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536 Body Systems > Pathology - Heart Failure/Myopathy > Flashcards

Pathology - Heart Failure/Myopathy Flashcards

1
Q

CMD

A

cardiac muscle dysfunction
loss of function or cardiac structure
ex) CHF, heart failure, cardiac conditions, etc - pump fails and heart can’t meet body’s demands

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2
Q

Hypertension - how it causes CMD

A

increased aa. pressure causes ventricular hypertrophy, stretching fibers and decreasing effectiveness of pump

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3
Q

CAD/MI - how it causes CMD

A

ischemia causes dysfunction of ventricles

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4
Q

cardiac arrhythmias - how it causes CMD

A

heart beating out of rhythm can impair ventricle function

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5
Q

renal insufficiency - how it causes CMD

A

acute or chronic, fluid overload due to excess reabsorption of fluid by the kidneys

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6
Q

cardiomyopathy - how it causes CMD

A

impaired contraction/relaxation of myocardium
from pathology or result of systemic disease
primary: genetic/acquired
secondary: infiltrative, storage, toxicity, inflammatory

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7
Q

types of cardiomyopathy

A

dilated
hypertrophic
restrictive
+ primary vs secondary

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8
Q

dilated cardiomyopathy

+ causes

A

enlarged ventricle causes systolic dysfunction
causes: idiopathic, uncontrolled HTN, genetic, inflammatory, toxic, metabolic, pregnancy

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9
Q

hypertrophic cardiomyopathy

A

abnormal L ventricular wall thickness, causes diastolic dysfunction
causes: genetic

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10
Q

restrictive cardiomyopathy

A

abn L ventricular wall stiffness, diastolic dysfunction
causes: infiltrates damaging heart’s ability to relax

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11
Q

primary cardiomyopathy

A

inherited
younger onset
genetic, mixed, or acquired

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12
Q

secondary cardiomyopathy

A

caused by a medical condition

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13
Q

dilated cardiomyopathy s/s

A

symptoms of HF
reduced EF
S3 heart sounds
mitral valve regurgitation
crackles/dullness to percussion
enlarged heart on imaging

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14
Q

hypertrophic cardiomyopathy s/s

A

varying symptoms, presents around age 20
dyspnea
angina
arrhythmia
syncope
S4 heart sound

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15
Q

restrictive cardiomyopathy s/s

A

decreased CO
fatigue
reduced exercise tolerance
systemic edema -> JVD, ascites, peripheral edema
arrhythmias

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16
Q

congenital heart disease - how it causes CMD

A

incompetent/blocked valves makes heart work harder

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17
Q

pulmonary embolism - how it causes CMD

A

increased pulmonary artery pressure increases R ventricle work
treat with rapid fibrinolytic or embolectomy

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18
Q

age related changed - how it causes CMD

A

decreased CO bc of altered contraction/relaxation
higher prevalence of heart disease

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19
Q

HF stages by EF

A

HF w reduced EF (HFrEF) - <40%
HF w mildly reduced EF (HFmrEF) <41-49%
HF w preserved EF (HEpEF) - > 50%
HF w improved EF (HFImpEF) baseline <40% improving

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20
Q

relationship between contractility, CO, EDV

A

increased EDV results in greater contractility
with heart failure contractility decreases, decreasing SV -> CO

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21
Q

3 heart failure etiologies

A

impair cardiac contractility
increase afterload (systolic dysfunction)
impaired ventricular relaxation/filling (diastolic dysfunction)

22
Q

impaired cardiac contractility

A

reduction in cardiac muscle mass
cardiomyopathy, MI

23
Q

increased afterload

A

caused by HTN or valve stenosis
these both cause ventricular hypertrophy

24
Q

impaired ventricular relaxation/filling

A

increased stiffness in ventricle or hypertrophy of the ventricle
MI, mitral/tricuspid valve stenosis, diseased pericardium

25
Q

heart failure etiologies - how does each specific disease cause heart failure?
HTN
CAD/MI
Dysrhythmia
Renal Insufficiency
Cardiomyopathy
Valve abnormality
Pericardial effusion
Pulmonary Embolism
Pulmonary HTN

A

HTN - increased pressure causes ventricle hypertrophy, pump less effective
CAD/MI - damage to L ventricle
Dysrhythmia - poor timing impairs ventricle fx/emptying
Renal Insufficiency - fluid overload
Cardiomyopathy - damaged ventricle
Valve abnormality - increase a. P or decrease emptying
Pericardial effusion - impaired contraction
Pulmonary Embolism - increased work of R ventricle
Pulmonary HTN - increased afterload on R ventricle

26
Q

What category of heart failure is HFrEF?

A

systolic dysfunction
L ventricle has reduced capacity to pump blood due to contractility, ventricle stretch, or afterload

27
Q

What category of heart failure is HFpEF?

