Heart Failure Flashcards
What is heart failure?
inability of the heart to maintain cardiac output to meet metabolic demands of the tissue to due abnormality of the heart muscles
what is the immediate consequence of heart failure?
SOB - feels like we’re drowning in our own lungs as fluid starts to leak out and blocks alveoli from fully expanding
Pulmonary Edema is associated w/ Heart Failure why?
because of the fluid being leaked out of the alveoli / blood vessels
what are the etiologies of HF?
HTN, CAD**, infections more common
what is cardiomyopathy?
sickness of the heart muscle
what does the heart muscle look like with cardiomyopathy?
dilated, hypertrophic, restrictive
what are the major clinical risk factors for HF?
age, gender(females), HTN, MI, diabetes, obesity, COPD
what are minor clinical risk factors for HF?
smoking, CKD, diet, sedentary lifestyle, low socioeconomic status / psychological stress
what are toxic risk factors for HF?
chemo, cocaine, excess alcohol
what is the process of HF?
risk factors –> vascular dysfunction –> vascular disease –> tissue injury (MI, HTN) –> pathologic remodeling –> organ dysfunction –> organ failure
is left vs right sided HF more common?
left
recall, what is the ejection fraction?
percentage of blood expelled w each LV contraction (about 50-75%)
What are the characteristics of Systolic HF?
HF w reduced EF, LV loses ability to contract normally, can’t pump w enough force to push sufficient blood into circulation, ventricles enlarged
what are the characteristics of Diastolic HF?
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
what are causes of systolic HF?
CAD, MI, ischemia, HTN, stenotic valve disease, regurgitant valve disease, chronic lung disease, familial/genetic, chronic arrhythmias
what are causes of diastolic HF?
pathologic hypertrophy, aging, restrictive cardiomyopathy, fibrosis
how does HTN lead to HF?
HTN produces overload on LV –> hypertrophies in compensation –> reduced LV compliance –> left atrial enlargement –> ischemia and ventricular arrhythmias
what is the connection between ventricular function and frank starling’s law?
increased venous return –> increased EDV –> increased preload –> initial stretch –> greater force generation –> increased SV
what is the connection between HF and frank starling’s law?
increased venous return –> increased EDV –> dilated ventricle –> increased stretch –> reduced force generation - reduced SV
what is the inotropic effect?
any mechanism that affects contractility of the heart
what are positive inotropic effects?
↑ strength of contraction (sympathetic, cardiac meds, optimized preload)
what are negative inotropic effects?
reduced strength of contraction (parasymp., dialtion of heart chambers)
characteristics of acute HF?
decompensated, rapid changes in S/S, associated w traumatic event, rapid shift of blood volume from systemic to pulmonary edema, acute sympoms
characteristics of chronic stable HF?
compensated, unchanged S/S >= a month, compensatory mechanisms attempt to restore CO
what is the compensatory mechanism
Initial body response to change in ventricular ability to maintain cardiac output
consequences of compenstory mechanism?
increased stress on ventricular function, dilation, reduced limb blood flow
what are the systemic effects of HF?
↓ 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
how does left-sided HF present in CLASSIC S/S?
dyspnea w/ mild exertion, orthopnea, Paroxysmal nocturnal dyspnea, persistent dry cough, fatigue, inspiratory crackles 2° edema, S3 gallop, edema/weight gain, muscle weakness
how does left-sided HF present in SEVERE S/S?
pleural effusion, peripheral cyanosis, ↑RR, ↓urine output, pink frothy sputum
how does right-sided HF present?
abdominal pain/ascites, anorexia/nausea, fatigue, dependent edema (pitting), ↓urine output, hepatojugular reflex, hepatomegaly, elevated CVP, right atrial pressure, peripheral edema
how does right-sided ventricular failure affect the left?
causes congestion of the peripheral tissues and viscera and impairs filling of the left
how does left-sided ventricular failure affect the right?
causes increased stress on the right side of the heart
what do you observe/look out for in regards to HF?
SOB, tachypnea at rest, jugular venous distention, paroxysmal nocturnal dyspnea, orthopnea, weight gain, fatigue/reduced exercise tolerance
regarding HF, what would exercise test results look like?
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
according to the NYHA, what is Class I for HF?
no limitation of physical activity, ordinary physical activity doesn’t cause symptoms
according to the NYHA, what is Class II for HF?
slight limitation of physical activity, comfortable @ rest, ordinary physical activity causes symptoms
according to the NYHA, what is Class III for HF?
marked limitation of physical activity, comfortable @ rest, less than ordinary activity causes symptoms
according to the NYHA, what is Class IIIa for HF?
no dyspnea at rest
according to the NYHA, what is Class IIIb for HF?
recent dyspnea at rest
according to the NYHA, what is Class IV for HF?
severe limitation and discomfort with any physical activity, symptoms present even at rest
according to the ACC/AHA, what is Stage A for HF?
high risk for developing CHF, no structural disorder of heart
according to the ACC/AHA, what is Stage B for HF?
structural disorder of heart, never developed symptoms of CHF
according to the ACC/AHA, what is Stage C for HF?
past or current symptoms of CHF, symptoms associated w underlying heart disease
according to the ACC/AHA, what is Stage D for HF?
end stage disease, requires specialized treatment strategies
what is the criteria for exercise in HF patients?
able to speak w/o S/S w/ RR <30 and
what are the 3 phases of post-heart transplant medications? (immunosuppressive regimen)
induction, maintenance, management
what is the induction phase of post-heart transplant meds?
high levels immediately post transplant paired with high dose corticosteroids
what is the maintainence phase of post-heart transplant meds?
dosing of meds based on regular organ biopsy to look for cellular rejection, doses tapered to lowest possible levels
what is the management phase of post-heart transplant meds?
management of acute rejection, occurs when immune system not adequately suppressed, increased doses of immunosuppressants
what are the PT implications for post-heart transplant patients?
adequate warm up/cool down, monitoring exerise tolerance, monitor BP, infection control
