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Cardiopulmonary > Unit 2 Week 6 CHF > Flashcards

Unit 2 Week 6 CHF Flashcards

1
Q

what is heart failure?

A

the inability of the heart to pump adequate amounts of blood through the circulation

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2
Q

what is the main job of the cardiac pump?

A

Pump blood from veins to arteries

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3
Q

what is BP created by?

A

volume of blood in vessels & the heart pump

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4
Q

what is systolic pressure?

A

peak pressure generated

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5
Q

what is diastolic pressure?

A

lowest pressure before next contraction

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6
Q

what is Mean arterial pressure (MAP)?

A

measure of BP over time.
MAP = 1/3 x SBP + 2/3 x DBP

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7
Q

what is Total peripheral resistance (TPR)? what is it affected by?

A

the amount of force exerted against the circulating blood by the vasculature of the body.
Affected by blood volume & resistance to flow in b. vessels

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7
Q

what is pulse pressure? what does it indicate?

A

how hard the heart is working
PP = SVP - DVP
indicates efficiency of heart

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8
Q

what is afterload?

A

the amount of pressure that the heart needs to exert to eject the blood during ventricular contraction (squeeze)

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9
Q

Cardiac Pumping increases ___.

A

arterial pressure

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10
Q

___ decreased at same time as pumping increased prevents excessive pressure

A

TPR

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11
Q

Preload of heart by venous pressure increases ___.

A

pumping force (contractility w/ stretch)

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12
Q

Greater pumping effectiveness also decreases ___.

A

venous pressure

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13
Q

SNS maintains venous pressure and preload on the heart by ___.

A

constricting veins when pumping increases

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14
Q

what is preload?

A

volume of blood received by the heart (stretch)

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15
Q

what causes blood to circulate?

A

small decreases in venous pressure and large
increases in arterial pressure

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16
Q

what droves stroke volume and cardiac output?

A

The differences in arterial and venous pressure

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17
Q

what is ejection fraction?

A

% of blood in ventricle ejected into arteries
efficiency of cardiac pump (normally 50 or 55-70%)
EF= (EDV-ESV)/EDV

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18
Q

what is CHF?

A

Heart failing to do its job: pumping blood from the veins to the arteries
* Arterial pressure may not rise enough with each contraction or
* Venous pressure may become too high
* EF typically low in HF- used to determine severity

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19
Q

what is the difference between pumping of left vs right ventricle?

A
  • Left ventricle is basically a thick cone pumping against a high pressure
  • Right ventricle is basically a thin flap pumping against a very low pressure
  • Left ventricle has a much greater oxygen consumption than the right
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20
Q

Right and left-sided cardiac output must be ___.

A

identical over a small time frame or one side will become back-up (congested) and the other will have low pressure

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21
Q

If cardiac output is balanced, regardless of demand on the heart, we can say it is ___

A

COMPENSATED

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22
Q

If the cardiac output is not balanced, or cannot keep up with demand, we can say it is

A

DECOMPENSATED

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23
Q

How is Cardiac Output Maintained?

A

by compensations

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24
Q

Lack of compensation (decompensation) leads to:

A
  • Too much fluid in the central veins
  • Too much blood volume in the heart
    chambers
  • Insufficient cardiac output
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25
Q

what is hypertension?

A

Increased arterial pressure leads to left ventricular hypertrophy
Leads to overstretched contractile fibers and less effective pump

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26
Q

what is medical management of hypertension?

A

ACE inhibitors, calcium channel blockers, diuretics, beta-blockers

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27
Q

what causes coronary artery disease?

A

Related to dysfunction of left or right ventricle or both as a result of injury

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28
Q

what are the types of cardiac muscle dysfunction?

A

Coordination issues
Cardiac arrhythmias

29
Q

what is dyskinesia?

A

Uncoordinated movement

30
Q

what is hypokinesia?

A

decreased movement

31
Q

what is akinesia?

A

Localized area of no movement

32
Q

what is Abnormal Automaticity?

A

Pacemaker not regular
* Tachycardia or Bradycardia
* Multiple areas of automaticity at once (fibrillation)

33
Q

what is a balloon valculoplasty?

