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DPT 528 > Quiz #2 > Flashcards

Quiz #2 Flashcards

1
Q

what is the most common cause of HF?

A

HTN

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2
Q

what are other causes of HF other than HTN?

A

MI, injury, or ischemia due to CAD

heart arrhythmias

renal insufficiency

cardiomyopathy

congenital heart disease

heart valve abnormalities

pulmonary embolus

pulmonary HTN

SCI

age-related changes

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3
Q

what are secondary causes of HF?

A

long-term significant alcohol abuse

infection

cigarette smoking

pregnancy

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4
Q

how does HTN lead to HF?

A

increased systemic pressure in arteries–> increased ventricular pressure–> hypertrophy–> stiff and thick–>can’t fill (diastolic dysfunction)

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5
Q

what is preload?

A

the volume of blood coming into the heart

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6
Q

what is afterload?

A

the pressure the ventricles have to overcome to get blood out of the heart

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7
Q

what is the Frank Starling mechanism?

A

a small amount of blood stays in the ventricles to keep it ready to contract

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8
Q

increased blood to the heart leads to ____ preload

A

increased

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9
Q

pulmonary disease changes what side of the heart?

A

the right side

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10
Q

what does L ventricular hypertrophy (LVH) lead to?

A

increased afterload, energy expenditure, and myocardial cell mass

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11
Q

how is LVH diagnosed?

A

echocardiogram (US)

ECG

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12
Q

what does an ECG show with LVH?

A

increased amplitude and width of the QRS complex

longer for depolarization signal bc of increased size of the myocardium

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13
Q

what is a common cause of HF?

A

CAD

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14
Q

how does CAD lead to HF?

A

ischemic injury leads to scarring and decreased contractility

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15
Q

how does cardiac arrhythmia lead to HF?

A

impairs the L/R ventricles

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16
Q

what can cause cardiac arrhythmias?

A

sick sinus syndrome/heart block (decreased HR)

a fib, a flutter, supraventricular tachycardia, vent tachycardia (increased HR)

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17
Q

how does renal insufficiency lead to HF?

A

fluid overload leads to increased blood volume

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18
Q

what is the goal of treatment in renal insufficiency?

A

to decreased reabsorption of fluid form the kidneys and increased fluid elimination

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19
Q

how does cardiomyopathy lead to HF?

A

impaired contraction and relaxation of the myocardium

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20
Q

what causes cardiomyopathy?

A

pathologic process w/in heart muscles

systemic disease process

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21
Q

what are the 3 types of cardiomyopathy?

A
  1. dilated
  2. hypertrophic
  3. restrictive
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22
Q

what is dilated cardiomyopathy?

A

dilation as a result of myocardial mitochondrial dysfunction from toxic, metabolic, or infectious agents

decreased pumping ability leading to increased LVEDP and LVEDV

increased pressure and volume dilate the LV

increased workload on the heart

LV can’t contract or relax

ineffective PUMPING/SYSTOLIC function

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23
Q

decreased pumping ability leads to ____ LVEDP and LVEDV

A

increased

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24
Q

which occurs first increased volume or increased pumping?

A

increased volume

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25
Q

is dilated cardiomyopathy ineffective pumping or filling?

A

pumping

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26
Q

what is hypertrophic cardiomyopathy?

A

results from malaligned muscles fibers

normal mitochondrial function

DIASTOLIC/FILLING dysfunction

increased LVEDP, LA pressure, pulmonary artery and capillaries pressure

hypercontractile LV

hypertrophy of myocardium

usually in middle age

high risk of sudden cardiac death/arrest from ventricular arrhythmias

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27
Q

what is restrictive cardiomyopathy?

A

stiff and less compliant LV

DIASTOLIC/FILLING dysfunction

decreased vent filling

decrease diastolic volume

increased diastolic pressure

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28
Q

how do valvular abnormalities and congenital acquired heart disease lead to HF?

