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Cardiopulmonary Test 1 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

heart failure

A

Inability of the heart muscle to pump blood to adequately meet the bodies needs for oxygen

Syndrome characterized by impaired cardiac pump function with inadequate systemic perfusion, and an inability to meet the bodies metabolic demands

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2
Q

pathophysiology of heart failure

A

injury to heart muscle

decrease myocardial contractility reducing the cardiac output

Reduction in cardiac output triggers RAAS
-Increase in renin and increase in angiotensin
-facilitates, sodium and water retention in renal tubules
-increases blood volume

sympathetic system is stimulated
-Increase the tone of blood vessels
-Increase contractility
-increase venous return

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3
Q

cardiac muscle hypertrophy and heart failure

A

Left ventricular muscle

Left ventricular failure is most common cause of increase in pulmonary capillary pressure

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4
Q

Pulmonary dysfunction

A

increase volume or volume overload

Impairs alveolar blood gas barrier
impairs diffusion across the alveolar membranes

Common clinical manifestation of heart failure is pulmonary edema

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5
Q

Pulmonary edema

A

Cardiogenic or non-cardiogenic

3 distinct stages

1-increase lymph flow, elevated capillary pressure, interstitial edema
2-alveolar edema, tachypnea, elevated PCWP
3- flooding of alveoli, hypercapnia, hypoxemia

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6
Q

heart failure, and liver

A

Impairs liver function
Hepatic venous congestion, hepatomegalty

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7
Q

Heart failure and pancreas

A

Reduces blood flow to pancreas

Impairs insulin secretion and glucose tolerance

Heart muscle depends on glucose metabolism

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8
Q

heart failure and blood

A

Polycythemia
Effect of anemia
Hemostasis- thrombocytopenia

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9
Q

Heart failure, and nutrition

A

malnutrition anorexia

protein calorie deficiency
Decrease production of a erythropoietin
Decreased synthesis of dihydroxycholecalciferol
Impaired intermediary metabolism

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10
Q

heart failure and skeletal muscle function

A

Myopathy

CHF without cardiomyopathy -decrease an average diameter of type one and type two

CHF with cardiomyopathy - type one and type two muscle fiber atrophy

Isometric muscle strength is reduced by 50%

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11
Q

Left sided heart failure

A

reduced cardiac output

Blood back up into left atrium and lungs

Shortness of breath and cough

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12
Q

Right sided heart failure

A

raised pulmonary artery pressure

Back up into right atrium and venous vasculature

raised jugular venous distention

peripheral edema

Fluid retention predominate

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13
Q

Biventricular heart failure

A

left ventricle pathology back up into lungs increasing PA pressure

Fluid back up into the right side of the heart

Fluid back up into the systemic venous vascular

Combination of SOB and peripheral edema

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14
Q

Left ventricular failure

A

Progressive dyspnea
Proximal nocturnal dyspnea

fatigue weakness
Enlarged heart
Pulmonary rales

Possible functional mitral, and tricuspid regurgitation

S3 heart gallop

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15
Q

right venticular failure

A

dependent edema
Hepatomegaly
Ascites
Anorexia, nausea, bloating

Right sided S3 or S4

Accentuated P2

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16
Q

risk factors of heart failure

A

hypertension
Coronary artery disease
Compromise cardiac muscle
Diabetes
dislipidemias
Hyperthyroidism
Sleep apnea
Aging

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17
Q

aging

A

Weight gain adipose tissue increase
impaired endothelium dependent vasodilation

left ventricular stiffness
vascular dysfunction
Impaired calcium regulation
Decreased beta adrenergic reserve
Deconditioning
decreased sympathetic nervous system

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18
Q

strong predictors of death with heart failure

A

Age
Renal function, blood pressure, blood sodium levels
Ventricular ejection fraction below 40%
Gender, diabetes
Elevated body mass index
Elevated brain natriueretic peptide level
poor Exercise capacity

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19
Q

Class one functional classification

A

Cardiac disease without limitations in physical activity

Ordinary physical activity does not cause undue, fatigue, palpitation, or dyspnea

Absence of dyspnea with daily activities

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20
Q

Class two functional classification

A

cardiac Disease resulting in slight limitation of physical activity

ordinary, physical activity can trigger symptoms of fatigue, palpitation, or dyspnea

Comfortable at rest

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21
Q

Class three functional classification

A

cardiac disease with marked limitation of physical activity

Less than ordinary activities, cause fatigue, palpitation, or dyspnea

Comfortable at rest

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22
Q

class 4 functional classification

A

Cardiac disease affecting the patient’s ability to carry out any physical activity without discomfort

