Heart Failure Flashcards
What is heart failure
A clinical syndrome that occurs when the heart cannot provide enough blood flow to meet metabolic requirements or accommodate venous return
T or F: Heart failure incidence has declined over the past 20 years
False, but the survival rate has increased due to better risk ID, earlier intervention, and long term management
List 12 possible causes of HF
- CAD
- HTN
- Diabetes
- Valve Disease
- cardiomyopathy
- congenital heart disease
- lung disease (cor pulmonale)
- metabolic
- anemia
- drug toxicity
- renal disease
- aging
What are the two types of LV Dysfunction
Systolic (impaired contraction and ejection) [most common]
Diastolic (impaired relaxation and filling)
What contributes to Left Ventricular Dysfunction?
Excessive overload and increased afterload leading to an increased in LVEDP, causing increased P in the lungs, leading to congestion and dyspnea
What is the major clinical symptom of LV Dysfunction
Dyspnea
What is the consequence of LV Dysfunction?
Decreased CO leading to dec perfusion t/o the body
What is ejection fraction reduced heart failure?
Dec CO from impaired contraction of the ventricles (change in EF to <40%)
What is ejection fraction preserved HF?
Inefficient CO from thickening of the ventricular walls, leading to smaller chambers and less ability to accept blood (no/min change EF)
What is the etiology of LV HF
- atherosclerosis
- cardiomyopathy
- HTN
- Valve Disease
- Drug toxicity
- congenital defects
- Diabetes
What are the s/s of LV HF?
- dyspnea
- dry cough
- fatigue
- orthopnea
- fluid retention
- pallor/cyanosis
- crackles in lung base
- mm weakness
- dizziness
- renal changes
What are the pulmonary effects of L HF?
Fluid acumm in pulmonary interstitium leading to early airway closure and a ground glass appearance on an x-ray
What are the stages of pulmonary edema?
1) Difficult to detect (weight gain > 3 lbs /day & difficulty lying flat)
2) Detectable via auscultation of lungs (crackles) and absence of air mvmt
3) Detectible via auscultation of lungs w/greater crackles and greater absence of air mvmt (blood-tinged foam, reduction of lung volumes, hypercapnia)
What stage of pulmonary edema is most commonly detected?
Stage 2, altho stage 1 would be better
What is the most common cause of RV HF
LV HF
What are the hallmark s/s of RV HF
LE Edema
Ascites
What occurs w/RV HF
inc in blood in ventricle leading to high RA & VC P, impairing venous flow in body, leading to inc P of the abdominal organs
What is the etiology of RV HF?
- COPD
- Pulm HTN
- LV F
- PE
What are the S/S RV HF?
- periph edema
- jugular vein distention
- fatigue
- ascites
- liver engorgement
- weight gain
- cyanosis
- decc exercise toelrance
- anorexia
The following are s/s of a) LV or b) RV HF:
Jugular vein distention
Peripheral edema
Weight gain
Fatigue
Ascites
b) RV
The following are s/s of a) LV or b) RV HF:
Dyspnea
Renal changes
Crackles in lung base
Fluid retention
a) LV
Define cor pulmonale?
Alteration in the structure and function of the RV leading to Right sided HF
Progression to cor pulmonale from COPD
COPD –> chronic inflamm of lungs–> pulm vasoconstrict –> increased p and volm in pulm a –> pulm HTN –> RV hypertrophy –> R HF
What are compensatory mechanisms of HF? (LIST)
- frank-starling mechanism
- neurohumoral compensation
- remodeling cardiac dysfunction
- inc oxygen extraction
- anaerobic metabolism
How does the Frank-Starling Mech work (HF)?
When preload increases (LVEDV), it causes an inc in pressure, causing an increase stretch, causing increase in CO to compensate for drop in CO w/HF
How does neurohumoral activation work (HF)?
Occurs when MAP drops w/HF, causing symp NS to release nor and epi which then increase HR and contractility to inc SV and TPR to inc MAP
What occurs w/ADH in HF?
It is increased so that BV can inc to inc CO but, long term, the increase in retention of fluid and pressure is bad as it contributes to the inc in afterload and preload already seen in HF
How does ventricular remodeling work in HF?