A

stenosis

incompetence

or both

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29
Q

what is the most commonly affected valve in valvular abnormalities?

A

the aortic valve

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30
Q

what can lead to valvular abnormalities?

A

rheumatic disease, endocarditis, and congenital abnormalities

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31
Q

valve abnormalities cause the myocardium to _____ force of contraction to _____ CO

A

increase, increase

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32
Q

stenosis leads to…

A

hypertrophy and diastolic dysfunction

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33
Q

regurgitation leads to…

A

dilation and systolic dysfunction

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34
Q

regurgitation leads to ____ filling volume

A

increased

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35
Q

stenosis leads to ____ ventricular contractility

A

increased

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36
Q

mitral and tricuspid valve insufficiency leads to _____ dilation

A

atrial

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37
Q

how are valvular abnormalities diagnosed?

A

heart auscultation

echocardiogram/cardiac US

cardiac catheterization

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38
Q

what are the s/s of valvular abnormalities?

A

cardiac arrhythmias

murmurs on heart auscultation

angina

sncope

dyspnea

acute HF

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39
Q

how does pericardial effusion/myocarditis lead to HF?

A

injured pericardium

cardiac compression

increased intrapericardial pressure

cardiac tamponade (sudden fluid accumulation)

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40
Q

what are the s/s of pericardial effusion/myocarditis?

A

impaired diastolic filling

tachycardia and increased contractility

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41
Q

what is pleuritic chest pain?

A

chest pain w/inspiration/expiration

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42
Q

what does pleural friction sound like?

A

leather rubbing on leather from the inflammed pericardium

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43
Q

what is pulsus paradoxus?

A

a sign of development of cardiac tamponade where there is a fall in BP during inspiration greater than 10 mmHg

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44
Q

how is pleural effusion/myocarditis diagnosed?

A

echocardiography

chest x-ray

CT scan

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45
Q

how does pulmonary embolism (PE) lead to HF?

A

increased pulmonary artery pressure lead to increased work of the RV leading to R HF 1st

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46
Q

what is R sided HF due to?

A

high pulmonary artery pressure from damaged lung tissue (from ischemia) and decreased area for gas exchange

increased work of the RV

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47
Q

what is L sided HF due to?

A

decreased volume and coronary perfusion of the LV

impaired LV pumping due to decreased stroke volume and decreased CO

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48
Q

how is PE treated?

A

fibrinolytic agents such as Heparin to keep blood thin

TPA (tissue plasminogen activase) to destroy blood clots

anticoagulants for 6 months or longer

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49
Q

how does pulmonary HTN lead to HF?

A

increased pressure in the pulmonary circulation–> increased PA pressure–> increased pulmonary vascular resistance–> increased work of the RV to overcome increased pressure

enlarged RV causes R sided failure

blood flow through lungs slows down and BP in lung arteries rises

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50
Q

what are the causes of pulmonary HTN?

A

scarring, damaged alveoli, blood clots, thickened capillary walls, and congested and enlarged vessels

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51
Q

what is cor pulmonale?

A

increased pressure from lung disease

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52
Q

what are the s/s of pulmonary HTN?

A

dyspnea

fatigue

dizziness/syncope

chest pressure/pain

peripheral edema

ascites (abdominal edema)

syanosis of lips and skin

palpitations/pounding HR/fast pulse

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53
Q

how does SCI lead to HF?

A

sympathetic and parasympathetic imbalance causes decreased sympathetic response (no increased HR, contraction rate, or constriction of vasculature)

can lead to volume depletion (IV fluids needed)

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54
Q

what age-related change leads to HF?

A

cardiac muscle dysfunction (CMD) which causes decreased CO and ability of heart to relax/contraction

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55
Q

what are some age related heart changes?

