotensinogen and Renin create

A

Angiotensin 1

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31
Q

ACE is produced

A

On the surface of pulmonary and renal endothelium

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32
Q

Angiotensin 1 and ACE create

A

Angiotensin 2

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33
Q

Angiotensin 2 causes

A

Increase Sympathetic activity

Increase Tubular NA and CL reabsorption and K excretion = H2O retention

Stimulation of Adrenal gland cortex

Stimulation of arteriolar vasoconstriction - increases blood pressure

Stimulation of pituitary gland posterior lobe

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34
Q

All the stimulations of angiotensin cause what

A

Water and Salt retension

Effective circulating volume to increase

Perfusion of the juxtaglomerular apparatus to increase - inhibitatory signal to stop renin from being produced in kidney

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35
Q

What does the stimulation of the adrenal gland cortex cause

A

Aldosterone secretion

Which stimulates H2O retention

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36
Q

What does the stimulation of the pituitary gland posterior lobe cause

A

ADH secretion

Which stimulates H2O absorption in collecting duct

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37
Q

Regulation of stroke volume includes

A

EDV

Aortic blood pressure

Contractility of ventricles

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38
Q

What is EDV

A

End diastolic volume

Volume of blood in ventricles = preload

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39
Q

What is aortic blood pressure

A

Pressure that heart must pump against to eject blood = afterload

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40
Q

What enhances contractility

A

Circulating Epi and NeoEpi

Direct sympathetic stimulation of heart

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41
Q

Coronary artery disease (CAD) is a result of

A

Ischemic heart disease (IHD)

Build up of plaque in the coronary arteries

Risk factors

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42
Q

What is the most common cause of death

A

Coronary artery disease

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43
Q

What does the build up of plaque in coronary arteries cause

A

Leads to limited blood flow to the heart (ischemia)

Leads to heart attack (MI)

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44
Q

What are the risk factos of CAD

A

High LDL

Low HDL

Hypertension

Family history

Diabetes

Smoking

Obesity

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45
Q

Medical management of CAD includes

A

Pharmacological treatment

Coronary intervention

Revascularisation

46
Q

Pharmacological treatment of CAD involves

A

Statin (cholesterol lowering)

Beta blockers

Calcium channel blockers

Antiplatelet drugs (aspirin)

47
Q

Coronary intervention of CAD involes

A

Angioplasty - unblocking blood vessel

Coronary stent - widening of blood vessel

48
Q

Revascularisation of CAD involves

A

Coronary artery bypass grafting

4 different levels:
Single
Double
Triple
Quadruple
49
Q

Myocardial infaraction occurs when

A

Blood flow stops to a part of the heart

Causes damage to cardiac muscle

Mostly due to coronary artery disease

50
Q

Heart attack (MI) risk in monitored by

A

Atherosclerotic plaque

Inflammation indicated by high sensitivity C - reactive protein (hs-CRP)

Calcification from calcium deposit as part of plaque formation

51
Q

rs-CRP risk levels are

A

<1 mg/L = low risk

1-3 mg/L = average risk

> 3 mg/L = high risk

52
Q

Elevated levels of CRP predict

A

Risk of MI and stroke

53
Q

Calcification can be detected by

A

CT scans

Detect calcium deposits from plaque formation

54
Q

What produces CRP and in response to what

A

Liver

In response to factors released by macrophages and adipocytes

55
Q

What are the typical signs of myocardial infarction

A

Discomfort in center of chest

Uncomfortable pressure, pain

Pain/discomfort in one or both arms, back, neck, jaw or stomach

Shortness of breath with or without chest discomfort

Breaking out in cold sweat, nausea or lightheadness

56
Q

Medications and precautions during exercise (list of drugs)

A

Diuretics

Beta Blockers

Vasodilators, ACE inhibitors and angiotensin receptor blockers

Calcium channel blockers

CNS active drugs

Alpha receptor blockers

57
Q

Diuretics result in

A

No impact on aerobic capacity

False positive test

58
Q

Beta blockers result in

A

Decreased submax and max HR

Sometimes decreased exercise capacity

59
Q

Vasodilators , ACE inhibitors and Angiotensin receptor blockers result in

A

Do not affect HR response

May experience Hypotension

60
Q

Calcium channel blockers may result in

A

Decrease HR response at rest and during exercise

61
Q

CNS active drugs result in

A

Attenuating effects on HR and BP during exercise

62
Q

Alpha receptor blockers result in

A

Significantly lower BP

Minimal effects on HR and metabolic responses to exercise

63
Q

True positive refers to

A

Positive exercise test

CVD

64
Q

True negative refers to

A

Negative exercise test

No CVD

65
Q

False positive refers to

A

Positive exercise test

No CVD

66
Q

False negative refers to

A

Negative exercise test

CVD

67
Q

Adrenalin and Noradrenalin affect on Alpha 1 leads to

A

Smooth muscle contraction

68
Q

Adrenalin and Noradrenalin affect on Alpha 2 leads to

A

Inhibition of transmitter release

Smooth muscle contraction

69
Q

Adrenalin and Noradrenalin affect on Beta leads to

A

Heart muslce contraction

Smooth muscle relaxation

Glycogenolysis

70
Q

In patient aerobic frequency (FITT) with CAD and MI

A

2-4 times/day for 1st 3 days in hospital

2 times/day for day 4 in hospital

71
Q

In patient aerobic Intensity (FITT) with CAD and MI

A

To tolerance if asymptomatic
RPE <= 13

Post MI/CHF = HR <=120 bpm or HRrest +20 bpm

Post surgery = HRrest +30 bpm

72
Q

In patient aerobic Time (FITT) with CAD and MI

A

Begin intermittent bouts of 3-5 mins as tolerated

Rest period - slower walk

2:1 exercise/rest ratio

Progress to 10-15mins

73
Q

In patient aerobic Type (FITT) with CAD and MI

74
Q

Aerobic prescription with CAD and MI (FITT)

