Exam 2 Weeks 5-7 Flashcards
What is CHF (Congestive Heart Failure)
The heart if failing to pump blood from the veins to the arteries
The cardiac output is not being maintained
Common signs of CHF
- Elevated jugular venous pressure (Right sided symptom)
- Hepatojugular reflux (45 degree angle)
- S3 sound ***** Major sign of CHF
- Bilateral Pulmonary wheezes
- Retention of excessive body fluid
- Peripheral edema
- weight gain
Common Symptoms of CHF
- fatigue
- Dyspnea on exertion
- decreased exercise tolerance
- Paroxysmal nocturnal dyspnea
- orthopnea (when you can’t lay flat)
- Inability to sleep unless partially upright
- Quantified by # of pillows used to allow one to sleep
- Signs and symptoms vary with classification
Acute Heart Failure
Emergency- life threatening
- Catastrophic loss of one way valve system or other structural integrity
- Left= rupture of the aorta
- Right = blockage by saddle embolus or hemopericardium
Right sided Heart Failure
- Failing to empty vena cava
- Jugular distention
- Systemic congestion
- dependent edema
- Sacral edema and ascites
- Nocturia as fluid is displaces from Legs to thorax while sleeping
- Congestive liver and spleen- Hepatomegaly/Splenomegaly
- Impaired liver function and immunity; further edema and decreased blood clotting
NYHA Class 1
No limitations experienced in any activities
- no symptoms for ordinary activities
NYHA Class 2
- slight- mild limitation of activity
- Patient is comfortable at rest or with mild exertion
NYHA Class 3
- marked limitation of any activity
- Patient only comfortable at rest
NYHA Class 4
Any physical activities cause discomfort
- Symptoms at rest
Left Sided Heart Failure
- Results from failure of LV to empty pulmonary veins and fill systemic arteries
- Congestion of pulmonary veins and capillaries
- Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
- Low cardiac output
- Cool, extremities, cyanosis, decreased cerebral profusion
What is the most common cause of Right sided Heart Failure
LHF
Problems Primarily Due to low cardiac output..
Forward HF
- Right side issue
- Ischemic injury of tissue
- Cool, cyanotic extremities and face
Problems Primarily due to venous congestion
Backward HF
- Left sided issues
- Increased venous pressure with leakage of fluid from capillaries
Extreme caution must be utilized in treating a patient with CHF and a/an:
Ejection fraction of 10%
A patient performing low-level exercise reports angina that is not typical of what the patient has previously experienced while doing the same level of activity. This type of angina would be classified as:
Unstable Angina
- Systolic HF
- Diastolic HF
- Right sided HF
- Left sided HF
- Smaller weaker muscle–> pumps less blood
- Larger thicker muscle–> pumps less blood
- Edema backs up into LE and systems
- Edema backed up into the lungs
T/F early mobilization minimizes the risk for a VTE (Venous thromboembolism )
True
Why might someone living with Heart Failure decompensate?
- Developing anemia from poor nutrition
2.An illness like pneumonia increases demand
- Eating high salt diet and drinking too many fluids
- Taking medications inconsistently
Which are common signs and symptoms of cardiac ischemia in women?
Unusual fatigue or indigestion
Which medications are used in emergency management of an MI from coronary artery occlusion to maintain and restore blood flow?
Thrombolytic
Heparin
In patients with congestive heart failure, which of the following positions should be avoided to minimize the preload on a failing heart?
Supine with lower extremities elevated
Systolic Failure
Insufficient myocardial muscle strength relative to conditions
Diastolic Failure
- Insufficient filling/ low Stroke volume
- May lead to sudden onset tachycardia, arrythmias and flash pulmonary edema
- Symptoms only during high exertion
Prinzmetals Angina
- Caused by coronary Vasospasm due to endothelial dysfunctionC
Coronary Vasospasm
Coronary vasospasm (CAS) is a sudden and reversible narrowing of the blood vessels that supply oxygen to your heart muscle.
STEMI
ST-Elevation MI
Is an ST elevation followed by a Q wave
- Rupture of coronary plaques–> thrombus/clot–> TOTAL OCCLUSION of coronary artery–> transmural infarction
- Elevated ST segment
- Increased Cardiac Enzymes Troponin
Non- STEMI
Coronary Artery is severely narrowed not completely blocked
- ST-segment depression or inverted T wave/ positive cardiac enzymes (Troponin and CK-MB
Transmural Infarction
- when injury to the myocardium is of the full thickness
PAD
PAD–> leg pain–> decreased activity–> deconditioning –> PAD
- Peripheral arterial disease in the lower extremities is the narrowing or blockage of the vessels that carry blood from the heart to the legs
-Claudication
- Ischemic Limb Pain
What is the legs appearance with PAD
- Pallor
- Cyanosis
- Skin smooth shiny
- no hair
- muscle atrophy
- cool to the touch
What are the 5 Ps of PAD
Pain
Pulselessness
Pallor
Parethesia
Paralysis
Signs and Symptoms of an MI
- History of claudication
- Shortness of breath
- Diaphoresis
- Characteristic changes on EKG (ST segment elevation)
- Enzymes of cardiac myocytes in blood especially CK-MB
- Enzymes monitored to either confirm suspicion of MI based on clinical signs or diagnose it in the absence of clinical signs
Exercise Protocol For PAD
- 5-10 minute warmup/cool down
- treadmill or track walking
- resistance exercise complementary, but not a substitute for walking
- Intensity sufficinet to cause claudication within 3-5 minutes
- Time- until moderately severe claudication reached
- rest until claudication resolves either sitting or standing
