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KIN 435 > Disordered Breathing During Exercise in Heart Failure > Flashcards

Disordered Breathing During Exercise in Heart Failure Flashcards

1
Q

Define Chronic Heart Failure

A

Congestive Heart Failure (CHF)
- Inability of Heart to supply sufficient blood flow to meet demand of body

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2
Q

How many Classes of Heart Failure does the New York Heart Association Classify?

A
  • Four
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3
Q

How Does New York Heart Association Classify Class I of Heart Failure?

A

No Limitation
- Ordinary physical exercise does not cause undue fatigue, dyspnoea, or palpitations

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4
Q

Define Class II Heart Failure from the New York Heart Association

A

Slight Limitation of Physical Activity
- Comfortable at rest
- Ordinary activity results in fatigue, palpitations, or dyspnoea

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5
Q

Define Class III Heart Failure

A

Marked Limitation of Physical Activity
- Comfortable at Rest
- Less than ordinary activity results in symptoms

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6
Q

Define Class IV Heart Failure

A

Unable to carry out any physical activity without discomfort
- Symptoms present at rest
- Increased discomfort with any physical activity

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7
Q

What is Stroke Volume?

A
  • Volume of blood pumped per contraction
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8
Q

What is End-Diastolic Volume (EDV)? What is End-Systolic Volume (ESV)?

A

EDV
- Volume of blood in ventricle before contraction
ESV
- Volume of blood in ventricle after contraction

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9
Q

What is Cardiac Output?

A
  • Total Volume of blood pumped by the ventricle per minute
  • Q = HR x SV
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10
Q

What is an Ejection Fraction (EF)?

A
  • Proportion of blood pumped out of the left ventricle each beat
  • EF = SV/EDV
  • Average 60% at rest
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11
Q

How is Heart Failure Defined Based on Ejection Fraction?

A
  • Normal EF should be 50-70%
  • In Systolic Heart Failure, EF drops below 40%
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12
Q

What happens in Restrictive Pulmonary Disease?

A

Forced Expiratory Volume
- Reduced
Forced Vital Capacity
- Reduced
FEV1.0/FVC%
- Normal or even increased

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13
Q

What happens during a Obstructive Pulmonary Disease?

A

Forced Expiratory Volume
- Reduced significantly
Forced Vital Capacity
- Reduced Slightly
FEV1.0/FVC%
- very low ratio

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14
Q

What are the Symptoms of Heart Failure?

A
  • Poor ventricular systolic function
  • Poor Hemodynamic Performance
  • Weak respiratory Muscles
  • Increased Left Atrial and Pulmonary Pressure
  • Lung Fluid Balance changed
  • Neuro-humoral Activity
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15
Q

Is Heart Failure obstructive or Restrictive?

A
  • Both
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16
Q

What is the disordered Breathing Pattern with Exercise?

A
  • Rapid Shallow Breathing (tachypnea)
  • Oscillatory Breathing
  • Reduced End-expiratory lung volume at rest
  • Significant expiratory flow limitation and adequate inspiratory reserve volume
17
Q

What are the different patterns of Oscillatory Ventilation?

A
  • Noisy oscillations at early exercise (considered no-exercise oscillatory breathing
  • Initial to intermediate phases of exercise: disappears around 60% whole exercise
  • Entire Exercise Oscillation: Wide amplitude of cycles that persist
18
Q

Where does Ventricular Hypertrophy occur in Heart Failure?

A
  • Left Ventricle
  • Right Ventricle
  • Left Atrial Enlargement
19
Q

What is Cardiomegaly?

A
  • Enlargement of the Heart due to Heart Failure
20
Q

What was the Rationale for the Study “Influence of cardiomegaly on disordered breathing during exercise in chronic heart failure”?

A
  • Hypothesize that significant changes in the cardiac system could have profound effects on the pulmonary system, particularly during physical activity
  • Determine the relationship between cardiac size and breathing patterns during exercise
21
Q

What was the Hypothesis of The Study on Cardiomegaly?

A
  • Increased competition for intra-thoracic space caused by the increased cardiac volume associated with HF contributes to the tachypnoeic breathing pattern during exercise
22
Q

What was the inclusion / exclusion criteria for the study on cardiomegaly?

A
  • Patient with a history of ischaemic or dilated cardiomyopathy
  • Stable HF symptoms (>3months)
  • Duration of HF Symptoms (>1year)
  • Left ventricular ejection fraction of <35%
  • Body mass <35kg/m^2
  • Current Non-smoker (past 15 year)
  • Smoking history less than 10 pack-years
23
Q

What was the Control Group for the study on Cardiomegaly?

A
  • Similar age, gender, and height distribution to the HF group
  • Normal Cardiac Function (EF >50%)
  • No history of hypertension
  • No history of lung disease
  • No history of coronary artery disease
24
Q

What were the Protocols used for the study on cardiomegaly?

A
  • Graded Exercise Testing
  • Spirometry
  • Chest Radiograph (PA and LAT)
  • Cardiomegaly: cardiac volume as a percent of total thoracic cavity volume (TTCV)
25
Q

How were the groups determined for the study on Cardiomegaly?

A

HF group median heart size
- 12% Total Thoracic Cavity Volume
Group A
- CV < Median
Group B
- CV > Median
Control
- Normal Cardiac Volume
- No HF

26
Q

What were the different measurements used in the Study on Cardiomegaly?

A

Spirometry
- Forced Vital Capacity (FVC)
- Forced Expiratory Volume in one Second (FEV1)
- Mean FEF between 25-75% (FEF25-75)
Diffusing capacity of the lung for carbon monoxide (DLco)
Alveolar Volume using single breath method

27
Q

What were the methods used to test exercise in the study on cardiomegaly?

A
  • Symptom-limited incremental treadmill test
  • Rating of perceived exertion (Borg)
  • VO2
  • VCO2
  • VE
  • VT
  • RR
  • Partial pressure end-tidal oxygen and carbon dioxide
28
Q

What were the Results of the Study on Cardiomegaly at 75% peak exercise?

A
  • Control had higher VO2, VCO2, VE
  • Group A/B had higher VE/VCO2 compared to control
  • Group A reduced VE due to lower RR
  • Group B reduced VE due to reduced VT
29
Q

What was the implications of the results from the study on cardiomegaly?

A
  • Cardiac Size is independently associated with VT at 75% of VO2 peak (-58ml/min per +10% cardiac size)
  • At VO2 peak VT was statistically significant (-315ml/min per +10% cardiac size)
  • Cardiac size was significantly related to reduced VT in the HF patients
30
Q

What was the Relationship between VT% of TTCV volume and VE% of TTCV volume?

A
  • HF patients with larger cardiac sizes demonstrated significant levelling off of VT
31
Q

Why is there a change in respiratory rate and tidal volume in HF patients with cardiomegaly?

A
  • Larger cardiac volume changes breathing architecture during exercise
  • Contributes to symptoms of dyspnoea and fatigue
32
Q

What is the relationship between cardiac volume and total lung volume?

A
  • Reduced lung volume reduces the effectiveness of the elastic recoil component of exhalation
  • Reduced stretch of lung results in reduced maximal volume and expiratory flow
  • HF patient with largest cardiac volume have reduced FVC and FEV 1.0

KIN 435 (14 decks)

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