Week 10 Flashcards
What is heart failure
the inability of the heart to pump enough blood to meet the demands placed upon it
other terms - enlarged heart
LV dysfunction, cardiomyopathy, weak heart, congestive cardiac failure (CCF), chronic heart failure (CHF)
Types of heart failure
Systolic dysfunction or LV dysfunction or
-LV impaired and unable to contract and pump enough blood systemically
Diastolic dysfunction or HF with preserved EF
- ability of LV to relax and fill with blood
Right side heart failure
- a consequence of left side HF where blood backs up through the lungs causing increased resistance and failure of RV
What causes heart failure
MI/Ischemic HTN Arrhythmia Virus Congenital Alcoholic/drug induced Familial Valvular Idiopathic
How is HF diagnosed
Echocardiogram - ultrasound assess cardiac function through valves
Electrocardiogram (ECG) Chest X-Ray
Ejection Fraction (EF)
a measurement of how much blood the left ventricle pumps out with each contraction
55-70% is normal
40-55% below average - some damage
Less than 40% may confirm diagnosis of heart failure - moderate HF
Symptoms of Heart Failure
Breathlessness lack of energy fluid overloaded ie. weight hain >2kg in 2 days Dizziness/light headed Chest pain Exercise intolerance/Deconditioning Muscle weakness Confusion Anxiety Depression
NYHA
NYHA Class I
No limitations. Ordinary physical activity does not cause undue
fatigue, dyspnoea or palpitations (asymptomatic LV dysfunction)
NYHA Class II
Slight limitations of physical activity. Ordinary physical activity
results in fatigue, palpations dyspnoea or angina pectoris (mild CHF)
NYHA Class III
Marked limitation of physical activity. Less than ordinary physical
activity leads to symptoms (moderate CHF)
NYHA Class IV
Unable to carry on any physical activity without discomfort.
Symptoms of CHF present at rest (severe CHF)
What is CVD
cardiovascular disease typically encompasses cardiac disease, vascular pathologies and stroke
Specifically we will look at cardiac rehab for coronary artery disease (CAD), including acute coronary syndromes (ACS) and stable angina
Stable angina - temporary discomfort from chronic flow limiting lesion within coronary artery and occurs when the demand for blood supplied to myocardium is increased, such as during physical exertion or emotional stress
How is CVD diagnosed
risk factor assessment Patient history ECG Blood markers (e.g. troponin, CK, Lipid profiles etc) Coronary angiogram
CVD symptoms
often acute onset however can be insidious and disguised by common conditions like heart burn and asthma
Chest pain (angina)
SOB
Pain in neck, jaw, throat, upper abdomen or back
Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed
Fluttering in your chest
Racing heartbear (tachycardia)
Lightheadedness
Fainting (Syncope) or near fainting
What contributes to exercise capacity
myocardial function
CO=HR x SV
SV depends on RV/LV dysfunction
Pulmonary
- ventilation
- gas exchange
- Respiratory muscle strength
Circulation
- O2 transport and exchange within the tissues
Skeletal muscle metabolism
- the ability of muscles to use the oxygen delivered
- energy systems
The body’s normal response to exercise is to increase SV, increase HR and increase RR and improve O2 transport through vasodilation
Unfortunately these system are impaired in HR, and CVD largely affects myocardial function and the circulatory system with flow on effects to peripheral systems
CVD and Exercise
Exercise has been shown to improve cardiovascular risk factor profile by
-lowering blood pressure lowering LDL cholesterol Increasing HDL cholesterol Lowering serum Triglycerides Reducing body weight and adiposity Improving insulin sensitivity Blood glucose homeostasis
Phase 1 of rehab
inpatient education and management
Phase 2 of rehab
Multidisciplinary management program ie. traditional rehab program (education and exercise)
Phase 3 of rehab
maintenance program empowering for self Mx
