Flashcards in Exam 1 Deck (614)
What are 4 symptoms of right sided heart failure:
1. weight gain
2. peripheral edema
3. hepatomegaly (abnormal enlargement of liver)
4. jugular venous distention
What are 6 symptoms of left heart failure:
3. paroxysmal nocturnal dyspnea
4. S3 heart sound
5. excessive weight gain (>2lbs /day)
6. decreased EX tolerance
Why is dyspnea a symptom of left sided heart failure?
b/c blood is backing up into lungs, caused belabored breathing
What is orthopnea?
trouble breathing while laying down
What is S3 heart sound?
abnormal sound associated w/ HF (normal in kids)
With left sided heart failure what sound is heard during auscultation?
crackles / rales
Describe the pulmonary edema associated with left sided heart failure?
- when pulmonary venous pressure > 20mmHg, fluid into lungs (increased hydrostatic pressure)
- decreased pulmnary compliance = increased work of breathing
The neurohormonal compensatory mechanism of decreased cardiac output leads to:
1. sympathetic stimulation
2. stimulate ADH (anti-diuretic) & increase vascular volume
3. renin - angiotensin
Decreased cardiac output --> Sympathetic stimulation leads to:
increase HR, increase contractility, and vasoconstriction.
Decreased cardiac output --> Renin-angiotensin, leading to:
vasoconstriction and increase in BP
The PURPOSE of compensatory adaptations in HF is to maintain_____________________ and _________ that adequately perfuses the brain and the heart.
The MAGNITUDE of the compensatory adaptations eventually leads to maladaptive processes which lead to a:
decompensated state or end-stage HF
List 5 compensatory mechanisms:
1. increase in MAP
2. Moderate fluid retention
3. increase LVEDP
4. Decreased strok volume (decreased EF)
5. Decreased contractility
"In compensated HF, symptoms are ______, and many overt features of fluid retention and pulmonary oedema are _____. Decompensated HF referst to a ___________, which may be present either as an acute episode of pulmonary oedema or as _______ and _______, a reduction in EX tolerance and increasing ________________ on exertion."
"In compensated HF, symptoms are STABLE, and many overt features of fluid retention and pulmonary oedema are ABSENT. Decompensated HF refers to a DETERIORATION, which may be present either as an acute episode of pulmonary oedema or as LETHARGY and MALAISE, a reduction in EX tolerance and increasing BREATHLESSNESS on exertion."
Which one (compensated or decompensated) can you work with as a PT?
What is B-type natriuretic peptide (BNP)?
-Endogenous neurohormones that maintain normal fluid status and promote normal cardiac function.
BNP is secreted by ______ ventricle in response to volume expansion & pressure overload - "myocardial stretch"
What is the purpsoe of BNP?
Counter-regulation of renin-angiotensin - aldosterone system (RAAS)
What does BNP encourage?
encourages vasodilation, diuresis while inhibiting the RAAS.
BNP >______pg/ml is diagnostic for CHF (sens 82%, spec 93%).
Class I HF:
No limitation of PA
Class II HF:
Slight limitation of activity - OK at rest
-Dyspnea & fatigue w/ "ordinary" PA
Class III HF:
OK at rest
-symptoms of HF with less than "ordinary" activity
Class IV HF:
Symptoms present @ rest
How do you control HF?
correct the underlying cause
Controlling HF, preload:
control salt and water retention (low sodium diet, diuretics)
Controlling HF, Improve contractility (cardiac muscle performance):
B-Blockers, inotropic meds (change force of heart contraction), pacemaker or decrease workload
Controlling HF, afterload:
reduce peripheral resistance (lower BP)
What medications are included in the "triple drug cocktail"?
1. ACE inhibitor