A

increased systolic arterial pressure and decreased aortic distensibility–>LVH

delayed LV filling

increased NE leading to decreased catecholemine sensitivity

decreased baroreceptor sensitivity

decreased plasma renin concentrations

increased pericardial and myocardial stiffness

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56
Q

what are the most common congenital heart diseases?

A

congenital bicuspid aortic valve

mitral valve leaflet abnormality

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57
Q

what are the symptoms of HF?

A

dyspnea

paroxsysmal nocturnal dyspnea

orthopnea

tachypnea

decreased aerobic tolerance or aerobic capacity

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58
Q

what are the signs of HF?

A

altered breathing patterns

rales/crackles

peripheral edema

pulmonary edema

cold, pale, cynanotic extremities

weight gain
hepatomegaly

JVD

S3 heart sound

sinus tachycardia

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59
Q

what is dyspnea the result of?

A

poor gas exchange b/w the lungs and cells

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60
Q

what is the most common s/s of HF?

A

dyspnea

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61
Q

t/f: dyspnea results in increased RR and tidal volume to compensate

A

true

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62
Q

what is paroxysmal nocturnal dyspnea?

A

sudden, unexplained SOB during sleep that awakes the person

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63
Q

what helps the symptoms of paroxysmal nocturnal dyspnea?

A

standing or sitting

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64
Q

what is orthopnea?

A

dyspnea when lying flat or in recumbent position

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65
Q

pts with _____ _____ _____ demonstrate early onset anaerobic metabolism and abnormalities in the skeletal muscles

A

decreased exercise tolerance

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66
Q

what is a method of measuring decreased exercise tolerance?

A

NYHA classification system

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67
Q

how can a PT assess exercise tolerance?

A

symptoms

HR

BP

heart rhythm via ECG

O2 saturation via pulse ox

RR of specific workloads

exercise tests such as the 6MWT

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68
Q

what is tachypnea?

A

increased RR, decreased depth of breath

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69
Q

what is Cheyne-Stokes respiration?

A

looks like they’re not breathing

waxing and waning depth of breathing with periods of apnea in b/w

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70
Q

what is rales?

A

crackling lung sound associated with CHF heard on INSPIRATION with lung auscultation

sounds like hair being rubbed b/w 2 fingers

heard bilateral at the bases of the lungs

not cleared by coughing

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71
Q

what are the 2 normal heart sounds?

A

S1 and S2 (lub-dub)

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72
Q

what causes the S1 lub sound?

A

closing of the tricuspid and mitral valves

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73
Q

what causes the S2 dub sound?

A

closing of the aortic and pulmonary valves

74
Q

what are the abnormal heart sounds?

A

S3 and S4

75
Q

what is the Hallmark sign of CHF?

A

S3 heart sound

76
Q

when is the S3 heart sound heard?

A

after S2 (lub-dub-DUB)

77
Q

what does the S3 sound represent?

A

non-compliant LV

78
Q

when is a S4 heart sound heard ?

A

presystolic sound heard b4 S1 (LUB-lub-dub)

79
Q

what is atrial kick?

A

vibration of the ventricular wall in atrial contraction

exaggerated atrial contraction

80
Q

when is S3 considered normal?

A

in young children and young adults

81
Q

t/f: peripheral edema may be absent, despite significant CHF

A

true

82
Q

what causes peripheral edema?

A

retained ECF that accumulated in dependent bilateral LE in HF

83
Q

is peripheral edema caused by right or left HF?

A

right

84
Q

is pulmonary edema caused by right or left HF?

A

left

85
Q

what is the common area affected by peripheral edema?

A

ankles and pre-tibial region

86
Q

t/f: as CHF worsens, peripheral edema can spread up to the thighs, sacral area, and abdomen

A

true

87
Q

is peripheral edema pitting or non-pitting?

A

pitting

88
Q

what causes pulmonary edema?

A

increased fluid in the vascular system and interstitial space

increased PCWP and flooded alveoli with fluid

89
Q

what does pulmonary edema cause?