A

catheter is inserted in the vessel of an extremity (femoral artery) and snaked up through the aorta to the stenotic aortic valve. the balloon is inflated to push the valve open

34
Q

what is cardiomyopathy?

A

progressive disease where the heart muscle is abnormally stretched thin in dilated cardiomyopathy, thickened in hypertrophic cardiomyopathy, and stiffened in restrictive
Contraction and relaxation of myocardial muscle fibers are impaired

35
Q

what is a Saddle Pulmonary Embolus?

A

Total or near total blockage of pulmonary arteries
No pulmonary blood flow
No filling of left ventricle
No output of left ventricle
Rapid onset of dyspnea, LOC, deat

36
Q

what is Hemopericardium?

A

pressure inside pericardium prevents filling of right ventricle
Cardiac tamponade

37
Q

what indicates class 1 on the New York Heart Association Functional Classification of CHF?

A
  • No limitation is experienced in any activities
  • No symptoms from ordinary activities
38
Q

what indicates class 2 on the New York Heart Association Functional Classification of CHF?

A
  • Slight, mild limitation of activity
  • Patient is comfortable at rest or with mild exertion
39
Q

what indicates class 3 on the New York Heart Association Functional Classification of CHF?

A
  • Marked limitation of any activity
  • Patient only comfortable at rest
40
Q

what indicates class 4 on the New York Heart Association Functional Classification of CHF?

A
  • Any physical activity causes discomfort
  • Symptoms present at rest
41
Q

what are the common signs of CHF?

A
  • Elevated jugular venous pressure
  • Hepatojugular reflux
  • Third heart sound
  • Bilateral pulmonary wheezes
  • Retention of excessive body fluid
  • Peripheral edema
  • Weight gain
42
Q

what are the common symptoms of CHF?

A
  • Fatigue
  • Dyspnea on exertion
  • Decreased exercise tolerance
  • Paroxysmal nocturnal dyspnea
  • Orthopnea
  • Inability to sleep unless partially upright
  • Quantified by number of pillows used to allow one to sleep
  • Signs and symptoms vary with the classifications of heart failure
43
Q

what is Acute Heart Failure?

A
  • Life-threatening condition
  • Cardiogenic shock and death without intervention
  • Catastrophic loss of one-way valve system or other structural integrity
44
Q

what happens with left acute heart failure?

A

rupture of aorta, blow out of aortic valve

45
Q

what happens with right acute heart failure?

A

blockage by saddle embolus or hemopericardium

46
Q

what are the signs of right-sided HF?

A
  • Jugular distention
  • Systemic congestion
  • Dependent edema
  • Sacral edema and ascites
  • Nocturia as fluid is displaced from LEs to thorax while asleep
  • Congestion of liver and spleen-hepatomegaly and splenomegaly
  • Impaired liver function and immunity: further edema and decreased blood clotting
47
Q

what are the signs of left-sided HF?

A
  • Congestion of pulmonary veins and capillaries
  • Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
  • Low cardiac output
  • Symptoms of decreased cerebral perfusion
  • Cool extremities may progress to rubor of dependency and to cyanosis
48
Q

what is the most common cause of RHF?

A

LHF

49
Q

what is forward HF? how does it present?

A

problems primarily due to low cardiac output
* Ischemic injury to tissues
* Cool, cyanotic extremities and face

50
Q

what is backward HF? how does it present?

A

problems primarily due to venous congestion
* Increased venous pressure with leakage of fluid from capillaries
* Pulmonary edema with LHF
* Peripheral edema with RHF

51
Q

what is the pitting edema scale?

A
  • 1+ Not obvious without checking; ~2-mm pit; pit lasts a few seconds
  • 2+ Obvious to a trained person; ~4-mm pit; pit last several seconds
  • 3+ Obvious to eye, ~ 6-mm pit; pit lasts a few minutes
  • 4+ Grossly distorted limb; “Sausage fingers or toes”; ~8-mm pit; pit lasts several minutes
52
Q

what is systolic failure?

A

Insufficient myocardial muscle strength relative to conditions
too much back pressure in the arteries or the heart is weak, stretched out so much that it can’t pump hard enough

53
Q

what is diastolic failure?

