Heart Failure

Question 1

Clinical Implications

Answer 1

¬ inc. Resting heart rate
¬ dec. Variability in HR and BP (i.e. blunted response)
¬ Autonomic dysfunction + endothelial dysfunction + inflammatory response
+ inc. catabolism > muscle ischemia >skeletal muscle myopathy

¬ dec. Peripheral blood flow
o Early fatigue
o Endurance rather than maximal strength lost

¬	Skeletal muscle atrophy
o	Oxidation changes
o	Mitochondrial changes inc. Type IIb (fast twitch)
o	dec. Type I (slow-twitch endurance)
o	Early anaerobic metabolism

Question 2

Which Patients are Suitable to Exercise?

- Suitable

Answer 2

• Stable on maximum medical management

Dilated cardiomyopathy of ischaemic or idiopathic origin

Question 3

Which Patients are Suitable to Exercise?

- Not Suitable

Answer 3

• Patients unable to cardiac output
• Hypertrophic obstructive cardiomyopathy (HOCM)
• Aortic stenosis
• Regurgitant valvular disease
• Diastolic dysfunction (poor filling of heart)
• If weight gain of > 2Kg over 2 days
in exercise tolerance or in SOBOE recently

Question 4

Type of Exercise

Answer 4

•	Hospital/home based exercise
•	Aerobic
•	Interval training
•	Intensity:
o	Low to moderate intensity 60% VO2 max
o	BORG scale (RPE) 9-13
o	BP

Question 5

Chronic Heart Failure - Causes of Improvements

Answer 5

• dec. Cardiovascular mortality for exercising patients vs. secondary controls
• dec. Hospital admission rate
• inc. Quality of life
• Increased strength of peripheral muscles
• Improvement in oxidative capacity of muscles
• Improved central haemodynamics
• Improved autonomic modulation
• dec. Inflammatory mediators (e.g. TNF alpha)

Question 6

Chronic Heart Failure -

At Rest:

Answer 6

•	dec. RHR
•	inc.  SV
•	inc.  LVEF (5%) - left ventricular ejection fraction
•	dec. LVED (diameter 4mm)
-left ventricle end-diastolic diameter

Question 7

Chronic Heart Failure -

During Exercise:

Answer 7

• dec. Mean total peripheral resistance

* inc. Mean SV