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Cardiopulmonary > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

inability of the heart to maintain cardiac output to meet metabolic demands of the tissue to due abnormality of the heart muscles

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2
Q

what is the immediate consequence of heart failure?

A

SOB - feels like we’re drowning in our own lungs as fluid starts to leak out and blocks alveoli from fully expanding

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3
Q

Pulmonary Edema is associated w/ Heart Failure why?

A

because of the fluid being leaked out of the alveoli / blood vessels

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4
Q

what are the etiologies of HF?

A

HTN, CAD**, infections more common

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5
Q

what is cardiomyopathy?

A

sickness of the heart muscle

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6
Q

what does the heart muscle look like with cardiomyopathy?

A

dilated, hypertrophic, restrictive

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7
Q

what are the major clinical risk factors for HF?

A

age, gender(females), HTN, MI, diabetes, obesity, COPD

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8
Q

what are minor clinical risk factors for HF?

A

smoking, CKD, diet, sedentary lifestyle, low socioeconomic status / psychological stress

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9
Q

what are toxic risk factors for HF?

A

chemo, cocaine, excess alcohol

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10
Q

what is the process of HF?

A

risk factors –> vascular dysfunction –> vascular disease –> tissue injury (MI, HTN) –> pathologic remodeling –> organ dysfunction –> organ failure

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11
Q

is left vs right sided HF more common?

A

left

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12
Q

recall, what is the ejection fraction?

A

percentage of blood expelled w each LV contraction (about 50-75%)

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13
Q

What are the characteristics of Systolic HF?

A

HF w reduced EF, LV loses ability to contract normally, can’t pump w enough force to push sufficient blood into circulation, ventricles enlarged

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14
Q

what are the characteristics of Diastolic HF?

A

HF w preserved EF, LV loses ability to relax normally, muscle becomes stiff. heart cant properly fill w blood between beats, SV still reduced, ventricles stiff/thickened

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15
Q

what are causes of systolic HF?

A

CAD, MI, ischemia, HTN, stenotic valve disease, regurgitant valve disease, chronic lung disease, familial/genetic, chronic arrhythmias

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16
Q

what are causes of diastolic HF?

A

pathologic hypertrophy, aging, restrictive cardiomyopathy, fibrosis

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17
Q

how does HTN lead to HF?

A

HTN produces overload on LV –> hypertrophies in compensation –> reduced LV compliance –> left atrial enlargement –> ischemia and ventricular arrhythmias

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18
Q

what is the connection between ventricular function and frank starling’s law?

A

increased venous return –> increased EDV –> increased preload –> initial stretch –> greater force generation –> increased SV

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19
Q

what is the connection between HF and frank starling’s law?

A

increased venous return –> increased EDV –> dilated ventricle –> increased stretch –> reduced force generation - reduced SV

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20
Q

what is the inotropic effect?

A

any mechanism that affects contractility of the heart

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21
Q

what are positive inotropic effects?

A

↑ strength of contraction (sympathetic, cardiac meds, optimized preload)

22
Q

what are negative inotropic effects?

A

reduced strength of contraction (parasymp., dialtion of heart chambers)

23
Q

characteristics of acute HF?

A

decompensated, rapid changes in S/S, associated w traumatic event, rapid shift of blood volume from systemic to pulmonary edema, acute sympoms

24
Q

characteristics of chronic stable HF?

A

compensated, unchanged S/S >= a month, compensatory mechanisms attempt to restore CO

25
Q

what is the compensatory mechanism

A

Initial body response to change in ventricular ability to maintain cardiac output

26
Q

consequences of compenstory mechanism?

A

increased stress on ventricular function, dilation, reduced limb blood flow

27
Q

what are the systemic effects of HF?

A

↓ myocardial performance –> pulm. edema –> ↓ renal perfusion / water/sodium retention –> skeletal muscle wasting from reduced perfusion –> liver cirrhosis induced by hypoperfusion or hepatic congestion –> anorexia from malnutrition –> cachexia

28
Q

how does left-sided HF present in CLASSIC S/S?

A

dyspnea w/ mild exertion, orthopnea, Paroxysmal nocturnal dyspnea, persistent dry cough, fatigue, inspiratory crackles 2° edema, S3 gallop, edema/weight gain, muscle weakness

29
Q

how does left-sided HF present in SEVERE S/S?

A

pleural effusion, peripheral cyanosis, ↑RR, ↓urine output, pink frothy sputum

30
Q

how does right-sided HF present?

A

abdominal pain/ascites, anorexia/nausea, fatigue, dependent edema (pitting), ↓urine output, hepatojugular reflex, hepatomegaly, elevated CVP, right atrial pressure, peripheral edema

31
Q

how does right-sided ventricular failure affect the left?

A

causes congestion of the peripheral tissues and viscera and impairs filling of the left

32
Q

how does left-sided ventricular failure affect the right?

A

causes increased stress on the right side of the heart

33
Q

what do you observe/look out for in regards to HF?

A

SOB, tachypnea at rest, jugular venous distention, paroxysmal nocturnal dyspnea, orthopnea, weight gain, fatigue/reduced exercise tolerance

34
Q

regarding HF, what would exercise test results look like?

A

exaggerated HR, HR fails to rise linearly or drops with incr. intensity, poor HR recovery after exercise (<12bpm down in first min) // SBP low peak or fails to rise linearly, falls w increasing workload and DBP may increase w exercise

35
Q

according to the NYHA, what is Class I for HF?

A

no limitation of physical activity, ordinary physical activity doesn’t cause symptoms

36
Q

according to the NYHA, what is Class II for HF?

A

slight limitation of physical activity, comfortable @ rest, ordinary physical activity causes symptoms

37
Q

according to the NYHA, what is Class III for HF?

A

marked limitation of physical activity, comfortable @ rest, less than ordinary activity causes symptoms

38
Q

according to the NYHA, what is Class IIIa for HF?

A

no dyspnea at rest

39
Q

according to the NYHA, what is Class IIIb for HF?

A

recent dyspnea at rest

40
Q

according to the NYHA, what is Class IV for HF?

A

severe limitation and discomfort with any physical activity, symptoms present even at rest

41
Q

according to the ACC/AHA, what is Stage A for HF?

A

high risk for developing CHF, no structural disorder of heart

42
Q

according to the ACC/AHA, what is Stage B for HF?

A

structural disorder of heart, never developed symptoms of CHF

43
Q

according to the ACC/AHA, what is Stage C for HF?

A

past or current symptoms of CHF, symptoms associated w underlying heart disease

44
Q

according to the ACC/AHA, what is Stage D for HF?

A

end stage disease, requires specialized treatment strategies

45
Q

what is the criteria for exercise in HF patients?

A

able to speak w/o S/S w/ RR <30 and

46
Q

what are the 3 phases of post-heart transplant medications? (immunosuppressive regimen)

A

induction, maintenance, management

47
Q

what is the induction phase of post-heart transplant meds?

A

high levels immediately post transplant paired with high dose corticosteroids

48
Q

what is the maintainence phase of post-heart transplant meds?

A

dosing of meds based on regular organ biopsy to look for cellular rejection, doses tapered to lowest possible levels

49
Q

what is the management phase of post-heart transplant meds?

A

management of acute rejection, occurs when immune system not adequately suppressed, increased doses of immunosuppressants

50
Q

what are the PT implications for post-heart transplant patients?

A

adequate warm up/cool down, monitoring exerise tolerance, monitor BP, infection control

Cardiopulmonary (9 decks)

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