A

4-7 days/wk (short bouts of 1-10mins)

RPE 11 to 16
40-80%
HR below ischemic threshold

Warm up 5 -10min
20-60 min exercise

Tolerate

75
Q

Muscular strength and endurance prescription with CAD and MI (FITT)

A

3-4 days/week

2-4 sets
12-15 reps
8-10 exercises

As long as it takes

Functional movements
Circuit training
Avoid straining and holding breath

76
Q

What are the increasing effects of exercise training with CAD and MI

A

Maximal oxygen consumption

Ventilatory response

Anaerobic and ventilatory threshold

HDL

Self efficacy

Numbers of endothelial progenitors cells and cells that promote angiogensis and vascular regeneration

Vegal tone

77
Q

What are the decreasing effects of exercise training with CAD and MI

A

Modest decrease in body weight, fat stores, BP, total blood cholesterol etc

Relief of angina

Protection against triggering MI by vigerous physical exertion

Coronary inflammatory markers (hs-CRP)

Adrenergic activity

78
Q

What is the exercise response in CHF

A

Alterations in Central, Peripheral and Ventilatory abnormalities

79
Q

Exercise testing considerations for CHF (table)*****

80
Q

Exercise programming in CHF consists of

A

Referral to cardiac rehabilitation

Basic CCD4 recommendations

Re evaluate frequently

Prolong warm up and cool down

Perceived exertion and dyspnea scales > target heart rates

No isometric exercise

Electrocardiogram monitoring required when history

Resistance training safe in people with systolic dysfunction who are stable

81
Q

What is the neural effect of exercise training in CHF

A

Central
Reflex
Neurohumoral

82
Q

What is the muscular effect of exercise training in CHF

A

Biochemical
Metabolic
Structural

83
Q

What is the cardiac effect of exercise training in CHF

A

Contractility

Hemodynamic

84
Q

What is the vascular effect of exercise training in CHF

A

Vasodilatory

85
Q

Overall exercise training in HF causes

A

RAAS to decrease

Chemoreceptors reducing stimulation of SNA

Arterial baroreceptors increasing inhibition of SNA

Exercise pressor reflex reducing stimulation of SNA

Overall reduction in ANG 2 - reduces SNA and ventilation

86
Q

Reduction in RAAS causes

A

Less circulating and tissue ANG 2

Increase blood flow

87
Q

Exercise pressor reflex causes

A

Reduced SNA stimulation

Increase TRPV 1 receptors

Increase CB1 recpetors

Decrease inflammation

88
Q

Missing ____ reflects absence of atrial depolarization in atrial fibrillation

89
Q

Restoring the heart to a normal rhythm by pharmacologic agents is one way for the medical management of atrial fibrillation

90
Q

Heart rate responses to exercise in individuals with atrial fibrillation can be affected by medication use

91
Q

During exercise, stroke volume in individuals with atrial fibrillation is reduced due to limited atrial assistance during ventricular systole

92
Q

Hs-CRP level 2mg/L classifies average risk for cardiovascular disease

93
Q

______ happens when the blood flow to a part of the heart is blocked and cause cardiac muscle cell death

A

Heart attack

94
Q

Which of following describes general pathophysiology of chronic heart failure

A

Increase in preload

95
Q

If your patient (with heart failure) takes __________, it will lower BP significantly during exercise (or testing) and will have minimal effects of HR and metabolic response to exercise

A

Alpha receptor blockers

96
Q

BNP is secreted by atria in response to high blood volume

97
Q

Aldosterone is secreted from pituitary gland, and it increases water retention in collecting duct

98
Q

Weakened heart muscle which cannot squeeze the ventricle well describes the typical characteristic of diastolic heart failure

99
Q

Which of the following describes the effect of exercise training in patients with Coronary Artery Disease and Myocardial Infarction

A

Decreased Hs-CRP level

100
Q

Coronary artery disease leads limited blood flow to the heart which causes ischemia, then it may lead ____

A

Heart attack

101
Q

Ventilation perfusion mismatching is a typical characteristic of heart failure indicated by VE/VCO2 slope ≤34 as a poor prognosis

102
Q

End diastolic volume in systolic heart failure will decrease with exercise training

103
Q

True positive in testing indicates

A

Tested positive for CVD

Have CVD

104
Q

False positive in testing indicates

A

Tested positive for CVD

But dont actually have CVD

105
Q

True Negative in testing indicates

A

Tested negative for CVD

No CVD

106
Q

False Negative in testing indicates

A

Tested negative for CVD

But you actually have CVD

107
Q

Diuretics do what

A

Increase urine production

Have no impact on aerobic capacity

Can result in a false positive test

108
Q

Beta blockers do what

A

Decrease submax and max heart rate

Sometimes decrease exercise capacity

109
Q

Vasodilators, ACE inhibitors and angiotensin receptor blockers do what

A

Have no affect on HR response

May experience hypotension

110
Q

Calcium channel blockers do what

A

Some may decrease HR response at rest and during exercise

111
Q

CNS active drugs do what

A

Have attenuating effects on HR and BP during exercise

112
Q

Alpha receptor blockers do what

A

Significantly lower BP

Have minimal effects on HR and metabolic responses to exercise

Kin 187 (21 decks)

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