Cardiovascular and Pulmonary Systems clinical application- Congestive Heart Failure

Question 1

when does congestive heart failure occur?

Answer 1

when the heart can no longer meet the metabolic demands of the body

Question 2

congestive heart failure occurs when the heart can no longer meet the __ demands of the body

Answer 2

metabolic

Question 3

what pathological processes occur within the heart with congestive heart failure?

Answer 3

insufficient or defective cardiac filling and/or impaired contraction and emptying of the heart causes an inability of the heart to pump a sufficient amount of blood

Question 4

congestive heart failure results in insufficient or defective __ __ and/or impaired __ and __ of the heart, causing an inability of the heart to pump a sufficient amount of __

Answer 4

cardiac filling; contraction; emptying; blood

Question 5

congestive heart failure results in impaired cardiac output, causing the body to compensate for this deficit, resulting in:

Answer 5

increase in blood volume
increase in cardiac filling pressure
increase in heart rate
increase in cardiac muscle mass

Question 6

congestive heart failure results in impaired cardiac output, causing the body to compensate for this deficit, resulting in an increase in blood __, cardiac __ __, heart __ and cardiac __ __

Answer 6

volume, filling pressure, rate, muscle mass

Question 7

congestive heart failure is a symptom of pathology within the __ __ or __ __

Answer 7

heart muscle, cardiac valves

Question 8

injury within the heart due to congestive heart failure can be __ sided, __ sided or __

Answer 8

left, right or both

Question 10

there are many __ and __ pathologies that can contribute to CHF

Answer 10

reversible and irreversible

Question 11

common etiologies show to contribute to CHF include (10):

Answer 11

arryhthmia (atrial fibrillation)
pulmonary embolism
HTN
valvular heart disease
myocarditis
unstable angina
renal failure
medication-induced problems
high salt intake
severe anemia

Question 12

CHF occurs when there is a decrease in cardiac __, abnormalities in __ __ metabolism, impaired __ ventricular function or all of the above

Answer 12

output, skeletal muscle, left

Question 13

initial sign of CHF is (1)? other initial signs include (3)?

Answer 13

initial sign:
tachycardia

other initial signs:
venous congestion
high catecholamine levels
impaired cardiac output

Question 14

as the severity of CHF increases, signs of __ __ usually become apparent

Answer 14

venous congestion

Question 15

what sign is left sided heart failure associated with?

Answer 15

pulmonary venous congestion

Question 16

pulmonary congestion is a sign typically associated with __ sided heart failre

Answer 16

left

Question 17

what sign is right sided heart failure associated with?

Answer 17

systemic venous congestion

Question 18

systemic venous congestion is a sign typically associated with __ sided (ventricular) heart failure

Answer 18

right

Question 19

impairment to either right or left ventricle in heart failure effects the __ ventricle, eventually leading to both __ and __ venous congestion in either case

Answer 19

other
pulmonary and systemic

Question 20

potential patient presentation as CHF severity increases (10)?

Answer 20

pulmonary edema
nocturnal dyspnea
orthopnea
S3 gallop
dry cough
exertional dyspnea with low level exercise
sudden weight gain
possible cyanotic extremities
cardiac hypertrophy
SOB

Question 21

what lab tests (2) and imaging studies (3) are useful in confirming the diagnosis of CHF?

Answer 21

urinalysis
CBC count including electrolyte, TSH, BUN, serum creatine
chest xray
electrocardiogram
echocardiogram

Question 22

a CBC count including what is useful in confirming the diagnosis of CHF?

Answer 22

electrolyte
TSH
BUN
serum creatine

Question 23

what can a Doppler echocardiogram specifically determine as it relates to CHF (4)?

Answer 23

systolic and diastolic performance
cardiac output (ejection fraction)
pulmonary artery filling pressure
ventricular filling pressure

Question 24

what additional information outside of lab/imaging studies should be obtained to assist in the diagnosis of CHF?

Answer 24

patient history
cardiac questionnaires

Question 25

what classification systems are associated with CHF?

Answer 25

Framingham classification system NY Heart Association Functional Capacity Classification

Question 26

Framingham classification system

Answer 26

diagnosis of CHF requires either: two major criteria one major and two minor criteria present concurrently

Question 27

NY Heart Association Functional Capacity Classification

Answer 27

heart disease is based on symptomology as it relates to physical activity

Question 28

what subjective history (8) should be documented when evaluating a patient with diagnosed CHF?

Answer 28

PMH medications current health status nutrition status social history/habits occupation living environment social support system

Question 29

what objective tests/measures (12) should be performed when evaluating a patient with diagnosed CHF?

