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CardioPulm > Exam 2: Wk 2 CHF and Cardiac Muscle Dysfunction > Flashcards

Exam 2: Wk 2 CHF and Cardiac Muscle Dysfunction Flashcards

1
Q

Define Heart Failure

A

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

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2
Q

MAP - mean arterial pressure

A

BP over TIME

MAP= 1/3 x SBP + 2/3 x DBP

MAP = CO x TPR

Norm: 65-110mmHg

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3
Q

Total peripheral resistance

A

Amt of force exerted against the circulating blood by the vasculature of the body

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4
Q

What affects total peripheral resistance?

A

Blood volume and resistance to flow in blood vessels

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5
Q

Define pulse pressure and what is the formula q

A

How hard the heart is working - indicates efficiency

PP= SVP-DVP

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6
Q

After load - arterial pressure

A

Pressure or resistance the heart has to overcome to eject blood ; SQUEEZE

Amt of pressure that the heart needs to exert to eject the blood during ventricular contraction

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7
Q

Decreased TPR= _____ after load

A

Decreased

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8
Q

Increased after load = _____ contraction

A

Reduced/decreased

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9
Q

Preload - Venous Pressure

A

Stretch; the amt of volume being returned to the heart

Preload increases pumping force (contractility w stretch)

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10
Q

What system controls venous pressure

A

SNS

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11
Q

Each heart beat we get ___ in venous pressure and ____ in arterial pressure which causes blood to circulate.

A

Small decrease

Large increase

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12
Q

Stroke volume, cardiac output, ejection fraction

A
  • SV = amt of blood ejected out of heart
  • CO= HR x SV in one minute
  • EF = (EDV-ESV)/EDV ; % of blood in ventricle ejected into arteries
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13
Q

CHF

A

Heart is failing to pump blood from veins to arteries

  • venous pressure too high
  • EF too low
  • arterial pressure may not rise enough with each contraction
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14
Q

Which side of the heart has more work to do? Which side has more resistance?

A

L side of the heart has more work for L ventricle and higher overall resistance than pulmonary

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15
Q

Which side of heart is thicker? Does it have high or low pressure?

A

L Ventricle = high pressure

Therefore > O2 consumption than R

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16
Q

Which side of the heart usually fails first?

A

L side unless there’s an injury to the R

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17
Q

If L side fails, where does the pressure build up?
- How about R

A

L side Into the lungs so high pulmonary and low systemic pressure

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18
Q

What is it called when CO is balanced, regardless of demand on the heart?

A

COMPENSATED

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19
Q

What is it called when CO is NOT balanced, or cannot keep up with the demand on the heart?

A

DECOMPENSATED heart

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20
Q

What are the two most common causes of Cardiac muscle dysfunction

A
  • HTN & CAD (MI)
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21
Q

Chronic hypertension

A

Increased arterial pressure whuch leads to L ventricular HYPERTROPHY

  • leads to overstretched contractile fibers and less effective pump
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22
Q

CAD effects

A
  • Coordination issues
  • cardiac arrhythmias
23
Q

Dyskinesia vs Hypokinesia vs Akinesia

A

Dyskinesia :Uncoordinated movement; common after MI
Hypokinesia: decreased mvmt
Akinesia: localized area of no mvmt

24
Q

Abnormal conduction

A

Decreases coordination of contraction

25
Q

Abnormal Automaticity

A

Pacemaker not regular (bradycardia or tachycardia)

26
Q

What are two heart valve abnormalities??

A

Stenosis: blockage; doesn’t open properly
Regurgitation: doesn’t close properly; incompensated

27
Q

Cardiomyopathy

A

Contraction and relaxation of myocardial muscle fibers are impaired

  • heart muscle is stretched too thin (dialated cardiomyopathy) or hypertrophic cardiomyopathy
28
Q

Saddle Pulmonary Embolus

A

Large embolus that straddles L and R pulmonary arteries

  • total blockage of pulmonary blood to flow
  • no output of L ventricle

RAPID DEATH

29
Q

Hemopericardium

A

Unusual; pressure inside pericardium prevents filling of R ventricle —> decrease in pulmonary blood flow and L ventricle cant be filled

