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KIN 187 Clinical Exercise Physiology > Chap 5. Chronic Heart Failure > Flashcards

Chap 5. Chronic Heart Failure Flashcards

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1
Q

Exercise response to chronic heart failure

A

Alterations in central/peripheral and ventilatory abnormalities

  • reduction of cardiac output
  • leg fatigue due to inadequate blood flow
  • altered catecholamine levels
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2
Q

Central abnormalities

A
  • systolic dysfuction
  • pulmonary hemodynamics
  • diastolic dysfunction
  • neurohumoral mechanisms
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3
Q

Peripheral Abnormality

A
  • Blood flow abnormalities
  • vasodilatory capacity
  • skeletal muscle biochemistry
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4
Q

Ventilatory Abnormality

A 
Pulmonary pressure 
Physiologic dead space
Ventilation-perfusion mismatch 
Respiratory contro 
Breathing patterns
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5
Q

Ventilatory Inefficiency

A 
VE/VCO2 slope 
V02 Kinetics 
Ventilatory Threshold
VO2 in recovery 
Exercise periodic (oscillatory) breathing during exercise
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6
Q

An increase in VCO2

A 
Ventilatory/perfusion mismatching
Early lactate accumulation
Deconditioning
Hyperventilation
CHF patients have a higher slope (VE/VCO2) than normal subjects
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7
Q

Exercise Testing considerations for CHF (VE/CO2)

A

VE/VCO2 slope ≥34 indicates poor prognosis

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8
Q

HR (exercise test conditions)

A

20-30% of CHF patients have chronotropic incompetence
it is associated with decreased myocardial beta receptor sensitivity (HRpeak should exceed ≥80% of age predicted HRreserve)

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9
Q

BP (exercise test conditions)

A

may be low or fail to rise due to LV dysfunction, afterload reducing medications or both

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10
Q

VO2peak (exercise test conditions)

A

inversely related to mortality <18ml/kg/min or significant drop with testing is a concern

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11
Q

Other exercise testing conditions

A
  • Atrial/ventricular arrhythmias, bundle branch block

- Left ventricular hypertrophy

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12
Q

Exercise Programming (CHF)

A
  • Referral to cardiac rehabilitation
  • Follow basic recommendations
  • Re-evaluate frequently
  • Pro-long warm-up and cool-down
  • Perceived exertion and dyspnea scales should take precedence over heart rate targets
  • Isometric exercises should be avoided
  • Electrocardiogram monitoring is required for persons with a history of ventricular tachycardia, cardiac arrest (sudden cardiac death), and exertional hypotension
  • resistance training appears safe in persons with HRrEF
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13
Q

Systolic Heart Failure

A
  • Less blood pumped out of ventricles

- Weakened heart muscle can’t squeeze as well

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14
Q

Diastolic Heart Failure

A

Less blood fills the ventricles

Stiff heart muscle can’t relax normally

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15
Q

Left Side Heart Failure

A

Failure to properly pump out blood to the body (Systolic and diastolic fall under this category)

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16
Q

Right Side Heart Failure

A

back-ups in the area that collects ‘used’ blood

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17
Q

CHF occurs when

A 
cardiac output is reduced 
systolic dysfunction (impairment of left ventricle)
diastolic dysfunction (due to resistance to filling of one or both ventricles)
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18
Q

Most common cause of CHF

A

coronary artery disease, HTN and myocardial infarction

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19
Q

Pathophysiology of Heart Failure

A

Impaired Contractility
Increased afterload
both lead to reduced ejection fraction then heart failure

Impaired diastolic filling leads to preserved ejection fraction

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20
Q

Heart failure with preserved ejection fraction

A

aortic stenosis

hypertension due to increased diastolic filling and compensatory ventricular hypertrophy

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21
Q

Pathophysiology of CHF

A

Myocardial Injury –>reduced Cardiac Output—->decrease in carotid baroreceptor stimulation, decrease in renal perfusion—> activation of the SNS and the RAAS—

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22
Q

BNP

A

secreted by the ventricles in response to excessive stretching of cardiomyocytes
decrease TPR and central venous pressure

