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Flashcards in Cardiac Muscle dysfunction Deck (87):
1

What does CMD result from?

Abnormality of structure or function

2

How does CMD affect the heart?

Impairs heart's ability to pump or receive blood

3

How does CMD affect function?

Exercise tolerance and functional abilities are mild/moderately reduced: myocardial ischemia/infarction, angina, cardiac arrhythmias, dyspnea

Decreased quality of life

4

T/F: CMD is the most common cause of congestive heart failure?

True

5

How is CHF manifested?

As pulmonary congestion, or pulmonary edema

6

What is the difference between chronic heart failure and congestive heart failure?

Chronic heart failure: person is living with heart failure
CHF: person has edema involved

7

What are the characteristics of CMD?

Ejection fraction: 30-40%
Angina and myocardial ischemia
Cardiac arrhythmias
MI
HTN
Cardiac arrhythmias
Renal insufficiency (acute/chronic)

8

What is cause for angina and myocardial ischemia in CMD?

Brought on by inadequate O2 supply/demand to heart

9

What do cardiac arrhythmias lead to?

Decreased myocardial function

10

What is the most common cause of CMD?

Myocardial infarction

11

What are causes for MI?

Chronically sustained ischemia to myocardium.

12

What are possible ways for chronic sustained ischemia to myocardium leading to an MI?

Coronary artery spasm (smooth muscle)
Sudden thrombotic occlusion (cell death)
Dysfunction of left or right ventricle or both from injury
Scar formation and decreased contractility occur

13

What is treatment for MI?

Fix underlying cause of infarction (surgical procedure, medications)

14

What happens to the cardiac muscle with chronic uncontrolled HTN?

Increased atrial pressure= strain of left ventricle: LVH, increased energy expenditure
Ventricle hypertrophies to compensate increased afterload
Myocardium stiffens: systolic and/or diastolic dysfunction
Left ventricle weakens and dilates: CHF

15

T/F: with chronic uncontrolled HTN there is increased energy expenditure in the heart because the muscles have to work harder to maintain adequate pump/cardiac output?

True

16

What is treatment for HTN?

Medications such as ACE inhibitors, Ca channel blockers, diuretics, and beta blockers
Regular exercise training

17

T/F: regular exercise training can reduce BP by 20 mmHg (systolic) and 15 mmHg diastolic?

False: reduces systolic 10 mmHg and 6-8 mmHg

18

T/F: if you stop exercise your blood pressure will stay the same?

False. Exercise needs to be maintained through life

19

What are cardiac arrhythmias and how is it a characteristic of CMD?

Decreased myocardial function: too rapid or slow which affects muscle function

Impaired atrioventricular conduction

20

What is treatment for cardiac arrhythmias?

Medications, pacemaker, ablation, ICD

21

What is renal insufficiency?

Fluid overload

22

What is treatment goal for renal insufficiency?

Decrease reabsorption of fluid (not just adjust fluid control) from kidney and rid the body of fluid (diuresed)

23

What is treatment for renal insufficiency?

Lasix (diuretic)
Monitor electrolyte levels for too high (further retention) or too low (cardiac arrhythmias)
Dialysis for severe cases

24

What is cardiomyopathy?

Disorder affecting the heart muscle: inadequate pumping of heart, contraction, relaxation

Primary/secondary causes

25

What does the heart do in cardiomyopathy?

It loses its ability to pump effectively. It becomes larger as it tries to compensate for its weakened condition

26

What are 2 categories of cardiomyopathy?

Ischemic: results from coronary artery disease
Nonischemic: disease of heart muscle itself, dilated, hypertrophic, restrictive

27

What is the most common cause of CHF?

Dilated cardiomyopathy

28

What populations normally get dilated cardiomyopathy?

Middle aged people
Men more than women (2.5 to 1)

29

what is cause of dilated cardiomyopathy?

Idiopathic in most cases
Familial (30-40%)
Viral infection
Chronic, excessive consumption of alcohol
Toxins (cobalt)
Cancer drugs
Pregnancy and childbirth
Long term alcohol use
Cigarette smoking

30

What is treatment for dilated cardiomyopathy?

transplantation

31

What are characteristics of dilated cardiomyopathy?

Dilated left ventricle and left atrium.
Bulging interventricular septum from left to right
Thin ventricular walls
Myocardial mitochondria dysfunction: energy

32

What structural changes occur in dilated cardiomyopathy?

Increased left ventricular mass
Normal or reduced left ventricular wall thickness
Increased left ventricular cavity size.
Ineffective/inefficient pump: poor cardiac output, end diastolic pressure not going up, bad squeeze.

33

T/F: in dilated cardiomyopathy normal activities will be easy for people

False; normal activities are harder

34

What is cause of hypertrophic cardiomyopathy?

