Heart Failure

Question 1

heart failure

Answer 1

Inability of the heart muscle to pump blood to adequately meet the bodies needs for oxygen

Syndrome characterized by impaired cardiac pump function with inadequate systemic perfusion, and an inability to meet the bodies metabolic demands

Question 2

pathophysiology of heart failure

Answer 2

injury to heart muscle

decrease myocardial contractility reducing the cardiac output

Reduction in cardiac output triggers RAAS
-Increase in renin and increase in angiotensin
-facilitates, sodium and water retention in renal tubules
-increases blood volume

sympathetic system is stimulated
-Increase the tone of blood vessels
-Increase contractility
-increase venous return

Question 3

cardiac muscle hypertrophy and heart failure

Answer 3

Left ventricular muscle

Left ventricular failure is most common cause of increase in pulmonary capillary pressure

Question 4

Pulmonary dysfunction

Answer 4

increase volume or volume overload

Impairs alveolar blood gas barrier
impairs diffusion across the alveolar membranes

Common clinical manifestation of heart failure is pulmonary edema

Question 5

Pulmonary edema

Answer 5

Cardiogenic or non-cardiogenic

3 distinct stages

1-increase lymph flow, elevated capillary pressure, interstitial edema
2-alveolar edema, tachypnea, elevated PCWP
3- flooding of alveoli, hypercapnia, hypoxemia

Question 6

heart failure, and liver

Answer 6

Impairs liver function
Hepatic venous congestion, hepatomegalty

Question 7

Heart failure and pancreas

Answer 7

Reduces blood flow to pancreas

Impairs insulin secretion and glucose tolerance

Heart muscle depends on glucose metabolism

Question 8

heart failure and blood

Answer 8

Polycythemia
Effect of anemia
Hemostasis- thrombocytopenia

Question 9

Heart failure, and nutrition

Answer 9

malnutrition anorexia

protein calorie deficiency
Decrease production of a erythropoietin
Decreased synthesis of dihydroxycholecalciferol
Impaired intermediary metabolism

Question 10

heart failure and skeletal muscle function

Answer 10

Myopathy

CHF without cardiomyopathy -decrease an average diameter of type one and type two

CHF with cardiomyopathy - type one and type two muscle fiber atrophy

Isometric muscle strength is reduced by 50%

Question 11

Left sided heart failure

Answer 11

reduced cardiac output

Blood back up into left atrium and lungs

Shortness of breath and cough

Question 12

Right sided heart failure

Answer 12

raised pulmonary artery pressure

Back up into right atrium and venous vasculature

raised jugular venous distention

peripheral edema

Fluid retention predominate

Question 13

Biventricular heart failure

Answer 13

left ventricle pathology back up into lungs increasing PA pressure

Fluid back up into the right side of the heart

Fluid back up into the systemic venous vascular

Combination of SOB and peripheral edema

Question 14

Left ventricular failure

Answer 14

Progressive dyspnea
Proximal nocturnal dyspnea

fatigue weakness
Enlarged heart
Pulmonary rales

Possible functional mitral, and tricuspid regurgitation

S3 heart gallop

Question 15

right venticular failure

Answer 15

dependent edema
Hepatomegaly
Ascites
Anorexia, nausea, bloating

Right sided S3 or S4

Accentuated P2

Question 16

risk factors of heart failure

Answer 16

hypertension
Coronary artery disease
Compromise cardiac muscle
Diabetes
dislipidemias
Hyperthyroidism
Sleep apnea
Aging

Question 17

aging

Answer 17

Weight gain adipose tissue increase
impaired endothelium dependent vasodilation

left ventricular stiffness
vascular dysfunction
Impaired calcium regulation
Decreased beta adrenergic reserve
Deconditioning
decreased sympathetic nervous system

Question 18

strong predictors of death with heart failure

Answer 18

Age
Renal function, blood pressure, blood sodium levels
Ventricular ejection fraction below 40%
Gender, diabetes
Elevated body mass index
Elevated brain natriueretic peptide level
poor Exercise capacity

Question 19

Class one functional classification

Answer 19

Cardiac disease without limitations in physical activity

Ordinary physical activity does not cause undue, fatigue, palpitation, or dyspnea

Absence of dyspnea with daily activities

Question 20

Class two functional classification

Answer 20

cardiac Disease resulting in slight limitation of physical activity

ordinary, physical activity can trigger symptoms of fatigue, palpitation, or dyspnea

Comfortable at rest

Question 21

Class three functional classification

Answer 21

cardiac disease with marked limitation of physical activity

Less than ordinary activities, cause fatigue, palpitation, or dyspnea

Comfortable at rest

Question 22

class 4 functional classification

Answer 22

Cardiac disease affecting the patient’s ability to carry out any physical activity without discomfort

Any physical activity increases symptoms

Symptoms of heart failure at rest

Question 23

systolic failure

Answer 23

weakness in contraction of the ventricles

reduces stroke volume cardiac output, and EF

Heart failure with reduced ejection fraction

Question 24

Diastolic failure

Answer 24

left ventricle is stiff and unable to relax

Reduced stroke volume and cardiac output

Ejection fraction is unaltered

Heart failure with preserved ejection fraction

Question 25

signs and symptoms of heart failure

Answer 25

dyspnea fatigue cough ejection fraction reduced or preserved ekg changes - systolic-LVH diastolic-RHV