A

severe hypoxemia and hypercapnia from decreased gas exchange (ventilation/perfusion mismatch)

decreased lung volumes

respiratory acidosis

90
Q

what is hepatomegaly?

A

enlarged liver and sign of of liver dysfunction

91
Q

what causes hepatomegaly?

A

volume overload w/CHF causing hepatic venous congestion

92
Q

what does hepatomegaly lead to?

A

hypoxemia and cardiac cirrhosis from low CO

cardiac cirrhosis

ascites (abdominal edema)

93
Q

what is a (+) hepatojugular reflex?

A

press on the liver and turn head to the side and the jugular vein becomes distended from so much fluid in the venous system of the liver

94
Q

what causes jugular vein distention?

A

fluid overload in the venous system from R sided HF

95
Q

significant CHF will show JVD when?

A

in any position

96
Q

what is the best position to measure JVD in?

A

45 deg semi recumbent

97
Q

what is pulsus alternans?

A

mechanical alteration and variability of pulse strength

represents depressed myocardial function and CHF

feel alternating strong and weak pulses

98
Q

what is pulsus alternans due to?

A

changing systolic pressure

99
Q

what is abnormal weight gain for someone with CHF that would be an emergency?

A

more than 3 lbs in a day

100
Q

what is systolic HF (HFrEF)?

A

impaired myocardial contractility/ventricular contraction

compromised ventricular function

decrease in SV, EF, and CO

increased ESV

101
Q

what is diastolic HF (HFpEF)?

A

impaired ventricular relaxation and filling

decreased EDV

increased EDP

normal/high EF

lower than normal SV and CO

102
Q

which has more research behind it: systolic or diastolic HF?

A

systolic HF

103
Q

an ejection fraction of <__%=failure

A

40

104
Q

what is ejection fraction?

A

ratio or % volume of blood ejected out of the ventricles relative to volume of blood received by the ventricles b4 contraction

systolic volume/ end diastolic volume OR
SV/LVEDV x 100

105
Q

what is normal EF?

A

60-70%

106
Q

why don’t you want a 100% EF?

A

bc according to the Frank-Starling mechanism there needs to be a little bit of blood left in the heart to maintain stretch of the myocardium

107
Q

what is CO?

A

the volume blood ejected out of the ventricles into the system arterial circulation per minute

CO = HR x SV

108
Q

what is normal CO?

A

4-6 L/min at rest

109
Q

what is normal SV?

A

55-130 mL of blood

110
Q

what is cardiac index (CI)?

A

CO per square meter of body surface area (takes body size into account)

111
Q

what is normal CI?

A

about 3L/min/m^2

112
Q

what is normal blood volume?

A

5.5 L

113
Q

what is the best indicator we have of heart function?

A

CI

114
Q

what is cardiogenic shock?

A

condition in which blood supply to the tissues is insufficient bc of inadequate CO

115
Q

what level of CI is CHF diagnosed at?

A

<2.2L/min/m^2

116
Q

what are the 2 types of pulmonary/L sided edema?

A

cardiogenic and noncardiogenic

117
Q

what is cardiogenic edema?

A

edema caused by L sided HF

increased hydrostatic pressure in pulmonary capillaries

leads to increased LVEDV and PCWP and L arterial pressure

118
Q

what helps distinguish b/w cardiogenic and noncardiogenic edema?

A

PCWP

119
Q

what are the causes of cardiogenic edema?

A

mitral valve stenosis

atrial myoxoma

LV systolic/diastolic dysfunction

dysrhythmias

CMP (cardiomyopathy)

acute myocardial dysfunction

MI
post-op cardiac dysfunction

pulmonary HTN

120
Q

what is non-cardiogenic edema?

A

edema caused by L HF

decreased alveolar pressure

elevated permeability

accumulation of fluid and protein in alveolar space

normal hydrostatic pressure

121
Q

what are some causes of non-cardiogenic edema?