Any physical activity increases symptoms

Symptoms of heart failure at rest

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23
Q

systolic failure

A

weakness in contraction of the ventricles

reduces stroke volume cardiac output, and EF

Heart failure with reduced ejection fraction

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24
Q

Diastolic failure

A

left ventricle is stiff and unable to relax

Reduced stroke volume and cardiac output

Ejection fraction is unaltered

Heart failure with preserved ejection fraction

25
Q

signs and symptoms of heart failure

A

dyspnea
fatigue
cough
ejection fraction reduced or preserved

ekg changes -
systolic-LVH
diastolic-RHV

26
Q

heart failure with reduced ejection fraction

A

Decreased ejection fraction

Heart failure with reduced cardiac output at rest and during during activity

27
Q

Heart failure with preserved ejection fraction

A

normal or near normal ejection fraction

More than 50% of heart failure, patient

Diastolic heart failure

Heart muscle stiffness and thickness

Typically occurs in older women

28
Q

In heart failure, increase in heart heart rate is associated with

A

Decrease in force of contraction

29
Q

Decrease in blood pressure with exercise indicates inability to

A

Maintain cardiac output

30
Q

S1

A

Closure of tricuspid and mitral valves

31
Q

S2

A

Closure of aortic and pulmonic valves

32
Q

S3

A

Heard in heart failure

33
Q

ECG diagnostic tool

A

History of ischemic disease
Abnormal ECG if ejection fracture is reduced

34
Q

Echocardiography diagnostic tool

A

Wall thickness
Chamber size
Left ventricular function

35
Q

chest x-rays diagnostic tool

A

cardiomegaly

Opacities from pulmonary edema

Blunting of costophrenic angle

36
Q

lab findings, diagnostic tool

A

Elevated brain natriuretic peptid BNP

Normal is <100 pg/mL
> 400 pg/mL indicative of heart failure

37
Q

non pharmacological management of heart failure

A

Oxygen therapy
Sleep management
Symptom recognition
Fluid overload
Activity
Exercise therapy

38
Q

pharmacological management of heart failure

A

Ace inhibitors
Angiotensin receptor blockers
ARNI
MRA
Diuretics
Beta blockers
ivabradine
Cardiac glycosides

39
Q

Exercise with patient with heart failure

A

exercise prescription
Aerobic exercise
Strength training
Ventilatory muscle training
Activity pacing and energy conservation
Education of patience

40
Q

Relative contraindications for exercise training

A

rapid increase in weight over 1 to 3 days

Supine, resting heart rate is greater than 100 bpm

Class 4 NYHA functional classification

Ventricular arrhythmias at rest or with exertion in the past three days

Decrease in SBP with exercise

41
Q

Absolute contraindications for exercise

A

significant angina at below 2 mets

New onset atrial fibrillation

42
Q

exercise prescription for patient with heart failure

A

Low level exercise if hemodynamically stable

Endurance training, systemic and peripheral O2 utilization

43
Q

Aerobic Exercise patient with heart failure

A

Low intensity, low impact
Start at 40% of THRR and progress to 60-80%

Gradual progression of intensity, frequency, and duration

Start with two times a week progressing towards 3 to 5 times a week

10 to 20 minutes gradually progressed to 30 to 40 minutes

Gradually progress on the scale from 9 to 14

44
Q

Strength training with a patient with heart failure

A

Low level resistance training

60 to 80% of one rep max
8 to 15 reps , one to three sets, three minutes of rest in between

Theraband for upper extremities
Lower extremity resistance with lightweights

45
Q

ventilatory muscle training

A

Breathing exercises

Diaphragmatic breathing
Pursed Lip breathing
Positive positive and expiratory pressure
Threshold inspiratory muscle trainer

46
Q

Activity pacing and energy conservation with heart failure

A

take frequent rest intervals

Participate in activities, which consume more energy when the patient has more energy

Avoid and delegate some activities

Alternate easy and difficult tasks

sit between Strenuous activities

47
Q

heart failure with reduced ejection fraction and pharmacological management

A

Medication to improve contractility
Medication to decrease cardiac workload

48
Q

Heart failure with preserved ejection fraction and pharmacological management

A

medication trials have not found significant positive responses

Medications to manage comorbidities

49
Q

Acute heart failure in pharmacological management

A

Decrease fluid buildup

50
Q

ACE inhibitors

A

for HFrEF

enalapril and captopril

Block conversion of angiotensin one to angiotensin two

Adverse effects, dry cough and rash

51
Q

angiotensin receptor blockers

A

for HFrEF

iosartan and valsartan

prevents angiotensin 2 from binding to receptors

adverse- slight risk of angioedema, hyperkalemia

alternate to ace id unable to tolerate them

52
Q

angiotensin receptor neprilysin inhibitors

A

for HFrEF

entresto

inhibits neprilysin and blocks angiotensin 2

adverse- hyperkalemia, renal failure, angioedema with overlap of aceis and arbs

53
Q

mineralocorticoid receptor antagonists

A

spironolactone and eplerenone

block aldosterone receptors in kidney

adverse- impotence and gynecomastia

54
Q

diuretics

A

inhibits reabsorption of sodium which decreases water reabsorption

loop diuretics
thiazide diuretics
potassium sparing diuretics

adverse- electrolyte imbalance, dehydration, monitor for OH

55
Q

beta blockers

A

Reduce heart rate

Decrease cardiac workload and prevent arrhythmias

Adverse - hypotension, blunts heart rate with exercise

56
Q

if channel blocker

A

indicated for patients with symptomatic HFrEF; LVEF<35% and HF >70bpm

Inhibits the pacemaker current of the SA node

Reduces heart rate without affecting the force of contraction of the heart or lower BP

Adverse - blurred vision, bradycardia, and headaches

57
Q

cardiac glycosides

A

Inhibits the sodium pump indirectly promoting calcium influx, improving the heart muscles ability to contract

Adverse effects, arrhythmias and bradycardia

58
Q

medication not recommended for heart failure with reduced ejection fraction

A

statins

oral anticoagulant and anti-platelet medications

Calcium channel blockers

Cardiopulmonary Test 1 (10 decks)

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