End result = detrimental
- increased stress = inc size, shape, structure and fun = lead to inc SV and higher CO even w/dec EF (SHORT TERM) –> LT = hypertrophy = less effective pumping
What is the onset, course, and prognosis of HF?
On: >= 60s
Course: Gradual
Prog = progressive
What medical tests are done for HF?
- Electrocardiogram (ID infarct, hypertrophy, arrhyth, conduction disturbances)
- Chest x-ray (heart size)
- Lab Values (ABGs, liver ensymes, ANP/BNP.CNP)
- MUGA
- Echo
What drugs are used for HF?
- ACE Inhib to help renal fun
- diuretics to dec fluid volume
- BB to assist Sym NS
- Digitalis to inc mm contract
- aldosterone antago to dec BV
What procedures are done for HF
- CABG
- Intra-aortic balloon pump
- Ventricular assist devices (VAD)
- Heart Transplant
- Pacemaker
What is an echo used for w/HF
to determine size/shape of heart, strength of contraction, valve function, thrombosis
What is MUGA (multigated acquisition imaging)
A noninvasive technique that calculates LV EF and studies the electrical activity of the heart
What are the s/s of digitalis toxicity?
Nausea, vomiting, diarrhea, confusion, arrythmias, & blurred vision w/green/yellow halo around an object
What does an increase in BUN indicate?
- kidneys are not functioning due to dec renal blood flow
What does an increase in creatinine indicate?
- kidneys are not functioning well
What does a rise in BNP indicate?
Pt likely has HF
T or F: Individuals w/HF have no change in capacity for exercise
False, it decreases leading to a poorer prognosis
What does dec. exercise capacity effect?
ADLs
Health QOL
Hospital admission rate
mortality
What are the two scales used to classify HF and the difference b/t them?
- AHA Classification: Based on structural damage
- NYHA: based on symptoms w/physical activity
What is Stage I of NYHA HF
No limitation in phys activity & ordinary phys A does not cause fatigue, palpitations or dyspnea
What is stage II of NYHA HF
Slight limitation of phys a, comfy at rest but ordinary activity results in fatigue, palpitations, or dyspnea
What is stage III of NYHA HF?
Marked limitation of physical a; comfy at rest but less than ordinary activity results in fatigue, palpitations, or dyspnea
What is stage IV of NYHA HF?
Symptoms at rest; unable to do any PA w/o symptomology
What is a state of compensated HF?
When the condition is stable and the pt is not exhibiting pulmonary and venous congestion-associated s/s
What is acute decompensated HF?
Presence of new or worsening s/s (related to inc congestion and inc ventricular filling P) of dyspnea, fatigue, or edema that lead to hospitalization or unscheduled medical care
When are you in the green zone for HF and PT?
NO:
swelling
SOB
Weight gain
Chest pain
Dec in ability to maintain activity level
= Can do PT
When are you in the yellow zone of HF and PT?
- weight gain 2-3 lbs in 24 hrs
- increase cough + SOB
- periph edema
- orthopnea
= communicate w/physician b4 exercise
When are you in the red zone for HF and PT?
- SOB @ rest
- Unrelieved chest pain
- wheezing or chest tightness at rest
- paroxysmal nocturnal dyspnea
- weight gain/loss of >5 lbs in 3 days
- confusion
= immediate visit to ER or physicians office
What are some HF Specific Qs?
- are symptoms stable/worsening?
- are they (sympt) provoked or at rest?
- any accompanied symptoms?
- orthopnea or PND?
- how far can u walk and is it typical?
- are you retaining fluid?
- do you restrict sodium in ur diet?
- are you losing/gaining weight?
- how do you sleep?
What do you do for a systems review of HF?
- CP
- integ
- MSK
- NeuroMusc
- Comm
- CP: vitals at rest & w/activity + edema
- Integ: LE skin & color
- MSK: ROM, strength, posture, height, weight
- Neuromusc: Gross mobility and sensation
- communi: affect, ability, cognition, lang, learning style
What are precautions and safety concerns for HF (aka what is the risk?)
- risk of:
rehospitalization, pneumonia, decompensation, & fall risk
Goals of HF Rehab?