Most are inherited (>100 mutations in 10 proteins)
Autosomal dominant trait

35

Who normally gets hypertrophic cardiomyopathy?

Most common early onset (10-25 years)
Principal cause of sudden death: young healthy individuals, athletes

36

What are characteristics of hypertrophic cardiomyopathy?

Hypertrophy is inappropriate for hemodynamic load.
Proper myocardial mitochondira function
Characterized by diastolic dysfunction
Increased LV diastolic pressure: eventually increased LA,PA, and pulmonary capillary pressures

37

What are structural changes in hypertrophic cardiomyopathy?

Severe thickening of interventricular septum.
Thickening of the left ventricular wall.
Tiny left ventricular chamber/ventricular cavity size

38

T/F: with hypertrophic cardiomyopathy the problem is that the heart will get a good squeeze but it can't fill with blood so no blood will get out?

True

39

How does hypertrophic cardiomyopathy impair function?

Exaggerated pump function (hypercontractile systolic function)
Poor heart relaxation (diastolic dysfunction)

40

What are causes and characteristics of restrictive cardiomyopathy?

Rare form (5%)
Worst prognosis
Characterized by diastolic function

Does not appear to be inherited

41

What are the forms of restrictive cardiomyopathy?

Amyloidosis: abnormal protein fibers accumulate
Sarcoidosis: inflammatory, forms lumps in lungs
Hemochromatosis: iron overload of body

42

What is the restrictive cardiomyopathy that has abnormal protein fibers (amyloid) accumulate in the heart's muscle?

Amyloidosis

43

What is the restrictive cardiomyopathy that is an inflammatory disease that causes the formation of small lumps in organs (lungs)?

Sarcoidosis

44

What is restrictive cardiomyopathy where there is iron overload of the body, usually due to a genetic disease

Hemochromatosis

45

What happens to heart muscle tissue in restrictive cardiomyopathy?

Stiffened walls of the ventricles with loss of flexibility due to infiltration by abnormal tissue

46

What are signs of CHF?

Chest X-ray
EF
Cold, pale, cyanotic extremities
Abnormal heart sounds
Sinus tachycardia
Abnormal breathing patterns
Peripheral edema
Crackles/rales
Systolic BP with controlled expiratory maneuver
Jugular vein distention
Decreased exercise tolerance
Decreased quality of life

47

What will you see on X-ray with person with CHF?

Cardiac silhouette (size and shape increased)
Fluid in lungs

48

What is ejection fraction in person with CHF?

49

What is cause of cold, pale, extremities in person with CHF?

Increased sympathetic activity

50

What are the abnormal heart sounds in CHF?

S3 occurs when LV is non-compliant and poor relaxation during diastole
Hallmark sign of CHF

51

What is cause of sinus tach in CHF?

Increased sympathetic activity

52

What does breathing pattern look like in person with CHF?

Quick, shallow breaths even with change in position

53

How does peripheral edema effect the body in CHF?

Inadequate blood flow to periphery: promotes decreased fluid excretion, fluid retention, weight gain > 3lbs

54

Why do you hear crackles/rales with CHF?

heard on inspiration and at lung base
Hear it because of alveolar opening in presence of pulmonary edema

55

What are symptoms of CHF?

Dyspnea
Paroxysmal nocturnal dyspnea
Orthopnea

56

What are causes of dyspnea in patients with CHF?

Poor gas transport: acute/chronic pulmonary edema
Abdominal ascites: peripheral edema, and limitation in diaphragmatic descent
Ventilatory muscle weakness

All contribute to inadequate oxygen supply: increased tidal volume and respiratory rate

57

What is paroxysmal nocturnal dyspnea?

Sudden SOB upon wakening from sleep

58

What is cause of paroxysmal nocturnal dyspnea?

Supine position increases venous return: this overloads the poorly functioning heart, increases pulmonary edema

59

What do patients who awaken with orthopnea occur?

Relief with upright position
Prefer to sleep with pillows, HOB propped up or in chair

60

What are NY Heart Association Classification?

Class 1: cardiac disease w/o limitations
Class 2: Cardiac disease slight limitation (physical activity results in fatigue, palpitations, dyspnea, angina pain
Class 3: Cardiac disease marked limitation (less than ordinary activity causes symptoms above)
Class 4: Cardiac disease but inability to perform physical activity w/o discomfort (symptoms may be felt at rest, physical activity intensifies symptoms)

61

If a person is okay at rest but less than ordinary activities cause symptoms what level are they at?

Level 3

62

If a person is doing activity and their heart pitter patters what class would they be?

Class 2

63

What is pathophysiology of CHF?