A
  • Insufficient filling/low SV
  • Ventricle(s) too stiff to allow sufficient filling
54
Q

what is MAP used to monitor? what are normal MAP ranges?

A

perfusion of organs
* MAP = CO x TPR
65 to 110mmHg

55
Q

what are the treatment options for CHF?

A

Lifestyle/dietary/PA
Correct underlying problem medically
Antihypertensive meds to compensate
Devices to supplement heart’s output
Correct underlying problem surgically
Repair/replace valve
Heart transplant

56
Q

what does medical management do for heart failure?

A

 Directed at underlying cause or causes
 Improve heart pump
 Reduce workload
 Control sodium intake and water retention

57
Q

how can dietary changes and nutritional supplementation affect the management of HF?

A

 Supplement vitamins, minerals, and amino acids
 Decrease sodium intake
 Fluid restrictions
 Eating heart healthy foods with low cholesterol/fat

58
Q

what pharmacologic treatments are there for HF?

A

 ACE Inhibitors: Cause vasodilation and fluid reduction
 Diuretics: Reduced fluid in veins reduces load on heart
 Beta blockers: Decrease cardiac work
 Digoxin: Increases contractility, decreases HR
 Pressors: for Acute (emergent) Decompensation

59
Q

what type of symptoms do diuretics treat?

A

backward symptoms

60
Q

what is the proper physical activity prescription for those with HF?

A

 Decrease/discontinue exhaustive activities
 Decrease/discontinue full-time work
 Introduce rest periods during day
 Progressive exercise/activity that fluctuates (day to day)
 Exercise intensity set by level of dyspnea or below level of adverse response (angina or DBP drop)
 Start with ADLs in hospital, enter cardiac rehab ASAP
 Progression to resistance exercise is recommended (see
Cardiac Rehab for more info)

61
Q

what is cardiac resynchronization therapy?

A

 Implantation of biventricular pacemaker device Electrical stimulation of right and left ventricles in synchronized manner provided by
 Improves cardiac function and hemodynamics

62
Q

what is Dialysis and ultrafiltration?

A

removal of fluid from pleural and abdominal cavities

63
Q

what is Assisted circulation

A

intraaortic balloon counterpulsation using a pump (IABP)

64
Q

what is a Ventricular assist device?

A

provides force to eject blood

65
Q

what is Pulmonary Capillary Wedge Pressure?

A

 Estimates pressure in L atrium (preload)
 Indicates severity of left ventricular HF
 Pressures > 20 likely result in pulmonary edema

66
Q

what are the S&S of Decompensation?

A

 Cyanosis of the hands, feet and lips
 Dyspnea/SOB/DOE
 Gurgling sounds
 Pink, frothy sputum
 Sudden onset of fatigue
 Decreased HR or systolic BP

67
Q

what special equipment is used with CHF>

A

-may have numerous lines
-continuous infusion of pressors by an IV pump
-minimum of pulse oximeter and equipment to take BP

68
Q

For NYHA Class II-III: PA/ training should include:

A

Aerobic
HIIT: High intensity interval Resistance
Combo resistance and aerobic
Inspiratory mm training
Combo inspiratory w/ aerobic

69
Q

what are the initial interventions for CHF?

A

Transfer and Balance training
Low level, low impact ex like walking, increasing as tolerated from 6 mins to 30. Intensity monitored with dyspnea/RPE, 1-2x/day
Breathing exercises—facilitate diaphragmatic breathing
Inspiratory/expiratory ex

70
Q

what is the goal of energy conservation with those with CHF?

A

decrease workload on heart without loss of function

71
Q

what are the signs and symptoms of heart failure?

A

Dyspnea: Breathlessness/shortness of breath
Paroxysmal nocturnal dyspnea: shortness of breath (SOB) episodes in supine
Orthopnea: recumbent position dyspnea
Crackles- Rales: abnormal breath sounds during inspiration
Heart sounds: S3
Pitting edema in Extremities
Jugular venous distention: Fluid overload
Weight gain: Fluid/amount of decompensation
Sinus tachycardia: Compensation for low stroke volume
Decreased exercise tolerance

Cardiopulmonary (23 decks)

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