- self-MGT improved w/behav for healthy habits acquired
- ability to perform phys tasks inc
- disability w/chronic illness reduced
- perform and independence in ADL inc
- phys response to inc o2 demand improved
What is required to start exercise in Pt w/HF?
- compensated
- speaking w/o dyspnea and RR <30
- < mod fatigue
- crackles in < 1/2 lungs
- Resting HR < 120 bpm
If on invasive monitors:
- Cardiac index > 2.0 L/min
- CVP < 12 mmHg (RAP)
What happens to skeletal mm w/exercise in HF
- Inc mitochondria
- II –> I fibers
- Inc capillary density
- Inc strength and endurance
What happens to vasculature w/exercise in HF
- Improved endothelium-mediated vasodilation
- favorable remodeling of conduit arteries
- inc. diameter of arterioles
- dec. TPR
What happens to ventilatory system w/exercise in HF
- inc MIP (max inspiratory P)
- enhanced efficiency of ventilation
- reduced lactate levels during exercise
- improved gas diffusion across alveolar capillaries
What are the ACSM Exercise recommendations for stable HF?
- Aerobic b/t 55-75% HRR and RPE 11-14
- Strength 30-40% 1RM progressed to 70% 1RM
What are the parameters for inspiratory mm training?
Class II and III w/HFrEF at: 30 min/day @ >30% MIP (max inspiratory pressure) 5-7x/week for 8-12 weeks
What is an abnormal physiological response to exertion?
Drop in SBP below standing rest or abnormally exaggerated rise in SBP
When should exercise be terminated in pts w/HF?
- dyspnea or fatigue
- RR > 40
- development of S3
- inc pulmonary crackles
- dec HR or BP > 10 bpm/mmHg
- diaphoresis, pallor, or confusion
- poor pulse pressure
- inc PVC
Define cardiomyopathy
Disease of the heart mm itself
List the 3 types of cardiomyopathies
- dilated (weak + enlarged heart)
- hypertrophic ( thickened + stiff heart mm)
- Restrictive (unusual w/stiff but not thickened heart)
What is the most common type of cardiomyopathy
Dilated
What is the cause of dilated cardiomyopathy
1/3 = idiopathic
2/3 = other heart disease, thyroid disease, viral infections, poor diet + alcohol, toxins
What occurs in dilated cardiomyopathy
LV dilates and myocardial wall thins, weakening the pump ability that can lead to HF, valve disease, arrythmias, and blood clots
What is a common cause of sudden cardiac arrest in young people?
Hypertrophic cardiomyopathy
What occurs in hypertrophic cardiomyopathy
Myocardial cells enlarge causing walls of LV or interventricular septum to thicken that can cause mitral value insufficiency or dangerous arrythmias
What are the symptoms of hypertrophic cardiomyopathy?
Chest pain, dizziness, SOB, fainting
Which cardiomyopathy looks like:
a) EF preserved HF
b) EF reduced HF
a) hypertrophic Cardiomyopathy
b) Dilated cardiomyopathy
What occurs in restrictive cardiomyopathy?
The ventricles are rigid from scar tissue, leading to dec filling and atrial hypertrophy that can eventually lead to HF and arrythmias
What are the risk factors of cardiomyopathies?
- chemo
- obseity
- LT ETOH abuse
- smoking
S/s of cardiomyopathies?
- chest pain
- dyspnea
- orthopnea
- tachycardia
- palpitations
- periph edema
- distended jugular vein
- fatigue
- weakness
What is the onset of cardiomyopathies
Any age
What is the course of cardiomyopathies
- depends on type, but could progress to: HF, arrythmias, or valve issues
What is the prognosis of Cardiomyopathies?
- Idiopathic dilated cardio = Poor
- hypertrophic = relatively normal life bc EF presereved
What are precautions should you take for cardiomyopathies?
- limited activity
- diminish stress
- take vitals
What medical tests are done w/cardiomyopathies
- chest x-ray
- echo
- PET
- blood chemistry
- EKG
What is the medical MGT of cardiomyopathies?
- lifestyle changes (be active and eat healthy)
- drugs (BB, Ca+ Blockers)
- Sx (mechanical circulatory support or transplant)
