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Cardiopulmonary PT > Heart failure > Flashcards

Heart failure Flashcards

1
Q

Causes of cardiac muscle dysfunction

A
  • HTN
  • CAD
  • Cardiac dysrhythmias
  • renal insufficiency
  • cardiomyopathy
  • heart valve abnormality
  • pericardial effusion
  • pulmonary embolism
  • pulmonary HTN
  • spinal cord injury
  • age-related changes
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2
Q

Heart failure

A
  • chronic progressive condition
  • heart muscle is unable to pump enough blood to meet needs for blood and oxygen
  • heart failure usually results in an enlarged heart
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3
Q

Heart failure typical path

A
  • normal: ventricles fill with blood and then pump out about 70% of the blood
  • diastolic dysfunction: the stiff ventricles fill with less blood and then pump out 70% but this is less than normal
  • systolic dysfunction: enlarged ventricles fill with blood and then pump out 40-50% of the blood
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4
Q

What does dysfunction in the heart eventually cause

What does it impact first and then what happens from there?

A
  • first impacts SV and EF
  • chronic elevation of pressures will be transmitted up the atria into the vascular system
  • the increase pressure leads to transudate of fluid from the vessels to the interstitial spaces of the lungs or peripheral tissue
  • leads to edema
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5
Q

Classifications of heart failure

A
  • right heart failure = peripheral edema
  • left heart failure = pulmonary edema
  • biventricular
  • systolic vs diastolic dysfunction
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6
Q

heart failure with reduced ejection fracture

A
  • EF<40
  • systolic dysfunction
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7
Q

heart failure with preserved EF >50%

A
  • still denotes lower than normal SV
  • diastolic dysfunction
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8
Q

Right sided heart failure typical presentation

A
  • congestion of peripheral tissues
  • dependent edema and ascites (fluid in abdomen)
  • GI tract congestion = anorexia, GI distress, weight loss
  • liver congestion: signs related to impaired liver function
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9
Q

left sided heart failure presentation

A
  • decreased CO: activity intolerance and signs of decreased tissue perfusion
  • pulmonary congestions: impaired gas exchange (cyanosis and hypoxia) and pulmonary edema (cough with frothy sputum, orthopnea, PND)
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10
Q

What does pulmonary edema sound like

A
  • crackles
  • wet = gurgling
  • dry = fire burning
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11
Q

what sound is expected with CHF

A
  • S3
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12
Q

pulse pressure related to CHF

A
  • normal = 40 (120-80)
  • CHF: systolic decreases and diastolic increases leading to a lower pulse pressure
  • indication heart is not functioning
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13
Q

Look at Left and right -sided heart failure diagram

A
  • look
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14
Q

Clinical manifestations of left sided heart failure

A
  • fatigue and weakness
  • poor tolerance to activity
  • progressive dyspnea
  • orthopnea and PND
  • tachypnea, pallor, cyanosis
  • crackles or rales
  • adventitious heart sounds (s3)
  • hypoxia/hypercapnia
  • voice sounds consistent with consolidation/infiltrates
  • decrease pulse pressure
  • weak pulse
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15
Q

clinical manifestations of right sided heart failure

A
  • fatigue and weakness/poor tolerance to activity
  • dependent peripheral edema/ascites
  • weight gain (fluid)
  • cold, pale and cyanotic extremities
  • JVD
  • decreased peripheral and ventilatory muscle strength and endurance
  • poor activity/exercise tolerance or physical work capacity
  • decreased quality of life/disability
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16
Q

Clinical diagnosis of CHF

A
  • echocardiography: left ventricular EF, structure of LV, other structural abnormalities
  • lab findings: elevated BNP, BUN, hematologic changes (increase RBCs), hypoxia/hypercapnia, changes in liver and electrolyte levels
  • radiologic findings: Evaluation of size and shape of cardiac silhouette; presence of interstitial, perivascular, alveolar edema (fluid in lungs)
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17
Q

NYHA classification of CHF

A
  • class 1: no limitation of physical activity
  • class 2: slight limitation of physical activity, comfortable at rest
  • class 3: marked limitation of physical activity, comfortable at rest (may have dyspnea at rest)
  • class 4: inability to carry any physical activity with discomfort, symptoms present even at rest
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18
Q

ACC/AHA stages of CHF

A
  • Stage A: high risk for developing CHF, no structural disorder to heart
  • stage B: structural disorder or heart, never developed symptoms of CHF
  • Stage C; past or current symptoms of CHF, symptoms associated with underlying heart disease
  • stage D: end-stage disease, requires specialized treatment strategies
19
Q

describe the CHF cycle

A
  • initially may have impaired cardiac function but have CO sufficient for activity

THEN

  • As HF progresses may decompensated with less tolerance to activity
  • this can become a long term cycle of compensated then uncompensated
20
Q