Phases of Cardiac Rehab: Phase 1
- Acute Phase or Monitoring Phase
- Begins when pt is medically stable following a MI, CABG, PTCA, valve repair, heart transplant, CHF
Phases of Cardiac Rehab: Phase 2
- Subacute phase of rehab/ conditioning phase
- Begins as early as 24 hours after DC and lasts up to 6 weeks
- Freq. of visits depends on pts clinic needs
- Initiate secondary prevention of disease
Phases of Cardiac Rehab: Phase 3
- Training or intensive rehabilitation
- Begins at end of phase 2 and extends indefinity
- Pt exercise in larger groups and continues to progress in exercise program
- resistance training often begins in this phase
Phases of Cardiac Rehab: Phase 4
- Ongoing conditioning/maintenance/ prevention program
- Individuals who are at high risk for infarction bc of risk factor profile and those who wish to be under supervision of trained personnel
PCI Percutaneous Coronary Intervention
Balloon tipped catheter is inserted into occluded vessel and inflated to restore patency of vessel by compressing the plaque and widening the lumen
Cholesterol Values
Normal= 200 mg/dl
Borderline= 200-239
High= >240
LDL Levels
Normal= <130
Borderline= 130-159
High= >160
HDL Levels
Low = <40
Cardioprotective >60
Anything <35 need to get on medication
Pitting Edema Scale
- 1+ 2mm/pitting lasts few seconds
- 2+ 4mm/lasts several seconds
- 3+ 6mm/pit lasts few minutes
- 4+ 8mm /lasts several minutes
Absolute Contraindications for Exercise Testing
1 Recent significant change in resting EKG suggesting ischemia, recent MI
2. Unstable Angina
3. Uncontrolled arrhythmias, causing symptoms, or hemodynamic compromise
4. Supraventricular tachycardia
5. Symptomatic severe aortic stenosis
6. Uncontrolled symptomatic heart failure
7. Acute pulmonary embolism or infarction
8. Acute myocarditis / pericarditis
9. Suspected or known dissecting or aneurysm
10. Acute systemic infection, accompanied by fever, body aches, or swollen lymph glands
INR
International ratio: standardization technique to correct for variations in pro-time test materials between labs
aPPT
Activated partial thromboplastin time
- measures intrinsic pathway clotting factors
The activated partial thromboplastin time (aPTT or PTT) measures the length of time (in seconds) that it takes for clotting to occur when specific reagents are added to plasma (liquid portion of the blood) in a test tube.
Termination of Activity
- Physical or verbal manifestation of severe fatigue
- Patient requests to stop
- Failure of monitoring equipment
- Signs of poor perfusion
- SOB or dyspnea
- Oxygen saturation <90%
- Peripheral ischemia claudication
- Onset of angina or angina like symptoms
- Excessive BP rise
- Failure of HR to increase with activity
- Wheezing or leg cramps
- Exercise hypotension ( SBP >10mmHg from baseline despite increase in workload)
- Noticeable change in Heart rhythm
CHF Pharmacologic Treatments
- ACE inhibitors= cause vasodilation and fluid reduction
2.Diuretics= Reduce fluid in veins reduces load on heart - Beta Blockers= decrease cardiac work
- Digoxin = increase contractility decrease HR
- Pressor= for acute emergent decompensation
Intra-aortic Balloon Pump
- Placed inside the aorta and the balloon end catheter inflates with the rhythm of the heart helping it pump blood
Signs and Symptoms of Decompensation
- Decompensation are decrease in blood supply from forward symptoms, dyspnea that is significant so you closely monitor with dyspnea scale
- Cyanosis of the hands, feet, lips
- dyspnea/SOB/DOE
- gurgling sound
- Pink, frothy sputum
- Sudden onset fatigue
- Decreased HR or systolic BP
Venous Insufficiency Signs and symptoms
- swelling
- Varicose veins
- pain and heaviness
- restless leg syndrome
- Leg cramps
- Itchy skin
- Darkened, hard, leathery skin
venous Insufficiency
happens because of weakened/damaged vessels and the valves allow back flow and pooling in the LE
Venous insufficiency Interventions
- Exercise
- elevation of affected extremities
- Avoiding long periods of standing or sitting
- Compression garments
- wound management
Venous Thromboembolism VTE
- VTE- formation of blood clot in a vein
Signs and Symptoms
-Leg pain or tenderness of the thigh or calf
-Leg swelling (edema)
-Skin that feels warm to the touch
-Reddish discoloration
Pulmonary Embolism
Life threatening acute complication of DVT
- DVT clot dislodges–> travels through the venous system through the right side of the heart blockage in the pulmonary circulation
Padue Prediction score
Predicting VTE
Assesses risk
Score >4 = high risk
Wells score for VTE
Wells score is used to Identify the presence of a VTE
REFER FOR FOLLOW UP WHEN WELLS SCORE IS >2 GET A D-DIMER LAB TEST
Signs and Symptoms of a Pulmonary Embolism PE
- dyspnea
- chest pain
- presyncope or syncope (spell of dizziness)
-hemoptysis - HR elevated >95 at rest
T/F PE is an emergent situation and you should call for back up
True
When is it safe to move a patient after a DVT is found?
- After initiation of coagulation
- check aPTT time 1.5-2.5
- No MOB <3 hours
- > 5 hours safe to mobilize
- Check with physician if 3-5 hours
Low Level Testing METS
2-6
Inpatient CR
-Mobilize ASAP
-Pt functioning at 4 MET level
- Resting HR 20+ if non surgical and 30+ if they had a surgery like a CABG
-Cant exercise if SBP >200mmHG and DBP >110 mmHg
- 20 SBP or 10 DBP increase/decrease
during exercise you should stop
By discharge they should be able to
- ascend/descend 2 flights of stairs without adverse symptoms
- ambulate >1000’ without adverse symptoms
- independently perform exercise program
- demonstrate an understanding of limits
