Heart Failure And Pulmonary Hypertension

Question 1

Describe benefits of a comprehensive Mx strategy for cardiac patients

Answer 1

Optimise physical, psychological and social functioning
Encourages Self Mx
Facilitates behaviour change

Question 2

List precautions and contraindications to exercise testing and training for patients with cardiovascular disorders

Answer 2

Precautions - >2kg body weight in past 1-3 days, decreased SBP with exercise, NYHA class IV or deteriorated to III, supine HR >100, SBP 120bpm, large or complicated MI in last three weeks, severe aortic stenosis, new onset atrial fibrillation

Question 3

Describe the exercise tests used for patients with cardiovascular disorders

Answer 3

MAX - exercise stress test (graded to find abnormal BP response or exercise induced ischaemia), cardiopulmonary exercise test (EST plus VO2 analysis)

SUBMAX - sub maximal cycle test (85% APHRM, is myocardial ischaemia present after MI), 6MWT, Shuttle test (85%APHRM or RPE of 15)

Question 4

Discuss strategies to address the prevention and modifications of risk factors for cardiovascular disease

Answer 4

Encourage self Mx
Patient-set goals
Use laymans terms when educating
Multimodal therapy and education
Multidisciplinary team

Question 5

Describe other outcome measures that may be used with people with cardiac disorders

Answer 5

New York heart association classification
BORG RPE
QOL (Minnesota living with heart failure questionnaire)

Question 6

Describe the adaptations achieved by exercise training

Answer 6

Decreased BP at rest
Decreased insulin resistance
Increased cardiac output
Cholesterol control
Improved peripheral oxygen extraction
Decreased myocardial oxygen demand
Increased fitness and strength

Question 7

Prescribe exercise for cardiac patients

Answer 7

F - 3x week aim for 7/7
I - 60-80%HRR or 11-13 RPE “light - somewhat hard”
T - 15-20 min aim for 45-60
T - large mm groups

strength training

Increase duration, frequency then intensity

Question 8

Nitrates

Answer 8

“Trates”
Use - angina
Action - vasodilation
Side effects - BP, syncope

Question 9

Beta blockers

Answer 9

“Lol”
Use - hypertension, Arrythmias, angina
Action - vasodilation, decreased heat contractility
Side effects - decreased resting and exercise HR

Question 10

Ace inhibitors

Answer 10

“Pril”
Use - hypertension, congestive HF
action - prevent peripheral vasoconstriction
Side effects - hypotension, GI upset

Question 11

Cardiac Glycosides

Answer 11

“D” or “oxide”?
Use - congestive HF, treat supra ventricular tachydysarthrythmias
Action - decrease HR, increase force of contraction
Side effects - hallucinations, ECG changes

Question 12

Diuretics

Answer 12

Use - pulmonary or peripheral oedema, hypertension etc

Action - increased fluid loss

Question 13

Statins

Answer 13

“Statin”
Use - cholesterol lowering
Side effect - mm weakness and pain