Flashcards in CHF Deck (55):
Which of the following is NOT a common condition with high-output CHF?
c) dilated cardiomyopathy
e) AV fistula
C) dilated cardiomyopathy = low output disease
Which of the following could NOT be a cause of the dyspnea seen in CHF?
a) decreased lung compliance
b) decreased CO2 production
c) decreased respiratory muscle strength/endurance
d) increased airway resistance
B) it's INCREASED CO2 production that causes dyspnea
What is cheyne-stokes respiration?
crescendo(faster/deeper)-decrescendo(slower) pattern of tidal volume followed by apnea for 15-20s
What heart sound is heard in CHF, which is a ventricular gallop?
What are the signs/symptoms of CHF?
- crackles (rales)
- S3 heart sound (gallop)
- peripheral edema
- cheyne-stokes respiration
- othopnea and paroxysmal nocturnal dyspnea
- weight gain
- sinus tachycardia
- cold, pale, cyanotic extremities
- jugular vein distention
Which heart rhythm may accompany heart failure?
Which of the following is NOT major Framingham criteria for CHF?
a) neck-vein distention (jugular)
c) S3 gallop
e) acute pulmonary edema
F) hepatomegaly = minor criteria
How do we confirm CHF? (in terms of having a number of criteria)
2 major criteria OR 1 major, 2 minor criteria
Is hepatojugular reflex a major or minor CHF criteria?
What is a positive hepatojugular reflex test?
jugular vein distension during or immediately after compression of the RUQ, > 4cm
What are some minor criteria for CHF?
- ankle edema
- night cough
- tachycardia >120
- pleural effusion
- dyspnea with exertion
Is paroxysmal nocturnal dyspnea a major or minor criteria for CHF?
Define class I - IV of heart failure.
I = no dyspnea or fatigue with ADL
II = dyspnea or fatigue with ordinary ADL
III = dyspnea or fatigue with less than ordinary ADL
IV = dyspnea or fatigue at rest
What are the exercise limitations for those with CHF?
- unable to deliver O2 to working muscle
- abnormal skeletal metabolism (more acidic enviro since have to rely on anaerobic system since no O2)
- deconditioned skeletal/respiratory muscles
- attenuated peripheral vascular response (incr. BP)
What test is best to assess survival rate for those with CHF? What distance constitutes poor survival rate?
6 min walk test:
T/F: walk distance is related with peak VO2
What is the threshold range of VO2 for survival rate?
How can PT's increase survival rate in these pts?
improve VO2 and walk test distance to improve survival rate
What are the two big issues with systolic cardiovascular dysfunction?
impaired contractility and pressure overload
Which of the following is FALSE about systolic dysfunction?
a) SV is less with systolic dysfunction
b) EDP is increased with systolic dysfunction
c) The graph is moved to the L
d) LV volume is greater than normal
e) all the above are true
C) the graph for systolic dysfunction is moved to the R, because the left ventricular volume is GREATER
The bottom line of the box also moves up since EDP is higher than normal
Is ejection fraction increased or decreased in systolic dysfunction?
Is stroke volume increased or decreased in systolic dysfunction?
What are the main two issues of diastolic cardiovascular dysfunction?
impaired ventricular relaxation and obstruction of LV filling
What are the main two issues of systolic cardiovascular dysfunction?
impaired contractility and pressure overload
Is pressure increased or decreased in systolic dysfunction?
pressure is increased
What 4 issues impact ventricular relaxation?
1) LV hypertrophy
2) hypertrophic cardiomyopathy
3) restrictive cardiomyopathy
4) transient myocardial ischemia
What two issues influence L ventricular filling?
1) mitral stenosis
2) pericardial constriction: cardiac temponade
- pericardial issues arise with low output heart failure
Which way does the graph slide when looking at diastole dysfunction?
L and up: pressure goes up while volume goes down slightly
- SV stays same
T/F: Pressure increases in both systolic and diastolic dysfunction of the heart.
Which of the following is NOT true about diastolic dysfunction?
a) EDV and ESV both decrease
b) stroke volume stays the same
c) ejection fraction increases
d) pressure increases
e) all are true
E) all are true
to compare to systolic...