Answer 29

-A&O -pain perception assessment scale, VAS -aerobic capacity/endurance: vital signs at rest/activity, perceived exertion scale, pulse ox, lung auscultation -ventilation/respiration/circulation: assess cough/secretion clearance, breathing patterns, vital capacity, perceived exertion scale, pulse ox, pulse palpation, lung and heart auscultation -circumferential measurements -A/PROM -muscle strength -skin assessment -proprioception/kinesthesia -gait, locomotion, balance: static/dynamic balance in sit/stand, safety during gait w/ & w/o AD -current and potential environmental, home and work barriers/hazards -community, work and leisure analysis

Question 30

what diagnoses (3) create pulmonary congestion that may result in left-sided CHF?

Answer 30

left ventricular infarction aortic or mitral valve disease HTN

Question 31

overtime, in left-sided heart failure, fluid accumulation spreads from the pulmonary system, resulting in what s/s (4)?

Answer 31

ankle edema congestive hepatomegaly ascites pleural effusion

Question 32

what are later stages of CHF characterized by?

Answer 32

symptoms of decreased cardiac output

Question 33

a patient with CHF will be treated based on the __ __ of heart failure

Answer 33

root cause

Question 34

what medications (5) are typically included in the pharmacological management of CHF?

Answer 34

diuretics nitrates cardiac glycosides analgesics angiotensin-converting enzyme inhibitor agents

Question 35

__ play a vital role in optimal management of the CHF disease process

Answer 35

medications

Question 36

PTs must be aware of potential __ __ of medications (like digitalis toxicity) when treating patients with CHF

Answer 36

side effects

Question 37

what might a patient with CHF generally be referred to physical therapy for?

Answer 37

generalized conditioning generalized mobility caregiver education/training

Question 38

primary goals of physical therapy for a patient with CHF?

Answer 38

improving exercise tolerance increasing knowledge of the disease process

Question 39

what intervention is commonly used to initiate an exercise program with cardiac patients?

Answer 39

walking

Question 40

how do patients with CHF typically progress their endurance in physical therapy (2)?

Answer 40

by following their own HR and perceived exertion guidelines

Question 41

what other aspects of care (3) are important components of a cardiac patients POC?

Answer 41

psychosocial support nutritional counseling (no salt diet and no alcohol) caregiver education

Question 42

what nutritional counseling guidelines (2) are typically prescribed to patients with CHF?

Answer 42

no salt diet no alcohol

Question 43

what is typically included in a cardiac patient's home exercise program? what type of physical therapy is sometimes indicated in combination with HEP for cardiac patients?

Answer 43

continuation of progressions to exercises initially prescribed in in hospital once discharged- may perform in combo with OP services if indicated

Question 44

what is the likely outcome of a course of physical therapy for a patient with CHF?

Answer 44

-not a cure for CHF or its cause -improved endurance and strength after decline in function from hospitalization/bed rest -improved skeletal muscle function -improved blood flow -improved metabolic capacity -overall exercise tolerance

Question 45

what is the prognosis of CHF?

Answer 45

poor

Question 46

why is the prognosis of CHF poor?

Answer 46

despite the heart's compensatory mechanisms, the ability of the heart to contract and relax progressively worsens until it eventually fails

Question 47

end-stage CHF without pharmaceutical or surgical intervention (transplantation) will result in __

Answer 47

death

Question 48

end-stage CHF without __ or __ __ will result in death

Answer 48

pharmaceutical or surgical intervention (transplantation)

Question 49

what are the most significant predictors (10) of mortality in patients with CHF?

Answer 49

decreasing left ventricular EF worsening NYHA functional status decreasing degree of hyponatremia decreasing peak exercise oxygen uptake widened QRS on ECG chronic hypotension resting tachycardia renal insufficiency intolerance to conventional therapy refractory volume overload

Question 50

what ECG change is indicative of CHF and also one of the most significant predictors of mortality in patients with CHF?

Answer 50

widened QRS

Question 51

what condition is a common differential diagnosis to CHF?

Answer 51

cor pulmonale

Question 52

what is cor pulmonale

Answer 52

a form of right sided heart failure normally seen as a consequence of chronic obstructive pulmonary disease (COPD)

Question 53

cor pulmonale is a form of __ sided heart failure normally seen as a consequence of __ __ __ __

Answer 53

right; chronic obstructive pulmonary disease (COPD)

Question 54

pathology of cor pulmonale

Answer 54

sustained hypoxia produces an increase in pulmonary artery pressure that leads to right ventricular atrophy and, finally, right-sided heart failure

Question 55

the pathology of core pulmonale includes sustained __ that produces increased __ artery pressure that leads to __ __ atrophy and, finally, __-__ heart failure

Answer 55

hypoxia; pulmonary; right ventricular; right-sided

Question 56

how does right-sided heart failure effect the left side of the heart?

Answer 56

the left side of the heart does not receive adequate amounts of blood and oxygen and then cannot sustain a normal cardiac output

Question 57

is cor pulmonale congestive in nature? why?

Answer 57

no- there is no fluid build up within the lungs

Question 58

right-sided heart failure associated with cor pulmonale does NOT present with an audible __ __

Answer 58

S3 gallop