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CardioPulmoaryPT1 > Heart Failure: Exam 1 > Flashcards

Heart Failure: Exam 1 Flashcards

1
Q

ALWAYS has a cause

“Heart Pump Failure”

A

HF

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2
Q

L Sided HF caused by

A

HTN

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3
Q

R or L HF caused by

A

MI

Congen Heart Dis

Pericarditis, Endocarditis, Myocarditis

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4
Q

RV CHF

A

PE

Pulm Dis and Pulm HTN

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5
Q

Causes of HF

HTN

L. side HF

A
  • prolonged HTN== irrev damage== sub-opt actin-myosin crossbridge== less effective heart pump
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6
Q

Causes of HF

MI

R or L HF

A

Zone of Necrosis is dead non-contract tissue==> heart pump dysf.

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7
Q

Causes of HF

Congenital Heart Dis

R or L HF

A

incompetent valves, septal defect, holes in heart, hypertrophied LV==> alters dir. blood flow==> incd demand on heart==> heart pump dysf

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8
Q

HF Causes

Pericarditis, Endocarditis, Myocarditis

A
  • infection of one of layers of heart causes myocardial damage==> less effective heart pump
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9
Q

Causes of HF

PE

RV CHF

A
  • elevated pulm artery pressures==> irrev damage to RV==> sub opt actin-myosin crossbridge ==> less effective RV heart pump (cor pulmonale)
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10
Q

HF Causes:

Pulm Disease and Pulm HTN

RV CHF

A
  • inc’d pulm cap pressure== elevated pulm aa pressures== irrev damage to RV== subopt actin-myosin crossbridge== less effective RV heart pump (cor pulmonale)
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11
Q

Heart not ejecting as much blood as it should===>

A

Heart “pump” Failure

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12
Q

Cardiac MM and the Frank Starling Law

A

relationship b/w length and tension of heart

when the curve starts to DEC==CHF

Normal curve should be INC SV, INC EDV (proportional)

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13
Q

Frank Starling Ex. W/ HF

A

see pics

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14
Q

Frank Starling Ex w/ HF

A

NOTE: compensatory tachycardia

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15
Q

Classification of HF:

HF w/ reduced EF or

A

Systolic Dysf

HFEF <40%

NOTE: EF=SV/EDV

  • MORE common
  • heart stretches
  • INC EDV
  • DEC SV
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16
Q

Class. HF

HF w/ Preserved EF or

A

Diastolic Dysf

HFpEF

  • take vitals more often***
  • has DEC SV
  • issue is DEC EDV during Diastole
  • tend to be w/ medically fragile people
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17
Q

L.Sided HF

can cause R sided HF

A
  • LV weakens, cannot empty=== diastolic or systolic dysf
  • DEC CO to system/DEC SV from LV
  • DEC renal blood flow stims RAS an aldosterone secretion
    • ​INC blood vol and vasodilation
  • backup of blood into pulm vein
  • HIGH press in pulm caps leads to pulm congestion or edema
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18
Q

R. sided HF

cor pulmonale

DEC preload (vent filling, blood returning)

A
  • RV weakens and cannot empty
  • DEC CO to system, DEC SV from RV, DEC blood TO LV
  • DEC renal blood flow stims RAS and aldosterone
  • backup of blood into systemic circ (vena cava)
  • INC venous press results in edema in legs, liver, an abd organs
  • VERY HIGH venous press causes distended neck vein an cerebral edema
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19
Q

L. sided HF what edema more likely

A

Pulmonary edema

LV not working and fluid builds up (BACK TO LUNGS)

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20
Q

S/S CHF

A
  • Fatigue
  • angina
  • pulses alternans: altering pulse/diminished pulse
  • periph extremities
    • cold, pale, cyanotic
  • Pulm edema
    • ​usually LHF
  • Periph edema
    • ​usually RHF
      • ​​lower legs/abd’s
  • Wt. gain
    • as tot. body fluid vol inc’s—so does BW
  • LOW BP
  • Sinus Tachy
  • DEC ex tol.
  • Dyspnea
    • @ rest
    • paroxysmal nocturnal dyspnea: SOB @ night
    • ​orthopnea
  • JVD
    • RHF
  • Auscultation
    • crackles
  • Presence of S3 or S4
  • Myopathy
  • Nocturia—> pee during night
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21
Q

Inc’d peRiph edema

Inc’d abd. edema

A

R. HF

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22
Q

PuLm edema

A

L HF

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23
Q

MORE common abnorm heart sound

A

S3

early diastole—vents filling

“thud”

Dx== CHF/cardiomyopathy, restricted vent

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24
Q

LESS common abnorm heart sound

A

S4

late diastole (during atrial systole)

uncommon

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25
Q

Subgroup of HF:

Cardiomyopathy

what is impaired?

A

contract/relax of myocardial mm fibers impaired

26
Q

diff b/w HF and Cardiomyopathy

A

HF: all due to a cause

Cardiomyopathy: from heart alone

27
Q

Cardiomyopathy:

primary causes

A
  • patho. process IN heart mm
    • ​Genetic hypertrophic cardiomyopathy
      • athlete’s hearts
    • prolonged QT syndrome
    • Myocarditis
28
Q

Cardiomyopathy:

Secondary Causes

A
  • results of systemic dis processes
    • ​pregnancy induced
    • stress induced—-broken heart synd “tako tsubo”—post meno women
    • amyloidosis
    • genetic hemochromatosis
    • drug, alco, hvy metals, chemo induced
    • sarcoidosis
    • DM/thyroid storm
    • progress. NMSK dis’s
    • radiation
29
Q