Neurohumonal: sympathetic symptoms
Muscle wasting
Pulmonary/edema
Renal: water retention d/t decreased Q, urine (oliguria)

64

For CHF what are the things we should look, listen, feel for?

Look: breathing pattern, color, edema, oximeter, JVD, changes in extremities, weight gain
Listen: breath and heart sounds, BP
Feel: edema, breathing pattern, pulse (rate, rhythm, force)

65

What happens when oxygen saturation is 90 and partial pressure of oxygen is 60?

Tachycardia, tachypnea, restlessness

66

What happens when oxygen saturation is 85 and partial pressure of oxygen is 50?

Incoordination, impaired judgement, labored respirations, confusion

67

What happens when oxygen saturation is 80 and partial pressure of oxygen is 45?

Tachycardia, tachypnea, restlessness
Incoordination, impaired judgement, labored respirations, confusion

68

Will someone have symptoms if their oxygen saturation and partial pressure O2 is 99-95 and 100-80 respectively?

No signs or symptoms

69

What are medical interventions for CHF?

Directed at pathophysiologic cause.

Improve hearts pumping ability: beta block, vasodilator therapy
Control sodium intake: diet, heart healthy, low cholesterol and fat
Water retention: diuretics will increase urine output
Devices
Cardiac transplantation

70

What should people with CHF avoid?

Antiarrhythmic agents: act as cardio depressants and have pro arrhythmic effects
Ca channel blockers: can worsen CHF, increase risk of CV events
Nonsteroid anti-inflammatory drugs: increases sodium retention, peripheral vasoconstriction

71

What are devices that can be used as medical interventions for CHF?

Bi-ventricular pacing
ICD (implantable cardiac difibrillators)
Intraaortic balloon pump
Left ventricular assistive device

72

When is and ICD used?

EF

73

What does a intra aortic balloon pump do

Inflates during diastole, improves myocardial blood flow

74

What does left ventricular assistive device do?

Helps maintain pumping ability of heart that can't work on its own.
Sometimes used as "bridge to transplant"
Hospitalization ~7-10 days

75

What is part of assessment for people with CMD?

When did sx begin?
Stable, worse, what brings on sx
Chest pain, claudication, SOBOE, sleeping hx
Activity level: FITT principle
Objective measures/labs: EKG, echo, blood gas levels, auscultation, 6MWT, questionnaires, physical appearance, RR, breathing pattern

76

What is inpatient care for CMD?

Flexibility exercises, cycle ergometry, treadmill ambulation
Energy conservation
Self management
Transfers
Education

77

What are guidelines for geometry/treadmill?

30 minutes
3-5 days/week
2-4 weeks
50-70% peak cycle work rate

Improvements reported in decreased symptoms, improved HR and exercise tolerance

78

What is done with home care PT for cardiac patients?

Flexibility exercises, cycle ergometry, walking
Self management of sx, diet, activity, energy conservation, ther ex/act
ADLs/IADLs

79

What are parameters of home care exercises? improvements?

20-60 minutes
3-7 days/wk
2-6 months
50-80% peak cycle heart rate or O2

Improvements: decreased symptoms, improved HR, BP, exercise tolerance via GXT

80

What methods of aerobic activity can be found with cardiac rehab centers?

Most use cycle erg
20-60 minutes, 3-7 days/wk, 2-57 months, 40-90% of peak cycle heart rate or VO2
Improvements reported in decreased symptoms, improved HR, BP, and exercise tolerance

81

Can SLE be used for PT with CHF?

Unilateral exercise better than 2 legged: severe CHF, limited exercise tolerance, low cardiac output especially with exercise

82

What are PT interventions for strength and breathing?

Strength: 10 reps for 2-4 months OR 60-80% of maximum voluntary contraction. Progress is slow

Breathing: inspiratory muscle training with hand held device, limited data on yoga (positive for decreasing dyspnea)

83

What is criteria for modification or termination of exercise?

Marked dyspnea or fatigue
RR >40 breaths/min
Development of S3 heart sound
Increase pulmonary crackles
Decrease in HR or BP of >10 bpm or mmHg during steady state or progressive exercise
Diaphoresis, pallor, or confusion

84

What are other causes of CMD?

Heart valve abnormalities
SCI: transection to cervical spinal cord
Pericardial effusion

85

How do heart valve abnormalities cause CMD?

Heart must contract more forcefully to expel Q because of the blocked/incompetent valves.
Leads to hypertrophy: decreased ventricular distensibility, diastolic dysfunction, incompetent valves associated with hypertrophy (regurgitated blood fills atria or ventricles)

86

How does a SCI cause CMD?

Disconnect between cardiovascular system and control with SNS

87

What does pericardial effusion cause CMD?

Increased pressure (fluid fills pericardial sac)
Decreased diastolic function