30
Q

Classes of CHF

A

CLASS I : no limitation in any activity & no symptoms in ordinary activities
CLASS II: mild limitation of activity; pt comfortable at rest/mild exertion
CLASS III: marked limitation of any activity; pt ONLY comfortable at rest
CLASS IV: PA causes discomfort & symptoms present AT REST

31
Q

S & S of Heart Failure

A
  • Jugular vein distension
  • hepatojugular reflux: 45 degree and press on liver
  • third heart sound S3
  • weight gain
  • fatigue, dyspnea,
  • orthopnea
  • cyanosis
32
Q

Different ways to classify heart failure

A

Chronic vs Acute
R vs L
Forward vs backward
Systolic vs Diastolic
High output vs low output
Compensated vs uncompensated vs decompensated

33
Q

Chronic VS Acute

A

Long term
Acute: life threatening condition; cardiac shot needed
- L side: rupture of aorta
- R side: blockage of saddle embolus

34
Q

R sided HF vs L sided HF

A

R: results of failing to empty vena cava (JVD, hepatomegally)
L: failure of LV to empty pulmonary veins and fill systemic arteries; congestion of pulmonary veins and capillaries

35
Q

Cycle of HF

A

Starts on L side —> low CO causes fluid retention in kidneys —> increases preload on R side —> congestion of pulmonary circulation increases after load on R ventricle

36
Q

Forward vs Backward HF

A

Forward: due to low CO; ischemic injury to tissues, cool, cyanosis

Backward: due to venous congestion; pulmonary edema(LHF) and peripheral edema (RHF)

37
Q

Systolic vs diastolic HF

A

Systolic: insufficient myocardial muscle strength relative to conditions
Diastolic: not enough blood filling ventricle

38
Q

Medical MGMT of HF

A

Stabilize, dietary changes, weigh daily to monitor fluid (there’s rapid weight gain due to fluid retention)

39
Q

Pharmalogical Tx & their function

A

ACE Inhibitors: cause vasodilation and fluid reduction
Diuretics: reduced fluid in veins reduce load on heart
Beta blockers: decrease cardiac work
Pressures: decompensation for acute/ emergent situations

40
Q

Who are ACE inhibitors for? -oprils

A

Those w/ systolic failure

  • decreases retention of water and vasoconstriction
41
Q

Who are diuretics used to treat? -ide

A

Those with backward symptoms as maintenance or emergency

  • reduced fluid in veins
42
Q

beta blockers used for

A

Centrally inhibit ANS; decrease hr and cardiac work

43
Q

General recs from PT on physical activity

A
  • educate on energy conservation
  • introduce rest periods during day
  • start ADLs in hospital, enter cardiac rehab ASAP
44
Q

Dialysis and ultrafiltration

A

Removal of fluid from pleural and abdominal cavities

45
Q

Assisted circulation

A

Intraaortic balloon counterpulsation using a pump (IABP) OR LVAD??

46
Q

Ventricular assist deceive

A

Provides force to eject blood

47
Q

Cardiomyoplasty

A

Surgical procedure where healthy muscle from somewhere else is wrapped around heart to provide support for failing muscle (like the lat)

48
Q

L partial ventriculectomy

A

Reduces cardiac volume

49
Q

BNP-B type Natuuretic Peptide

A

Secreted by ventricles in HF

> 300 mild hf
600 mod hf
900 severe hf

50
Q

Radiological findings in HF in Heart and Lungs

A

Heart - enlarged when CTR ratio >50% (cardiomegaly)
Lungs: when L atrial pressure >20mmHg

51
Q

Pressures >20 likely result in what

A

Pulmonary edema

52
Q

What scale should we use with patients with HF instead of RPE?

A

Dyspnea scale bc its more specific to O2 delivery

53
Q

Signs and Symptoms of decompensation

A
  • cyanosis
  • dyspnea, SOB
  • gurgling sounds
  • pink, frothy sputum
  • sudden onset of fatigue
  • decreased HR or systolic BP
54
Q

for NYHA Class II-III physical activity goal should be

A

Aerobic: 20-60 min at 50%-90% intensity at peak VO2

3-5x/wk for ~8 wks

CardioPulm (17 decks)

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