Types of Cardiomyopathies

A

see pics

30
Q

Sx’s Cardiomyopathy

A

generally same as HF

  • SOB
  • orthopnea
  • JVD
  • periph edema
  • tachycardia
  • Hypertrophic cardiomyopathy tend to be asymptomatic****
31
Q

Cardiomyopathy:

Prognosis and Med mgmt

**Ea. cause has its own prognosis**

A
  • can not be “cured” medically
  • CAN be treated w/ same pharma mgmt as CHF
  • LIFE SAVING MEASURES:
    • LVAD, IABP, heart transplant
32
Q

Cardiomyopathy and PT

A
  • Monitor Vitals to det. approp ex intensity
    • TERM if SBP drops!
    • and/or if DBP INCs >= 10mmHg
  • improved ex. tolerance may be demo’d by little change in HR and BP and fatigue
33
Q

CHF:

Dx

Lab Findings in CHF:

A
  • BNP=== R vent myocardium
  • Cr: Creatinine
34
Q

CHF:

DX

Echocardiography

A
  • LVEF== L vent ejection fraction
    • norm== 65%
  • structure of heart
  • pressures of vents
  • Pulm AA Press
    • aorta==120/80
  • CO== HR*SV
    • Norm== 4-6L/min
  • CI: Cardiac Index
    • 2.7-4.0L/min/m2
      • >2.2 == cardiogenic shock==acute heart failure
35
Q

New York Heart Association (NYHA) Functional Class. of Breathlessness

For HF pts

A

NYHA Classes I-IV

36
Q

CHF: Tx

Med Mgmt

A
  • directed @ underlying causes
  • + Inotropic drugs
    • ​improve heart pump
  • Beta Blockers
    • ​DEC excitability of heart and optimize Preload (EDV)
  • Diuretics, ACE inhibs, Alpha antagonist
    • ​Reduce AFTERload
  • Pacemakers and AICD
    • if arrhythmias OR @ risk for acute HF
      • ​cardiogenic shock
37
Q

CHF Tx:

Lifestyle Alterations

A
  • control or DEC sodium intake
  • RESTRICT H2O intake
    • fluid restricts
38
Q

CHF

Prognosis

SLOW PROGRESSION

A
  • Sig predictors of Lack of Survival:
    • DECing LVEF
    • WORSENING NYHA funct. status
    • Arrythmias or Dysrhythmias
    • Renal insuff.
    • intol to med mgmt
    • Immobility
    • QOL
    • Quads mm strength
39
Q

CHF

Sx Mgmt

A
  • Intra-Aortic Balloon Pump
    • works OPP L vent
  • LVAD
    • 6-8000 RPM to keep blood pumping
    • NOT working w/ L vent
  • BiVAD
    • cannot leave hospital
    • NO PULSE
  • Heart Transplant
40
Q

CHF: PT Exam

A
  • QOL in CHF
    • Minnesota Living w/ HF Questionnaire
    • Depression—> assoc’d w/ INCd risk functional decline
  • 6min Walk Test
  • Vitals!!!
    • esp resp to ex.
41
Q

PT Interventions for CHF

A

NYHA Class II and III are Cardiac Rehab Pts

42
Q

Summary of Interventions for CHF:

In general

A
  • LOW int
  • LOW duration
  • HIGH freq
  • Progress duration and freq BEFORE intensity
  • Aerobic AND Strength components!
43
Q

Summary of Interventions for CHF w/ LVAD

A
  • Obtain clear baseline of endurance
    • ​before and since LVAD
  • progress int, duration, freq as tol’d
  • Values obtained on LVAD cent monitor
44
Q

Summary of intervents for CHF:

Expiratory mm training

A

exp mm training

breathing against resist

45
Q

Summary intervents for CHF

Inspiratory mm training

A

Insp mm trainig

breathing IN against resist to work diaphragm

46
Q

intervents for CHF:

Energy conservation

A

do everything in segments and rest

47
Q

intervents for CHF

A

Self-mgmt tech’s – resp for own health

Lifestyle mods***

48
Q

PT Education for CHF:

Energy Conservation

A

DEC workload on heart w/out LOF

49
Q

CHF Self Mgmt Tech’s

A

monitor wt same time/day

contact MD when change >= 3lbs

monitor # pillows needed for sleeping –> orthopnea

monitor sx’s w/ activty and rest

50
Q

Vital signs and CHF:

A
  • HR
  • BP
  • O2 sats
  • RPE Borg
  • RR
  • **Must take BP often
  • **Use RPE if on Beta Blocker
51
Q

MET Lvls:

Met. Equiv of Task

A

see pics

*remember Frank Starling—-they can start crashing when reach certain point and SBP starts to DROP!!!

52
Q

Frank Starling Law

A

more the vent mm’s are stretched== more forcefully they will contract

SV of L vent INCs as L vent volume INCs due to myocyte stretch===> more powerful systolic contract

53
Q

pulm aa’s carry

A

DeO2 blood TO lungs

54
Q

Blood circ===

A

TPMA

Toilet Paper My Ass

55
Q

SV==

A

EDV-ESV

blood pumped FROM L vent/beat

56
Q

EF==

A

SV/EDV *100

how much blood L vent pumps out w/ ea contraction

ex. 60% EF means 60% tot amt of blood in L vent is pushed OUT w/ ea beat

57
Q

Orthopnea w/ HF Example

A

see pics

58
Q

Preload===

A

EDV

initial stretch of myocytes PRIOR to contraction

ventricular FILLING

blood returning

59
Q

Afterload===

A

TPR

*INC TPR==DEC SV*

Force or load AGAINST which heart has to contract to eject blood

**blood ejected out from pressure generated in vents

60
Q
A

CardioPulmoaryPT1 (12 decks)

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