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571

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

572

What are 6 symptoms of left heart failure:

1. dyspnea
2. orthopnea
3. paroxysmal nocturnal dyspnea
4. S3 heart sound
5. excessive weight gain (>2lbs /day)
6. decreased EX tolerance

573

Why is dyspnea a symptom of left sided heart failure?

b/c blood is backing up into lungs, caused belabored breathing

574

What is orthopnea?

trouble breathing while laying down

575

What is S3 heart sound?

abnormal sound associated w/ HF (normal in kids)

576

With left sided heart failure what sound is heard during auscultation?

crackles / rales

577

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

578

The neurohormonal compensatory mechanism of decreased cardiac output leads to:

1. sympathetic stimulation
2. stimulate ADH (anti-diuretic) & increase vascular volume
3. renin - angiotensin

579

Decreased cardiac output --> Sympathetic stimulation leads to:

increase HR, increase contractility, and vasoconstriction.

580

Decreased cardiac output --> Renin-angiotensin, leading to:

vasoconstriction and increase in BP

581

The PURPOSE of compensatory adaptations in HF is to maintain_____________________ and _________ that adequately perfuses the brain and the heart.

CO
arterial pressure

582

The MAGNITUDE of the compensatory adaptations eventually leads to maladaptive processes which lead to a:

decompensated state or end-stage HF

583

List 5 compensatory mechanisms:

1. increase in MAP
2. Moderate fluid retention
3. increase LVEDP
4. Decreased strok volume (decreased EF)
5. Decreased contractility

584

"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."

585

Which one (compensated or decompensated) can you work with as a PT?

Compensated

586

What is B-type natriuretic peptide (BNP)?

-Endogenous neurohormones that maintain normal fluid status and promote normal cardiac function.

587

BNP is secreted by ______ ventricle in response to volume expansion & pressure overload - "myocardial stretch"

left

588

What is the purpsoe of BNP?

Counter-regulation of renin-angiotensin - aldosterone system (RAAS)

589

What does BNP encourage?

encourages vasodilation, diuresis while inhibiting the RAAS.

590

BNP >______pg/ml is diagnostic for CHF (sens 82%, spec 93%).

>100pg/ml

591

Class I HF:

No limitation of PA

592

Class II HF:

Slight limitation of activity - OK at rest
-Dyspnea & fatigue w/ "ordinary" PA

593

Class III HF:

OK at rest
-symptoms of HF with less than "ordinary" activity

594

Class IV HF:

Symptoms present @ rest

595

How do you control HF?

correct the underlying cause

596

Controlling HF, preload:

control salt and water retention (low sodium diet, diuretics)

597

Controlling HF, Improve contractility (cardiac muscle performance):

B-Blockers, inotropic meds (change force of heart contraction), pacemaker or decrease workload

598

Controlling HF, afterload:

reduce peripheral resistance (lower BP)

599

What medications are included in the "triple drug cocktail"?

1. ACE inhibitor
2. Diuretics
3. Beta-blockers

600

What do ACE inhibitors do?

decrease afterload