Exam 2: Wk 2 CHF and Cardiac Muscle Dysfunction Flashcards
Define Heart Failure
inability of the heart to pump adequate amts of blood through the circulation
MAP - mean arterial pressure
BP over TIME
MAP= 1/3 x SBP + 2/3 x DBP
MAP = CO x TPR
Norm: 65-110mmHg
Total peripheral resistance
Amt of force exerted against the circulating blood by the vasculature of the body
What affects total peripheral resistance?
Blood volume and resistance to flow in blood vessels
Define pulse pressure and what is the formula q
How hard the heart is working - indicates efficiency
PP= SVP-DVP
After load - arterial pressure
Pressure or resistance the heart has to overcome to eject blood ; SQUEEZE
Amt of pressure that the heart needs to exert to eject the blood during ventricular contraction
Decreased TPR= _____ after load
Decreased
Increased after load = _____ contraction
Reduced/decreased
Preload - Venous Pressure
Stretch; the amt of volume being returned to the heart
Preload increases pumping force (contractility w stretch)
What system controls venous pressure
SNS
Each heart beat we get ___ in venous pressure and ____ in arterial pressure which causes blood to circulate.
Small decrease
Large increase
Stroke volume, cardiac output, ejection fraction
- SV = amt of blood ejected out of heart
- CO= HR x SV in one minute
- EF = (EDV-ESV)/EDV ; % of blood in ventricle ejected into arteries
CHF
Heart is failing to pump blood from veins to arteries
- venous pressure too high
- EF too low
- arterial pressure may not rise enough with each contraction
Which side of the heart has more work to do? Which side has more resistance?
L side of the heart has more work for L ventricle and higher overall resistance than pulmonary
Which side of heart is thicker? Does it have high or low pressure?
L Ventricle = high pressure
Therefore > O2 consumption than R
Which side of the heart usually fails first?
L side unless there’s an injury to the R
If L side fails, where does the pressure build up?
- How about R
L side Into the lungs so high pulmonary and low systemic pressure
What is it called when CO is balanced, regardless of demand on the heart?
COMPENSATED
What is it called when CO is NOT balanced, or cannot keep up with the demand on the heart?
DECOMPENSATED heart
What are the two most common causes of Cardiac muscle dysfunction
- HTN & CAD (MI)
Chronic hypertension
Increased arterial pressure whuch leads to L ventricular HYPERTROPHY
- leads to overstretched contractile fibers and less effective pump
CAD effects
- Coordination issues
- cardiac arrhythmias
Dyskinesia vs Hypokinesia vs Akinesia
Dyskinesia :Uncoordinated movement; common after MI
Hypokinesia: decreased mvmt
Akinesia: localized area of no mvmt
Abnormal conduction
Decreases coordination of contraction
Abnormal Automaticity
Pacemaker not regular (bradycardia or tachycardia)
What are two heart valve abnormalities??
Stenosis: blockage; doesn’t open properly
Regurgitation: doesn’t close properly; incompensated
Cardiomyopathy
Contraction and relaxation of myocardial muscle fibers are impaired
- heart muscle is stretched too thin (dialated cardiomyopathy) or hypertrophic cardiomyopathy
Saddle Pulmonary Embolus
Large embolus that straddles L and R pulmonary arteries
- total blockage of pulmonary blood to flow
- no output of L ventricle
RAPID DEATH
Hemopericardium
Unusual; pressure inside pericardium prevents filling of R ventricle —> decrease in pulmonary blood flow and L ventricle cant be filled
Classes of CHF
CLASS I : no limitation in any activity & no symptoms in ordinary activities
CLASS II: mild limitation of activity; pt comfortable at rest/mild exertion
CLASS III: marked limitation of any activity; pt ONLY comfortable at rest
CLASS IV: PA causes discomfort & symptoms present AT REST
S & S of Heart Failure
- Jugular vein distension
- hepatojugular reflux: 45 degree and press on liver
- third heart sound S3
- weight gain
- fatigue, dyspnea,
- orthopnea
- cyanosis
Different ways to classify heart failure
Chronic vs Acute
R vs L
Forward vs backward
Systolic vs Diastolic
High output vs low output
Compensated vs uncompensated vs decompensated
Chronic VS Acute
Long term
Acute: life threatening condition; cardiac shot needed
- L side: rupture of aorta
- R side: blockage of saddle embolus
R sided HF vs L sided HF
R: results of failing to empty vena cava (JVD, hepatomegally)
L: failure of LV to empty pulmonary veins and fill systemic arteries; congestion of pulmonary veins and capillaries
Cycle of HF
Starts on L side —> low CO causes fluid retention in kidneys —> increases preload on R side —> congestion of pulmonary circulation increases after load on R ventricle
Forward vs Backward HF
Forward: due to low CO; ischemic injury to tissues, cool, cyanosis
Backward: due to venous congestion; pulmonary edema(LHF) and peripheral edema (RHF)
Systolic vs diastolic HF
Systolic: insufficient myocardial muscle strength relative to conditions
Diastolic: not enough blood filling ventricle
Medical MGMT of HF
Stabilize, dietary changes, weigh daily to monitor fluid (there’s rapid weight gain due to fluid retention)
Pharmalogical Tx & their function
ACE Inhibitors: cause vasodilation and fluid reduction
Diuretics: reduced fluid in veins reduce load on heart
Beta blockers: decrease cardiac work
Pressures: decompensation for acute/ emergent situations
Who are ACE inhibitors for? -oprils
Those w/ systolic failure
- decreases retention of water and vasoconstriction
Who are diuretics used to treat? -ide
Those with backward symptoms as maintenance or emergency
- reduced fluid in veins
beta blockers used for
Centrally inhibit ANS; decrease hr and cardiac work
General recs from PT on physical activity
- educate on energy conservation
- introduce rest periods during day
- start ADLs in hospital, enter cardiac rehab ASAP
Dialysis and ultrafiltration
Removal of fluid from pleural and abdominal cavities
Assisted circulation
Intraaortic balloon counterpulsation using a pump (IABP) OR LVAD??
Ventricular assist deceive
Provides force to eject blood
Cardiomyoplasty
Surgical procedure where healthy muscle from somewhere else is wrapped around heart to provide support for failing muscle (like the lat)
L partial ventriculectomy
Reduces cardiac volume
BNP-B type Natuuretic Peptide
Secreted by ventricles in HF
> 300 mild hf
600 mod hf
900 severe hf
Radiological findings in HF in Heart and Lungs
Heart - enlarged when CTR ratio >50% (cardiomegaly)
Lungs: when L atrial pressure >20mmHg
Pressures >20 likely result in what
Pulmonary edema
What scale should we use with patients with HF instead of RPE?
Dyspnea scale bc its more specific to O2 delivery
Signs and Symptoms of decompensation
- cyanosis
- dyspnea, SOB
- gurgling sounds
- pink, frothy sputum
- sudden onset of fatigue
- decreased HR or systolic BP
for NYHA Class II-III physical activity goal should be
Aerobic: 20-60 min at 50%-90% intensity at peak VO2
3-5x/wk for ~8 wks
