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S2 MAP II > Cardiac Muscle Dysfunction: Heart Failure Part 2 > Flashcards

Cardiac Muscle Dysfunction: Heart Failure Part 2 Flashcards

1
Q

causes of right HF

A

increased pulmonary resistance
increased afterload - pulmonary HTN or valve stenosis
low preload or poor pump

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2
Q

causes of left HF

A

impaired contractility
increased afterload
loss of myocardial tissue
low preload

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3
Q

symptoms of right HF

A 
venous congestion
weight gain
peipheral edema
hepatomegaly
jugular venous distension
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4
Q

symptoms L HF

A 
dyspnea
orthopnea
-need 3 pillows to breathe at night
paroxysmal nocturnal dyspnea
S3 heart sound
excessive weight gain (> 2 lbs/day)
decreased exercise tolerance
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5
Q

left-sided HF and dyspnea

  • what do you hear during auscultation
  • pulmonary edema
A

crackles (rales)
pulmonary edema
-when pulmonary venous pressure > 20 mmHg, fluid into lungs (increased hydrostatic pressure)
-decreased pulmonary compliance = increased work of breathing

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6
Q

neurohormonal compensatory mechanisms

-decreased CO –>

A 
sympathetic stimulation
-increase HR
-increase contractility
-vasoconstriction
stimulate ADH
increase vascular volume
renin-angiotensin
-vasoconstriction
-increase BP
INCREASING PRESSURE AND VOLUME DO NOT HELP SOMEONE WHO WITH HF
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7
Q

compensatory mechanisms

  • purpose
  • magnitude eventually leads to…
A

purpose of compensatory adaptations in HF is to maintain a CO and arterial pressure that adequately perfuses the brain and heart
magnitude of the compensatory adaptations eventually leads to maladaptive processes which lead to a decompensated state or end-stage HF

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8
Q

compensatory mechanisms

-what are they

A 
increase in MAP
moderate fluid retention
increase in LVEDP
decreased stroke volume (decreased ejection fraction)
decreased contractility
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9
Q

compensated vs. decompensated HF

A

compensated
-symptoms are stable and many overt features of fluid retention and pulmonary edema are absent
decompensated
-refers to a deterioration, which may present either as an acute episode of pulmonary edema or as lethargy and malaise, a reduction in exercise tolerance, and increasing breathlessness on exertion

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10
Q

diagnostic marker of HF

A

B-type natriuretic peptide (BNP)

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11
Q

BNP

  • what is it
  • purpose
  • BNF _____ is diagnostic for HF
A

what
-endogenous neurohormones that maintain normal fluid status and promote normal cardiac function
-secreted by left ventricle in response to volume expansion and pressure overload - “myocardial stretch”
purpose
-counter-regulation of renin-angiotensin-aldosterone system (RAAS)
-encourages vasodilation, diuresis while inhibiting the RAAS
BNP > 100 pg/ml is diagnostic for CHF

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12
Q

New York Heart Association function classification of HF

A

class I
-no limitation of physical activity
class II
-slight limitation of activity - OK at rest
-dyspnea and fatigue with “ordinary” physical activity
class III - OK at rest
-symptoms of HF with less than “ordinary” activity
class IV
-symptoms present at rest

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13
Q

control of HF strategies

  • preload
  • contractility
  • afterload
A

preload - control salt and water retention
-low-sodium diet, diuretics
improve contractility
-B-blockers, inotropic meds, pacemaker or decrease workload
afterload
-reduce peripheral resistance
-lower BP

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14
Q

medications that decrease cardiac workload

  • HF triple drug cocktail
  • -purpose of each
A 
ACE inhibitors
-decrease afterolad
diuretics
-decrease volume
beta-blockers
-limit sympathetic stimulation to heart, hold heart rate down
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15
Q

agents that increase cardiac muscle contraction

A

digitalis (glycosides) - fallen out of favor

  • inhibit Na/K pump, increase intracellular Ca++
  • increases CO
  • signs of digitalis toxicity (N/V, headache, confusion, arrhythmias, sinus bradycardia)
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16
Q

other treatments for HF

A

ventricular assist

heart transplant

17
Q

if fluid is pooled in the legs, what is the kidney thinking?

A

not as much volume in the body (not as much going through the kidney)

  • stimulate ADH
  • increase renin-angiotension (maybe)
18
Q

relationship between exercise capacity and measures of HF

A

most clinical measures of cardiac function correlate poorly with the clinical severity of HF

19
Q

measurement of exercise capacity in HF

  • measurements include…
  • peak VO2 threshold for heart transplant candidates
  • what tests predicts VO2
  • what test is prognostic? How?
A

measurements include
-peak oxygen uptake
-anaerobic threshold
peak VO2 < 14 ml/kg/min threshold for heart transplant candidates
6 minutes walk predicts VO2
6 min walk is prognostic
-40% who walked <300 m died or were admitted for mechanical support within 6 months

20
Q

acute cardiac responses to exercise in patients with HF

A

progressive decrease in CO, SV, and HRR capacity

exercise tolerance limited by reduced CO during exercise

21
Q

acute circulatory responses to exercise in patients with HF

A

muscle blood flow is reduced during an acute bout of exercise in patients with HF

  • not entirely due to a reduction in CO or local vascular impairment
  • change in the distribution of blood flow during exercise
22
Q

acute skeletal muscle metabolic responses to exercise in patients with HF

A

higher lactate levels at submaximal workloads

slower on- and off- kinetics with exercise (O2 consumption increases and decreases at a slower rate)

23
Q

10-year exercise training in chronic HR

  • who
  • what did they do
  • what was measured
  • conclusion
A

123 patients
trained group: supervised exercise training at 60% VO2peak, x2/week, x10 years
nontrained group: “did not exercise formally”
changes in peak VO2
conclusion
-moderate supervised ET performed twice weekly for 10 years maintains functional capacity of more than 60% of maximum VO2
-NT patients, peak VO2 decreased progressively

24
Q

aerobic interval training versus moderate continuous training

  • training types
  • results
A

training
-continuous: 70% peak HR, x3/wk, x12 weeks
-interval: 95% peak HR, x3/wk, x12 weeks
results
-VO2 peak increased: 46% IT, 16% C
-decreased LVEDV and LVESV (IT only): 18% and 25%
-LV EF increased: 35% (IT only)
-BNP (B-type natriuretic peptide) decreased: 40%

25
Q

benefits of exercise in HF

A

exercise training may reverse peripheral abnormalities

  • autonomic function
  • skeletal muscle blood flow
  • localized oxidative capacity
26
Q

heart failure education

A

frequent bouts with rests in-between
teach daily weighting to check for changes in fluid
teach daily checks on activity by instructing in RPE or dyspnea monitoring
teach about watching for dyspnea when laying down
-fluid retention
energy conservation

27
Q

aerobic exercise improves _____ in patients with HF

A

VO2 max
dyspnea
LV function

28
Q

resistance exercise improves _____ in patients with HF

A

LV function
peak lactate levels
muscle strength and muscle endurance

29
Q

contraindications to exercise training

A

progressive worsening of exercise tolerance or dyspnea at rest over previous 3-5 days
significant ischemia during low-intensity exercise (2 METs)
-legs
-chest
uncontrolled diabetes
recent embolism
thrombophlebitis
-inflammation of a vein
-similar to DVT
new-onset atrial fibrillation/atrial flutter

30
Q

potential outcome tools

A 
knowledge of disease/self-management of disease
chair rise
gait speed
6-MWT
balance
Sx history
anxiety/depression
QOL - HRQOL

S2 MAP II (17 decks)

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