Abnormal Transport & Perfusion: Heart Failure, CVI, VTE, & Arterial vs Venous Ulcer (Week 3)

Question 1

Causes of Chronic Heart Failure

Answer 1

CAD & HTN
Rheumatic Heart Disease
Congenital Heart Disease
Pulmonary Disease
Cardiomyopathy
Anemia
Valvular Disorders
Bacterial Endocarditis

Question 2

Causes of Acute Heart Failure

Answer 2

Acute MI
Dysrhythmias
Pulmonary emboli
Thyrotoxicosis
HTN crisis
Rupture of papillary muscle
Ventricular septal defect
Myocarditis

Question 3

Heart Failure Etiology

Answer 3

Interference with Cardiac Output regulating mechanisms of:
Preload
Afterload
Myocardial contractili
Heart Rate
Metabolic State
Valve dysfunction

Question 4

Major HF Contributing Factor

Answer 4

Hypertension - increases risk y threefold

Question 5

Risk Factors

Answer 5

Hypertension
Diabetes 
Cigarette Smoking
Obesity
High Serum Cholesterol

Question 6

Types of Heart Failure

Answer 6

Systolic Heart Failure
Diastolic Heart Failure
Mixed Systolic and Diastolic Heart Failure
Abnormal Transport and Perfusion
Backwards and forwards flow dysfunctions

Question 7

Systolic Heart Failure

Answer 7

Most Common type of HF
Inability of heart to pump blood
Caused by defect in ability of ventricles to contract or by increasing afterload or mechanical abnormalities - LV loses ability to generate enough pressure to eject blood through high pressure aorta
*** Decrease in the LV ejection fraction

Question 8

Systolic Heart Failure Causes

Answer 8

impaired contractile function, (MI) 
increased afterload (hypertension)
cardiomyopathy
mechanical abnormalities (valvular heart disease)

Question 9

Diastolic Heart Failure

Answer 9

Heart Failure with preserved systolic function
Impaired ability of ventricles to fill during diastole
Will result in decreased stroke volume
*high filling pressures and the resultant venous engorgement in both pulmonary and systemic vascular systems
Diagnosis made on presence of pulmonary congestion, pulmonary hypertension, ventricular hypertrophy and a normal EF

Question 10

Diastolic Heart Failure Causes

Answer 10

Left ventricular hypertrophy from chronic systemic hypertension, aortic stenosis, or hypertrophic cardiomyopathy
Myocardial fibrosis
Hypertension

Question 11

L Sided Heart Failure Signs and Symptoms

Answer 11

LV Heaves, Cheyne-Stokes respirations, tachycardia, pulsus alternans, crackles, S3S4 sounds
Fatigue, dyspnea(shallow up to 32-40/min), orthopnea, dry hacking cough, pulmonary edema, nocturia

Question 12

L Sided Heart Failure

Answer 12

Results from LV dysfunction, causing blood to back up through left atrium and into pulmonary veins
Increased pressure causes fluid extravasation from pulmonary capillary bed into interstitium and then the alveoli&raquo_space; pulmonary congestion and edema

Question 13

R Sided Heart Failure

Answer 13

Causes backward blood flow to R atrium and venous circulation. Venous congestion in systemic circulation results in peripheral edema, hepatomegaly, splenomegaly, vascular congestion of GI tract, jugular vein distension

Question 14

Primary cause of R Sided Heart Failure

Answer 14

Left sided heart failure
L sided results in pulmonary congestion and increased pressure in the blood vessels of the lung - eventually leading to right-sided hypertrophy and failure

Question 15

R Sided Heart Failure Signs and Symptoms

Answer 15

RV Heaves, murmurs, peripheral edema, weight gain, increased HR, ascites, jugular vein distension, fatigue, dependent edema, RUQ pain, anorexia and GI bloating, nausea

Question 16

Clinical Symptoms of Heart Failure

Answer 16

Dilated Pupils
Skin pale, gray, or cyanotic
Dyspnea
Orthopnea
Crackles
Cough
Decreased BP
Nausea and vomiting (peristalsis slows)
Ascitis
Dependent pitting edema
Anxiety
Falling )2 Sats
Confusion
Jugular Vein Distension
Infarct
Fatigue
S2 gallop, tachycardia
Enlarged spleen and liver
Decreased Urine Output
Weak Pulse
Cool, moist skin

Question 17

NYHA Heart Failure Class 1

Answer 17

No limitation on physical activity

Normal activity does not cause fatigue, dyspnea, palpitations, or anginal pain

Question 18

NYHA Class 2 HF

Answer 18

Slight limitation of physical activity, no symptoms at rest

Ordinary physical activity results in fatigue, dyspnea, palpitations, or anginal pain

Question 19

NYHA Class 3 HF

Answer 19

Marked limitation of physical activity. Usually comfortable at rest
Ordinary physical activity causes fatigue, dyspnea, palpitations, or anginal pain

Question 20

NYHA Class 4 HF

Answer 20

Inability to carry on any physical activity without discomfort
Symptoms of cardiac insufficiency or of angina may be resent at rest
If any physical activity is undertaken, discomfort is increased

Question 21

Non-Invasive Positive Pressure Ventilation

Answer 21

CPAP 
PEEP
IPAP
EPAP
BiPap

Question 22

NIPPV Inspiration

Answer 22

IPAP = Pressure Support = Pressure Boost
Increase Tidal Volume - decrease pCO2

Indications: COPD, Respiratory Failure, Pulmonary Edema, Sleep Apnea

Question 23

NIPPV Expiration

Answer 23

CPAP = EPAP = PEEP
Alveoli remain slightly inflated during expiratory phase
Increase oxygenation to tissues
Increases pO2
Facilitates inspiratory phase
Indications: Sleep apnea, atelectasis, pulmonary edema, respiratory failure

Question 24

Pharmacological Interventions

Answer 24

Correct Na and water imbalances (volume overload)
Reduce cardiac workload
Improve myocardial contractility

Question 25

Chronic Venous Insufficiency

Answer 25

Venous stasis occurs when normal blood in venous system is disturbed by:
Dysfunctional Vein Valves
Inactivity in muscles of limb
Change in unidirectional blood flow
Blood then pools leading to edema

Question 26

Chronic Venous Insufficiency

Answer 26

Often occurs as a result of previous episodes of DVT - can lead to venous leg ulcers
Hydrostatic pressure in veins increases and serous fluid and RBCs leak from capillaries into and venules into tissue, resulting in edema

Question 27

CVI Causes

Answer 27

Vein incompetence
Deep vein obstruction
Congenital venous malformation
Arteriovenous fistula
Calf Muscle Failure
**Incompetent valves of the deep veins