Heart Failure: Exam 1 Flashcards
ALWAYS has a cause
“Heart Pump Failure”
HF
L Sided HF caused by
HTN
R or L HF caused by
MI
Congen Heart Dis
Pericarditis, Endocarditis, Myocarditis
RV CHF
PE
Pulm Dis and Pulm HTN
Causes of HF
HTN
L. side HF
- prolonged HTN== irrev damage== sub-opt actin-myosin crossbridge== less effective heart pump
Causes of HF
MI
R or L HF
Zone of Necrosis is dead non-contract tissue==> heart pump dysf.
Causes of HF
Congenital Heart Dis
R or L HF
incompetent valves, septal defect, holes in heart, hypertrophied LV==> alters dir. blood flow==> incd demand on heart==> heart pump dysf
HF Causes
Pericarditis, Endocarditis, Myocarditis
- infection of one of layers of heart causes myocardial damage==> less effective heart pump
Causes of HF
PE
RV CHF
- elevated pulm artery pressures==> irrev damage to RV==> sub opt actin-myosin crossbridge ==> less effective RV heart pump (cor pulmonale)
HF Causes:
Pulm Disease and Pulm HTN
RV CHF
- inc’d pulm cap pressure== elevated pulm aa pressures== irrev damage to RV== subopt actin-myosin crossbridge== less effective RV heart pump (cor pulmonale)
Heart not ejecting as much blood as it should===>
Heart “pump” Failure
Cardiac MM and the Frank Starling Law
relationship b/w length and tension of heart
when the curve starts to DEC==CHF
Normal curve should be INC SV, INC EDV (proportional)
Frank Starling Ex. W/ HF
see pics
Frank Starling Ex w/ HF
NOTE: compensatory tachycardia
Classification of HF:
HF w/ reduced EF or
Systolic Dysf
HFEF <40%
NOTE: EF=SV/EDV
- MORE common
- heart stretches
- INC EDV
- DEC SV
Class. HF
HF w/ Preserved EF or
Diastolic Dysf
HFpEF
- take vitals more often***
- has DEC SV
- issue is DEC EDV during Diastole
- tend to be w/ medically fragile people
L.Sided HF
can cause R sided HF
- 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
R. sided HF
cor pulmonale
DEC preload (vent filling, blood returning)
- 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
L. sided HF what edema more likely
Pulmonary edema
LV not working and fluid builds up (BACK TO LUNGS)
S/S CHF
- 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
- usually RHF
- 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
Inc’d peRiph edema
Inc’d abd. edema
R. HF
PuLm edema
L HF
MORE common abnorm heart sound
S3
early diastole—vents filling
“thud”
Dx== CHF/cardiomyopathy, restricted vent
LESS common abnorm heart sound
S4
late diastole (during atrial systole)
uncommon
Subgroup of HF:
Cardiomyopathy
what is impaired?
contract/relax of myocardial mm fibers impaired
diff b/w HF and Cardiomyopathy
HF: all due to a cause
Cardiomyopathy: from heart alone
Cardiomyopathy:
primary causes
-
patho. process IN heart mm
-
Genetic hypertrophic cardiomyopathy
- athlete’s hearts
- prolonged QT syndrome
- Myocarditis
-
Genetic hypertrophic cardiomyopathy
Cardiomyopathy:
Secondary Causes
-
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
Types of Cardiomyopathies
see pics
Sx’s Cardiomyopathy
generally same as HF
- SOB
- orthopnea
- JVD
- periph edema
- tachycardia
- Hypertrophic cardiomyopathy tend to be asymptomatic****
Cardiomyopathy:
Prognosis and Med mgmt
**Ea. cause has its own prognosis**
- can not be “cured” medically
- CAN be treated w/ same pharma mgmt as CHF
- LIFE SAVING MEASURES:
- LVAD, IABP, heart transplant
Cardiomyopathy and PT
-
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
CHF:
Dx
Lab Findings in CHF:
- BNP=== R vent myocardium
- Cr: Creatinine
CHF:
DX
Echocardiography
- 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
- 2.7-4.0L/min/m2
New York Heart Association (NYHA) Functional Class. of Breathlessness
For HF pts
NYHA Classes I-IV
CHF: Tx
Med Mgmt
- 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
-
if arrhythmias OR @ risk for acute HF
CHF Tx:
Lifestyle Alterations
- control or DEC sodium intake
- RESTRICT H2O intake
- fluid restricts
CHF
Prognosis
SLOW PROGRESSION
- 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
CHF
Sx Mgmt
- 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
CHF: PT Exam
- QOL in CHF
- Minnesota Living w/ HF Questionnaire
- Depression—> assoc’d w/ INCd risk functional decline
- 6min Walk Test
- Vitals!!!
- esp resp to ex.
PT Interventions for CHF
NYHA Class II and III are Cardiac Rehab Pts
Summary of Interventions for CHF:
In general
- LOW int
- LOW duration
- HIGH freq
- Progress duration and freq BEFORE intensity
- Aerobic AND Strength components!
Summary of Interventions for CHF w/ LVAD
- Obtain clear baseline of endurance
- before and since LVAD
- progress int, duration, freq as tol’d
- Values obtained on LVAD cent monitor
Summary of intervents for CHF:
Expiratory mm training
exp mm training
breathing against resist
Summary intervents for CHF
Inspiratory mm training
Insp mm trainig
breathing IN against resist to work diaphragm
intervents for CHF:
Energy conservation
do everything in segments and rest
intervents for CHF
Self-mgmt tech’s – resp for own health
Lifestyle mods***
PT Education for CHF:
Energy Conservation
DEC workload on heart w/out LOF
CHF Self Mgmt Tech’s
monitor wt same time/day
contact MD when change >= 3lbs
monitor # pillows needed for sleeping –> orthopnea
monitor sx’s w/ activty and rest
Vital signs and CHF:
- HR
- BP
- O2 sats
- RPE Borg
- RR
- **Must take BP often
- **Use RPE if on Beta Blocker
MET Lvls:
Met. Equiv of Task
see pics
*remember Frank Starling—-they can start crashing when reach certain point and SBP starts to DROP!!!
Frank Starling Law
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
pulm aa’s carry
DeO2 blood TO lungs
Blood circ===
TPMA
Toilet Paper My Ass
SV==
EDV-ESV
blood pumped FROM L vent/beat
EF==
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
Orthopnea w/ HF Example
see pics
Preload===
EDV
initial stretch of myocytes PRIOR to contraction
ventricular FILLING
blood returning
Afterload===
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