A

neurogenic

drowning

aspiration

inhalation injury

trauma

burns

acute kidney disease

allergic rxn

quick IV infusion of fluids

opiate OD

increased altitude

ARDS

122
Q

what are the s/s of non-cardiogenic edema?

A

normal early physical exam

hypoxemia due to intrapulmonary shunting

PCWP<18mmHg (normal)

classic “batwing” pattern on chest x-ray

normal/increased lung volumes

123
Q

what happens when CHF causes hypoxia?

A

it may stimulate RBC production, increasing blood volume and further increasing the volume overload

124
Q

what happens with anemia and CHF?

A

decreased hemoglobin and hematocrit

decreased blood viscocity

decreased systemic vascular resisitance

may lower arterial O2 and O2 saturation levels and increased the work of the heart

125
Q

is there a R or L shift on the oxyhemoglobin curve with anemia?

A

R shift

126
Q

why should you be cautious of blood transfusions with CHF?

A

because it could increase the blood volume and therefore the work of the heart

increased preload as well

127
Q

what should be done for patients with CHF who need a blood transfusion?

A

given additional diuretics to prevent an increase in blood volume

128
Q

what 3 skeletal muscle abnormalities are often found with CHF?

A

selective atrophy of type 2 fibers

pronounced non-selective myopathy

hypertrophy of type 1 fibers

129
Q

there can be a decrease in isometric muscles strength by __% in pts with CHF

A

50

130
Q

does exercise capacity in pts with CHF increase or decrease?

A

decrease

131
Q

t/f: severe LV failure can decrease flow to the pancreas

A

true

132
Q

what are the consequences of decreased flow to the pancreas?

A

impaired insulin secretion leading to less energy for the heart from glucose metabolism

increased BS levels

133
Q

what does renal function have to do with CHF?

A

there is sodium retention in HF due to inadequate CO which stimulates the RAAS

kidney try to retain fluid from stimulation from reduced blood flow which further contributes to fluid retention in HF and can lead to kidney damage

134
Q

what lab values test renal function?

A

BUN and serum creatinine

135
Q

serum creatinine below what would indicate serious impairment in renal function?

A

<4

136
Q

what nutritional abnormalities are pts with CHF prone to?

A

GI abnormalities

anorexia

malnutrition

protein-calorie deficiency

vitamin deficiency

thiamine deficiency

carnitine and coenzyme Q10 decrease

137
Q

why are their cognitive effects with CHF?

A

decrease in cerebral perfusion and oxygenation

structural changes in the brain (hippocampal damage)

loss of gray matter

atrophy

microemboli

138
Q

t/f: cognitive function is a predictor of clinical outcomes, repeat hospitalizations and higher mortality rate

A

true

139
Q

what is effective in preventing and reducing the effects and changes on brain function from CHF?

A

exercise/aerobic activity

140
Q

what are some ways that HF can be managed?

A

nutritional supplementation

dietary changes (<2000mg sodium/day, decrease cholesterol and sat fat and fluid restricted to 2L or less/day)

pharmacologic treatment

self management techniques

141
Q

what are common meds used for HF management?

A

ACE inhibitors

calcium channel blockers

diuretics

beta-blockers

potassium and magnesium repletion with diuretics

142
Q

what lab values are used to diagnose HF?

A

BNP (blood naturetic peptide) increased in blood serum

troponin I

troponin T

magnesium

potassium

ABGs (arterial blood gas)

143
Q

when is BNP released?

A

in response to stretch from high filling pressure

high arterial pressure

cardiac dilation

144
Q

what are normal BNP levels?

A

<100 pg/mL

145
Q

what are normal NT-pro-BNP levels?

A

<300 pg/mL

146
Q

what level of BNP indicated that heart failure is likely?

A

> 400 pg/mL

147
Q

what does BNP do?

