Unit 2 Week 6 CHF Flashcards
what is heart failure?
the inability of the heart to pump adequate amounts of blood through the circulation
what is the main job of the cardiac pump?
Pump blood from veins to arteries
what is BP created by?
volume of blood in vessels & the heart pump
what is systolic pressure?
peak pressure generated
what is diastolic pressure?
lowest pressure before next contraction
what is Mean arterial pressure (MAP)?
measure of BP over time.
MAP = 1/3 x SBP + 2/3 x DBP
what is Total peripheral resistance (TPR)? what is it affected by?
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
what is pulse pressure? what does it indicate?
how hard the heart is working
PP = SVP - DVP
indicates efficiency of heart
what is afterload?
the amount of pressure that the heart needs to exert to eject the blood during ventricular contraction (squeeze)
Cardiac Pumping increases ___.
arterial pressure
___ decreased at same time as pumping increased prevents excessive pressure
TPR
Preload of heart by venous pressure increases ___.
pumping force (contractility w/ stretch)
Greater pumping effectiveness also decreases ___.
venous pressure
SNS maintains venous pressure and preload on the heart by ___.
constricting veins when pumping increases
what is preload?
volume of blood received by the heart (stretch)
what causes blood to circulate?
small decreases in venous pressure and large
increases in arterial pressure
what droves stroke volume and cardiac output?
The differences in arterial and venous pressure
what is ejection fraction?
% of blood in ventricle ejected into arteries
efficiency of cardiac pump (normally 50 or 55-70%)
EF= (EDV-ESV)/EDV
what is CHF?
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
what is the difference between pumping of left vs right ventricle?
- 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
Right and left-sided cardiac output must be ___.
identical over a small time frame or one side will become back-up (congested) and the other will have low pressure
If cardiac output is balanced, regardless of demand on the heart, we can say it is ___
COMPENSATED
If the cardiac output is not balanced, or cannot keep up with demand, we can say it is
DECOMPENSATED
How is Cardiac Output Maintained?
by compensations
Lack of compensation (decompensation) leads to:
- Too much fluid in the central veins
- Too much blood volume in the heart
chambers - Insufficient cardiac output
what is hypertension?
Increased arterial pressure leads to left ventricular hypertrophy
Leads to overstretched contractile fibers and less effective pump
what is medical management of hypertension?
ACE inhibitors, calcium channel blockers, diuretics, beta-blockers
what causes coronary artery disease?
Related to dysfunction of left or right ventricle or both as a result of injury
what are the types of cardiac muscle dysfunction?
Coordination issues
Cardiac arrhythmias
what is dyskinesia?
Uncoordinated movement
what is hypokinesia?
decreased movement
what is akinesia?
Localized area of no movement
what is Abnormal Automaticity?
Pacemaker not regular
* Tachycardia or Bradycardia
* Multiple areas of automaticity at once (fibrillation)
what is a balloon valculoplasty?
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
what is cardiomyopathy?
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
what is a Saddle Pulmonary Embolus?
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
what is Hemopericardium?
pressure inside pericardium prevents filling of right ventricle
Cardiac tamponade
what indicates class 1 on the New York Heart Association Functional Classification of CHF?
- No limitation is experienced in any activities
- No symptoms from ordinary activities
what indicates class 2 on the New York Heart Association Functional Classification of CHF?
- Slight, mild limitation of activity
- Patient is comfortable at rest or with mild exertion
what indicates class 3 on the New York Heart Association Functional Classification of CHF?
- Marked limitation of any activity
- Patient only comfortable at rest
what indicates class 4 on the New York Heart Association Functional Classification of CHF?
- Any physical activity causes discomfort
- Symptoms present at rest
what are the common signs of CHF?
- Elevated jugular venous pressure
- Hepatojugular reflux
- Third heart sound
- Bilateral pulmonary wheezes
- Retention of excessive body fluid
- Peripheral edema
- Weight gain
what are the common symptoms of CHF?
- 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
what is Acute Heart Failure?
- Life-threatening condition
- Cardiogenic shock and death without intervention
- Catastrophic loss of one-way valve system or other structural integrity
what happens with left acute heart failure?
rupture of aorta, blow out of aortic valve
what happens with right acute heart failure?
blockage by saddle embolus or hemopericardium
what are the signs of right-sided HF?
- 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
what are the signs of left-sided HF?
- 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
what is the most common cause of RHF?
LHF
what is forward HF? how does it present?
problems primarily due to low cardiac output
* Ischemic injury to tissues
* Cool, cyanotic extremities and face
what is backward HF? how does it present?
problems primarily due to venous congestion
* Increased venous pressure with leakage of fluid from capillaries
* Pulmonary edema with LHF
* Peripheral edema with RHF
what is the pitting edema scale?
- 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
what is systolic failure?
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
what is diastolic failure?
- Insufficient filling/low SV
- Ventricle(s) too stiff to allow sufficient filling
what is MAP used to monitor? what are normal MAP ranges?
perfusion of organs
* MAP = CO x TPR
65 to 110mmHg
what are the treatment options for CHF?
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
what does medical management do for heart failure?
Directed at underlying cause or causes
Improve heart pump
Reduce workload
Control sodium intake and water retention
how can dietary changes and nutritional supplementation affect the management of HF?
Supplement vitamins, minerals, and amino acids
Decrease sodium intake
Fluid restrictions
Eating heart healthy foods with low cholesterol/fat
what pharmacologic treatments are there for HF?
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
what type of symptoms do diuretics treat?
backward symptoms
what is the proper physical activity prescription for those with HF?
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)
what is cardiac resynchronization therapy?
Implantation of biventricular pacemaker device Electrical stimulation of right and left ventricles in synchronized manner provided by
Improves cardiac function and hemodynamics
what is Dialysis and ultrafiltration?
removal of fluid from pleural and abdominal cavities
what is Assisted circulation
intraaortic balloon counterpulsation using a pump (IABP)
what is a Ventricular assist device?
provides force to eject blood
what is Pulmonary Capillary Wedge Pressure?
Estimates pressure in L atrium (preload)
Indicates severity of left ventricular HF
Pressures > 20 likely result in pulmonary edema
what are the S&S of Decompensation?
Cyanosis of the hands, feet and lips
Dyspnea/SOB/DOE
Gurgling sounds
Pink, frothy sputum
Sudden onset of fatigue
Decreased HR or systolic BP
what special equipment is used with CHF>
-may have numerous lines
-continuous infusion of pressors by an IV pump
-minimum of pulse oximeter and equipment to take BP
For NYHA Class II-III: PA/ training should include:
Aerobic
HIIT: High intensity interval Resistance
Combo resistance and aerobic
Inspiratory mm training
Combo inspiratory w/ aerobic
what are the initial interventions for CHF?
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
what is the goal of energy conservation with those with CHF?
decrease workload on heart without loss of function
what are the signs and symptoms of heart failure?
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