- volume increases in systolic, decreases in diastolic
- SV decreases in systolic, stays same in diastolic
- EF decreases in systolic, increases slightly in diastolic
- pressure increases for both systolic and diastolic
When systolic dysfunction occurs with CHF, what happens to the neural system?
- SNS is activated
- Renin-angio system is activated
- increased antidiuretic hormone released
What effect does activating the renin-angio system have on CHF?
helps retain Na+ and water so as to increase blood volume and BP to make up for lack of CO
Why is the SNS more activated in CHF?
to increase epi/norepi to help increase contractility and HR to improve lowered CO
Why is antidiuretic hormone released more in CHF?
to help increase blood volume to make up for lack of CO
What neurotransmitter indicates poorer survival rate in CHF?
norepi: if you have greather than 800 pg/ml in peripheral norepi, you have a very poor survival rate
- the more peripheral norepi, the worse the heart disease
Which of the following is not true about pulmonary edema with CHF?
a) it's cardiogenic in nature
b) accompanied by anxiety, dyspnea, tachypnea
c) occurs when PCWP > 10 mmHg
d) it's a lifethreatening emergency
e) all are true
D) PCWP needs to be >25
What 2 hepatohemological changes can occur from CHF?
hepatomegaly and polycythemia
What muscular changes can we expect from pts with CHF?
- decreased isometric max strength (~55% of normal)
- atrophied muscle fibers
- intracellular acidosis (having to rely on anaerobic, producing more lactate)
- reduced PCr
- myogenic myopathy
Why does the heart become ischemic with CHF?
1) since O2 isn't being delivered, fat oxidation is inhibited
2) acyl CoA now gets built up
3) this causes inhibition of adenin nucleotide translocase (which brings mitochondria into cytosol)
4) we now have a lack of ATP in cytosol
Myocardial ischemia is related to what kinds of CHF?
Low output, systolic dysfunction, and diastolic dysfunction (for transient myocardial ischemia)
Hypertension can be found in what kinds of CHF?
low output, L-sided failure,
How does oxidative stress impact the endothelium?
hypertension and heart failure result in production of more ROS
- this outweighs balance with NO, resulting in less NO
- less NO = endothelial issues like decreased dilation, platelet aggregation, inflammation, etc
T/F: People with CHF will have an increased BP response.
Does restrictive cardiomyopathy affect L ventricular filling, or L ventricular relaxation?
L ventricular relaxation
- also LV hypertrophy, hypertrophic cardiomyopathy, transient myocardial ischemia
**L ventricular filling = from mitral stenosis or pericardial issue like cardiac temponade**
What kind of diet do those with CHF follow?
How is CHF treated?
with CABG, HTN meds, tx for endocrine disorders (norepi/epi, aldosterone), exercise, LVAD, transplant, intra-aortic balloon pump
How does an intra-aortic balloon pump help CHF?
- balloon deflates when ventricles contract, allowing blood to go through
- expands when ventricles fill to prevent blood from going back to pulmonary capillaries and to give coronary artery more pressure to perfuse
How does an LVAD help with CHF?
blood from L ventricle flows into LVAD, gets pumped from LVAD through aorta for more pressure and gets greater perfusion
T/F: The main mechanism of progressive heart failure is the remodeling of the L ventricle.
true: remodeling causes enlargement and functional deterioration
T/F: An LVAD can help with ischemic heart failure.
false, only non-ischemic (heart failure not involving coronary artery issue)
As far as breathing, what can PT's do for our patients with CHF issues?
work on diaphragmatic breathing
What should be our main goals for exercise with CHF patients?
- work on breathing
- improve endurance and VO2
- strengthening! (since atrophy/deconditioned)
- functional activity training
- exercise training
What questionnaire can be given to those with CHF to know about QOL?
minnesota living w/ heart failure questionnaire
- higher scores = worse off
T/F: Hospital readmission for heart failure AND cardiac death significantly decreased after cycling training for pts with CHF.