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23
Q

ANP

A

Secreted by atria in response to high blood volume

decrease TPR and central venous pressure

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24
Q

Vasoconstriction increases

A

afterload

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25
Hemodynamic alterations increases
preload
26
SNA
has do to with SV and TVC
27
PNA
has to do with HR
28
Adrenal Gland cortex
releases aldosterone
29
Angiotension>Angiotension 1
Renin
30
Angiotension1>Angiotension2
ACE
31
Pituitary Gland
ADH secretion (vassopressin)
32
Regulation of Stroke Volume
EDV Aortic Blood Pressure Contractility
33
Contractility refers to
the strength of the ventricular contraction
34
Stroke Volume vs afterload
decreasing graph
35
Stoke volume vs EDV
increasing | Higher values of EDV if there is greater contractility
36
Coronary Artery Disease
CAD Build up of plaque in the coronary arteries Leads to ischemia and heart attack The most common cause of death
37
Ischemia
limited blood flow to the heart
38
Risk factors of CAD
High LDL, Low HDL, Hypertension, family history, diabetes, smoking, obesity, etc
39
Medical treatment for CAD
Angioplasty/coronary stent Coronary bypass grafting Medicines: beta-blockers, anti platelet drugs, calcium channel blockers, statins (lower cholesterol)
40
Balloon Angioplasty
minimally invasive, | widens the arteries, deflated balloon goes through catheter and then you inflate it
41
Coronary Stent
stent uses balloon to widen the artery and compress the plaque
42
Myocardial Infarction
Occurs when the blood flow stops to a part of the heart causing damage to the cardiac muscle Most commonly happens due to CAD
43
Pathophysiology of MI
Atherosclerotic plaque Inflammation: high sensitivity C-reactive protein (hs-CRP), calcification from calcium deposit as a part of plaque formation (can see this in CT scans)
44
Elevated CRP
predicts the risk of MI and stroke
45
CRP
c reactive protein | synthesized by the liver in response to factors released by macrophages and adipocytes
46
A heart (CT) scan
can show calcification (bright white spots on the CT scan)
47
Signs of a myocardial infarction
Discomfort in the center of the chest that lasts more than a few minutes (or goes away and comes back) Uncomfortable pressure, squeezing, fullness or pain pain/discomfort in arms, back, neck, jaw or stomach Shortness of breath with or without chest discomfort Breaking out in cold sweat, nausea or lightheadedness
48
True positive
positive exercise test and CVD
49
False Negative
negative exercise test and CVD
50
False Positive
Positive exercise test and no CVD
51
True Negative
Negative exercise test and no CVD
52
Alpha receptor blockers (exercise)
significantly lower BP | Minimal effects on HR and metabolic responses to exercise
53
CNS active drugs (exercise)
ex. clonidine, guanfacine, guanabenz | attenuating effects on HR and BP during exercise
54
Calcium Channel Blockers (exercise)
some may decrease HR response at rest and during exercise
55
Vasodilators, ACE inhibitors and angiotensin receptor blockers (exercise)
do not effect HR response | patients might experience hypotension
56
Beta-Blockers (exercise)
decreased submax and max hr | sometimes decreased exercise capacity
57
In Patient aerobic prescription (CAD and MI)
first 2-4 times/day for the 1st 3 days in the hospital then 2 times/day beginning day 4 in hospital to tolerance of intensity if they are asymptomatic (RPE ≤13 on 6 - 20 scale) Post-MI/CHF: HR ≤120 bpm or HRrest +20 bpm Postsurgery: HRrest +30 bpm bouts of 3-5 min rest=slower walk 2:1 exercise/rest ratio progress to 10-15 min
58
Aerobic Prescription (CAD and MI)
``` 4-7 days/wk multiple short bouts of 1-10 min RPE 11 to 16 (6 – 20 scale) 40 to 80% HRR or VO2R HR below ischemic threshold Warm up 5-10 min and then 20-60 min workout to toleration ```
59
Muscular Strength/endurance prescription(CAD and MI)
3-4 days /wk 2-4 sets; 12-15 reps; 8-10 various exercises take as much time as needed functional movements, circuit training, avoid straining and holding breath
60
Effects of exercise training
increased maximal oxygen consumption improved ventilatory response improved anaerobic and ventilatory threshold relief of angina modest decreases in bw, fat stores, bp, total cholesterol, serum triglycerides and LDL Increases in HDL Improved psychosocial well-being and self-efficacy Protection against triggering MI by vigorous physical exertion Decreased coronary inflammatory markers increases numbers of endothelial progenitor cells and cells that promote angiogensis and vascular regeneration Increased vagal tone and decreases adrenergic activity
61
Neurohumoral effects of exercise
decrease in norepinephrine, decrease in vasopressin, decrease in ang 2, decrease in aldostersone
62
Musculature effects of exercise
increase oxidative enzymes, increase mitochondria content, increase IGF-1. decrease proinflammatory cytokines, decrease oxidative stress
63
Inflammatory response of exercise
decrease in iNOS, TNF, IL-1B, IL-6, IL-10, CD4OL, P-selectin, GM-CSF, MCP-1, ICAM-1, VCAM-1
64
Cardiac Function effects of exercise
Increase Ca2+ sensititvity | Decrease myocyte contractility, improved hemodynamic, restoration of IP
65
Vasculature effects of exercise
increase in eNOS, NO, SOD, Endothelial function | Decrease in ROS, Oxidative Stress
66
Vascular reflex effects of exercise
increase of arterial baroreceptors, decrease in chemoreceptors
67
Nervous System effects of exercise
Decrease in Ang 2, decrease in AT1, decrease in ROS, increase in NO, decrease SNA, Increase in vagal activity

KIN 187 Clinical Exercise Physiology (16 decks)

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