Ability of pump or accept blood depends on

A
  • total blood volume
  • body position and gravity
  • skeletal muscle pump
  • intrathoracic pressure
  • atrial contribution to ventricular filling
  • venous tone
  • intrapericardial pressures
21
Q

associated effects of CHF

On differnet systems

A
  • pulmonary: back up of blood and pressures
  • biochemical/nutritional: anorexia
  • renal: sodium and fluid retention
  • MSK: decrease blood flow, muscle atrophy
  • hematological: abnormal blood cell function and increase blood volume
  • pancreatic: impaired insulin and glucose imbalance
  • hepatic: hypo fusion and/or venous congestion leading to cirrhosis
  • neurochemical: increase sympathetic stimulation
22
Q

HF impact on the heart

A
  • stretching of the myocardium with increase ventricular EDV
  • contractile state of myocardium declines
23
Q

How can the kidneys contribute to the progression of CHF

A
  • sense low arterial blood flow
  • intiate a process to retain fluid
  • this contributes to CHF
24
Q

Pulmonary edema and its relation heart failure

A
  • left ventricle cannot handle overload of blood volume
  • pressure increases in the pulmonary vasculature
  • fluid moves out of the pulmonary capillaries into the interstitial space of lungs and alveoli
25
Q

Stage 1 of pulmonary edema in relation to left sided heart failure

A
  • excessive fluid is present but managed by lymphatic system
  • pressures are starting to increase
26
Q

Stage 2 of pulmonary edema in relation to left sided heart failure

A
  • characterized by the presence of interstitial edema
  • increases in pressure causes the fluid to move into the interstitial space
  • dry crackles with lung sounds
27
Q

Stage 3 pulmonary edema in relation to left sided heart failure

A
  • characterized by the presence of alveolar edema
  • invades the parenchyma
  • fluid overload
  • compromised gas exchange
  • wet crackles with lung sounds
  • blood twinged sputum
28
Q

Cardiogenic causes of pulmonary edema

A
  • left ventricular failure
  • HTN
  • cardiomyopathy
29
Q

non-cardiogenic causes of pulmonary edema

A
  • smoke or toxin inhalation
  • idiopathic pulmonary HTN
  • sepsis/pneumonia (increase permeability)
  • near drowning (inhaling water)
30
Q

intrapulmonary shunt

A
  • hypoxic blood
  • O2 goes out of the alveoli normally
  • with a fluid filled alveoli there is not as much gas exchange and therefore the it is perfused by not ventilated
31
Q

Medical treatment for pulmonary edema

A
  • manage HTN and CAD
  • diet, nutrition, fluid management
  • sometimes given a set amount of water to drink so they do not increase fluid too mcc
  • proper prescription of activity (too high can cause fluid overload)
  • medications
  • mechanical/surgical intervention
  • education and disease self-management is key
32
Q

Management of heart failure

A
  • directed at underlying causes or cause - HTN, atherosclerosis, ischemia, valve dysfunction, arrhythmia etc.
33
Q

What are the goals when managing heart failure

A
  • improve heart pump
  • reduce the workload for the heart
  • control sodium intake and water retention
  • supplement vitamins, minerals and amino acids
  • decrease sodium intake
  • fluid restrictions
  • eating heart healthy foods with low cholesterol and fat
34
Q

Medication that patients with heart failure may be on

A
  • diuretics: lassie, thiazides to eliminate fluids
  • vasodilators: nitrates to decrease PVR
  • ACE inhibitors: prevent vasoconstriction
  • beta blockers: decreases sympathetic stimulation
  • positive inotropic drugs: increase contractility
35
Q

Look over management diagrams in lecture slides and understand where each comes into play

A
36
Q

Mechanical/surgical management for CHF

A
  • cardiac assistive devices (pacemakers/defibrillators)
  • cardiac transplant
  • assisted circulation (mechanical circulatory derives - MCD’s)
37
Q

examples of assisted circulation devices

A
  • intra-aortic ballon pump (can go home with this)
  • extra corporal membrane oxygenation
  • ventricular assist device
38
Q

Life vest

A
  • external cardiac defibrillator
  • these people are waiting for other treatment such as transplant
39
Q

transplantation

A
  • if you work with these patients you are working in a specific center
40
Q

Intra-aortic ballon pump

A
  • systole: deflation to decrease after load, decrease cardiac work, decrease myocardial oxygen consumption and increase CO
  • diastole: inflation: augmentation of diastolic pressure, increase coronary perfusion, allows more blood flow to the heart
  • inserted through femoral artery
41
Q

Extra corporal membrane oxygenation (ECMO)

A
  • not going home with this
  • waiting to get LVAD or transplant
  • gives heart and lungs a break
  • ECMH manages all the blood
  • femoral access - try to avoid this as it limits mobility
  • commonly used with premature babies since they don’t have surfactant
42
Q

Ventricular assist devices

A
  • can be left or right or biventrcualr
  • heart can rest
  • blood gets sucked or pumped out of the ventricle
  • LVAD = left ventricular assistive device
43
Q

Bridge vs destination therapy with HF

A
  • bridge is that the LVAD or ECMO is bridging them to the next step
  • destination therapy is the last thing they are doing
44
Q

Education and self management techniques for patients with CHF

A
  • assist with patient with taking responsibility for health (monitoring weight and symptoms)
  • optimization of medical therapy/consistency with meds
  • vigilant management and follow up
  • exercise monitoring during and next day/next treatment
  • early attention to fluid overload

Cardiopulmonary PT (25 decks)

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