Heart Failure

Question 1

What risk factor is most commonly present with HF?

Answer 1

HTN (75%).

Question 2

Name 4 common causes of HF.

Answer 2

1. CAD/MI
2. HTN
3. Infection
4. Congenital Heart Disease

Question 3

What is the process of heart failure (7 steps)?

Answer 3

1. Risk factors
2. Vascular dysfunction
3. Vascular disease
4. Tissue injury (MI, HTN)
5. Pathologic remodelling
6. Organ dysfunction
7. Organ failure

Question 4

The HF cascade starts when initial damage to the myocardium (e.g. from an MI) starts the remodelling process. How does this lead to heart failure?

Answer 4

Damage weakens area, unable to withstand pressure. Dilation occurs, scarring and LV shape changes.

Over time, LV mass and volume increase (RAAS), negatively impacting function.

Question 5

Considering that a stretch to the LV increases contractility (optimal sarcomere length), when does the LV dysfunction?

Answer 5

When it’s stretch so much that the actin / myosin don’t overlap and cannot contract.

Question 6

What happens, physiologically in HF?

Answer 6

Increase length = decreased contractility = decreased CO.

HR and RAAS come in to compensate, but lead to LV hypertrophy.

FS Law plateau and no more compensation available.

Question 7

What is systolic HF and what is it characterized by?

Answer 7

Contractile dysfunction: myocardium cannot contract.

EF < 40%.

Question 8

What is diastolic HF? What are some common causes?

Answer 8

Compliance dysfunction: myocardium cannot expand during diastolic filling.

< SV, < CO.

EF normal.

CAUSES

• HTN w/ LV hypertrophy
• CAD

Question 9

With pulmonary disease, it is possible to have associated R HF. How?

Answer 9

Chronic = RV hypertrophy, > RA pressure

Ancities
peripheral edema

-exercise can make worse due to increase venous return to backed up heart.

Question 10

Name 5 major risk factors for HF.

Answer 10

1. Age
2. Sex (men)
3. HTN
4. MI
5. DM
6. Valvular heart disease
7. Obesity

Question 11

When referring to how the body deals with HF, acute means ___ and chronic means ___.

Answer 11

Uncompensated, compensated.

Question 12

What happens in acute HF?

Answer 12

Rapid decrease in CO. Blood shift to pulmonary system.

Dyspena, edema, < activity.

Question 13

What types of muscle changes occur with HF?

Answer 13

< flow to MS

• poor nutrition
• insulin resistance
• increased tumor necrosis factor (systemic inflammation)

RESULT

• < muscle mass
• > atrophy
• myopathy

Question 14

What important effects does HF have that a PT should note?

Answer 14

1. Depression
2. Malnutrition
3. Cognitive changes
4. Increased ventricular arrythmias

Question 15

What type of heart failure must a patient in to engage in exercise?

Answer 15

Compensated / chronic

-myopathy common

Question 16

Name 4 factors that precipitate hospitalization for HF.

Answer 16

1. Acute MI
2. Uncorrected high BP
3. PE
4. Excessive ETOH or drug use

Question 17

What lab values are helpful when treating a patient with a history of HF?

Answer 17

• BNP
• CK, CK-MB, Troponin
• Weight: dry
• BUN, Cr
• ECG
• PFT
• exercise test