A

lowers blood volume and venous dilation, and suppresses secretion of renin and aldosterone

148
Q

what are normal troponin T levels?

A

<0.1 ng/mL^3

149
Q

what are normal troponin I levels?

A

<0.03 ng/mL^3

150
Q

what are normal adult magnesium levels?

A

1.3-2.1 ng/mL^3

151
Q

what are possible critical values for magnesium?

A

<0.5 or >3 ng/mL^3

152
Q

what is potassium important for?

A

function of excitable cells

153
Q

what is the normal range for adult potassium levels?

A

3.5-5.0

154
Q

what are possible critical values for adult potassium levels?

A

<2.5 or >6.5

155
Q

what are ABGs used to evaluate?

A

pt’s ventilatory, acid-base, and oxygenation status

156
Q

in CHF PaO2 levels are ____

A

reduced

157
Q

in CHF PaCO2 levels are____

A

elevated

158
Q

in CHF O2 saturation is ____

A

reduced

159
Q

what is the normal pH range?

A

7.35-7.45

160
Q

what is the normal range for PaCO2?

A

35-45 mmHg

161
Q

what is the normal range for HCO3?

A

21-28 mEq/L

162
Q

what is the normal range for PaO2?

A

80-100 mmHg

163
Q

what are possible critical values for pH?

A

<7.25 or >7.55

164
Q

what are possible critical values for PaCO2?

A

<20 or >60

165
Q

what are possible critical values for HCO3?

A

<15 or > 40

166
Q

what are possible critical values for PaO2?

A

<40

167
Q

what can radiology tell us about CHF?

A

size and shape of cardiac silhoutte

presence of interstitial, perivascular, and alveolar edema

168
Q

what is the Hallmark radiologic finding in CHF?

A

presence of interstitial, perivascular, and alveolar edema

169
Q

how is HF diagnosed?

A

ECG, echocardiogram, or cardiac catheter

170
Q

what is the most useful tool for diagnosing CHF?

A

echocardiogram

171
Q

what can echocardiogram show us about CHF?

A

EF

vent wall dimensions and volume

wall thickness

chamber geometry

regional wall motion

172
Q

what can be used for medical/surgical management of CHF?

A

implantable cardiac defibrillator

cardiac resynchronization therapy (CRT)/BiV PPM

valve surgeries

swan ganz catheter

pulmonary artery catheter

intraaortic balloon pump (IABP)

impella

ventricular assist device

transplant

173
Q

how does a BiV PPM work?

A

leads in BOTH ventricles to provide stim in synchronized manner

174
Q

is a TAVR valve procedure done for regurgitation or stenosis?

A

stenosis

175
Q

what does the swan ganz catheter intermittently measure?

A

LA and LV EDP through the pulmonary artery

176
Q

what is the prime indicator of LV performance?

A

LVEDP

177
Q

what is the IABP used for?

A

to help the heart relax

counterpulsation device to decrease myocardial ischemia

178
Q

what is an impella?

A

temporary ventricular support device inserted in the LV and across the aortic valve to support blood pumping from the LV to the aorta

179
Q

for patients who don’t get enough fluids taken off with diuretics, what is done?

A

ultrafiltration

180
Q

what is ultrafiltration?

A

mechanical removal of excess fluid through removal of plasma, water, and sodium from the blood via highly permeable membrane

181
Q

what are the predictors for poor survival with CHF?

A

Decreasing LVEF

Worsening NYHA classification

Degree of hyponatremia

Decreasing peak exercise O2 uptake

Decreasing hematocrit

Widened QRS on ECG

Chronic hypotension

Resting tachycardia

Renal insufficiency

Refractory volume overload

182
Q

what is the prognosis for CHF?

A

Risk of CHF following MI

Determined by BNP, higher the BNP, the higher risk

Marked elevation in serum BNP levels during hospitalization for CHF may predict rehospitalization and death.

DPT 528 (9 decks)

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