A

diastolic dysfunction
filling issue due to stiffness of ventricle/hypertrophy

28
Q

S/S of L sided heart failure - diastolic

A

dyspnea
cardiac asthma
pulmonary edema
frothy cough (hemoptysis)
can’t breathe when lying down (orthopnea)
rales/wheezing, sputum cytology
presystolic gallop
protodastolic gallop
cold extremities
oliguria

29
Q

S/S of L sided heart failure - systolic

A

exercise intolerance
fatigue
decreased physical/mental performance
nocturia
rales/wheezing, sputum cytology
presystolic gallop
protodastolic gallop
cold extremities
oliguria

30
Q

S/S of R sided heart failure

A

symptoms:
PVD
peripheral edema
LE edema/bodily swelling
nausea/vomiting
upper abdominal pain
nocturia
signs:
increased central venous pressure
hepatomegaly reflux
congestive hepatomegaly
ascites
proteinuria
4th heart sound

31
Q

findings to both sides of heart failure

A

tachypnea
tachycardia
peripheral cyanosis
cardiomegaly
pleural effusion
cachesia (thin)

32
Q

AHA classification of heart failure

A

Stage A: at risk
Stage B: structural heart disease, no symptoms
Stage C: clinical heart failure
Stage D: refractory heart failure needing advanced intervention

33
Q

compensated heart failure

A

diagnosed heart failure without symptoms of pulmonary or peripheral congestion
stages 1-3 or a-c
few symptoms

34
Q

acute uncompensated heart failure

A

new or worsening symptoms
dyspnea, fatigue, edema, weight gain, chest pain, exercise intolerance
leads to hospitalization

35
Q

how does decreased CO from HF cause peripheral and pulmonary congestion?

A

decreased CO causes increased ADH, renin angiotensin, and sympathetic output
vasoconstriction increases w circulating volume to increased preload, leading to accumulation in venous system as heart can’t keep up with load

36
Q

How is the renal system affected by heart failure?

A

decreased CO leads to fluid and Na retention, loading the kidneys
kidneys are also poorly perfused w O2

37
Q

How does HF affect pulmonary function?

A

increased fluid in lungs impairing gas exchange

38
Q

How does HF affect liver function?

A

fluid overload congests hepatic vein
poor perfusion of O2 to liver causing cirrhosis

39
Q

How does HF affect skeletal muscle function?

A

increased weight of limbs
poor perfusion
atrophy
poor exercise tolerance

40
Q

How does HF affect pancreas function?

A

poor perfusion
impaired insulin secretion
impaired energy metabolism

41
Q

medical management of HF includes:

A

lifestyle change - activity, nutrition, smoking/alc/drugs
Pharm - diuretics, beta blockers, etc
Mechanical - pacemaker, LVAD, etc
surgery - repair valves, transplant, CABG
dialysis

42
Q

PT exam for HF patient

A

vitals
breathing rate/rhythm
orthopnea
heart/lung sounds
peripheral edema
assess exercise tolerance/fxal capacity
cognition
nutritional status

43
Q

pitting edema scale

A

0+-4+
1+ 2 mm depression, doesn’t last
2+ 4mm depression, 10-15 s
3+ 6mm depression, 1+ min
4+ 8mm depression, 2+ min

44
Q

Should a HF pt with no SOB, swelling, weight gain, chest pain, or decreased ability in activity continue activity?

A

Yes!

45
Q

Should a HF pt with mild weight gain, cough, peripheral edema, increased SOB, orthopnea continue therapy?

A

may need medication adjustment
contact physician before continuing

46
Q

Should a HF pt with SOB at rest, unrelieved chest pain, chest tightness at rest, paroxysmal nocturnal dysnpnea/sleeping in chair, 5+ lbs weight gain, and confusion continue therapy?

A

No, indicates acute decompensation
warrants immediate emergency medical attention

47
Q

Specific physiologic benefits of exercise for heart failure

A

improved exercise tolerance
improved coronary a. flow
improved quality of life

47
Q

Effect of exercise/rehabilitation on HF patients

A

does not decrease mortality
does improve quality of life and decrease hospitalizations

48
Q

guidelines for rehab for HF pts

A

low-mod intensity (6-11 RPE)
supervised exercise
150 min/wk, 5-7 days a week
aerobic>resistive
prolonged warm up and cool down
monitor vitals
HIIT effective for heart remodeling?

49
Q

LIfe’s simple 7
+ essential 8

A

modifiable risk factors to reduce risk of heart failure/prevention
1. smoking cessation
2. diet
3. GLC control
4. BMI
5. physical activity
6. BP control
7. decrease cholesterol
+
8. sleep

50
Q

Aspects of HF education for patient

A

adhere to meds
explain s/s of exacerbation of HF
weight diary for fluid retention
diet
importance of activity

51
Q

PT recomendations for HF pts

A

aerobic exercise, resistance exercise, inspiratory muscle training
duration: 30-60 min
frequency: 3-7 x week aerobic, 2-3 x week other
40-70% aerobic
40-50% resistance
HIIT if safe for heart remodeling

536 Body Systems (11 decks)

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