Question 26

heart failure with reduced ejection fraction

Answer 26

Decreased ejection fraction Heart failure with reduced cardiac output at rest and during during activity

Question 27

Heart failure with preserved ejection fraction

Answer 27

normal or near normal ejection fraction More than 50% of heart failure, patient Diastolic heart failure Heart muscle stiffness and thickness Typically occurs in older women

Question 28

In heart failure, increase in heart heart rate is associated with

Answer 28

Decrease in force of contraction

Question 29

Decrease in blood pressure with exercise indicates inability to

Answer 29

Maintain cardiac output

Question 30

S1

Answer 30

Closure of tricuspid and mitral valves

Question 31

S2

Answer 31

Closure of aortic and pulmonic valves

Question 32

S3

Answer 32

Heard in heart failure

Question 33

ECG diagnostic tool

Answer 33

History of ischemic disease Abnormal ECG if ejection fracture is reduced

Question 34

Echocardiography diagnostic tool

Answer 34

Wall thickness Chamber size Left ventricular function

Question 35

chest x-rays diagnostic tool

Answer 35

cardiomegaly Opacities from pulmonary edema Blunting of costophrenic angle

Question 36

lab findings, diagnostic tool

Answer 36

Elevated brain natriuretic peptid BNP Normal is <100 pg/mL > 400 pg/mL indicative of heart failure

Question 37

non pharmacological management of heart failure

Answer 37

Oxygen therapy Sleep management Symptom recognition Fluid overload Activity Exercise therapy

Question 38

pharmacological management of heart failure

Answer 38

Ace inhibitors Angiotensin receptor blockers ARNI MRA Diuretics Beta blockers ivabradine Cardiac glycosides

Question 39

Exercise with patient with heart failure

Answer 39

exercise prescription Aerobic exercise Strength training Ventilatory muscle training Activity pacing and energy conservation Education of patience

Question 40

Relative contraindications for exercise training

Answer 40

rapid increase in weight over 1 to 3 days Supine, resting heart rate is greater than 100 bpm Class 4 NYHA functional classification Ventricular arrhythmias at rest or with exertion in the past three days Decrease in SBP with exercise

Question 41

Absolute contraindications for exercise

Answer 41

significant angina at below 2 mets New onset atrial fibrillation

Question 42

exercise prescription for patient with heart failure

Answer 42

Low level exercise if hemodynamically stable Endurance training, systemic and peripheral O2 utilization

Question 43

Aerobic Exercise patient with heart failure

Answer 43

Low intensity, low impact Start at 40% of THRR and progress to 60-80% Gradual progression of intensity, frequency, and duration Start with two times a week progressing towards 3 to 5 times a week 10 to 20 minutes gradually progressed to 30 to 40 minutes Gradually progress on the scale from 9 to 14

Question 44

Strength training with a patient with heart failure

Answer 44

Low level resistance training 60 to 80% of one rep max 8 to 15 reps , one to three sets, three minutes of rest in between Theraband for upper extremities Lower extremity resistance with lightweights

Question 45

ventilatory muscle training

Answer 45

Breathing exercises Diaphragmatic breathing Pursed Lip breathing Positive positive and expiratory pressure Threshold inspiratory muscle trainer

Question 46

Activity pacing and energy conservation with heart failure

Answer 46

take frequent rest intervals Participate in activities, which consume more energy when the patient has more energy Avoid and delegate some activities Alternate easy and difficult tasks sit between Strenuous activities

Question 47

heart failure with reduced ejection fraction and pharmacological management

Answer 47

Medication to improve contractility Medication to decrease cardiac workload

Question 48

Heart failure with preserved ejection fraction and pharmacological management

Answer 48

medication trials have not found significant positive responses Medications to manage comorbidities

Question 49

Acute heart failure in pharmacological management

Answer 49

Decrease fluid buildup

Question 50

ACE inhibitors

Answer 50

for HFrEF enalapril and captopril Block conversion of angiotensin one to angiotensin two Adverse effects, dry cough and rash

Question 51

angiotensin receptor blockers

Answer 51

for HFrEF iosartan and valsartan prevents angiotensin 2 from binding to receptors adverse- slight risk of angioedema, hyperkalemia alternate to ace id unable to tolerate them

Question 52

angiotensin receptor neprilysin inhibitors

Answer 52

for HFrEF entresto inhibits neprilysin and blocks angiotensin 2 adverse- hyperkalemia, renal failure, angioedema with overlap of aceis and arbs

Question 53

mineralocorticoid receptor antagonists

Answer 53

spironolactone and eplerenone block aldosterone receptors in kidney adverse- impotence and gynecomastia

Question 54

diuretics

Answer 54

inhibits reabsorption of sodium which decreases water reabsorption loop diuretics thiazide diuretics potassium sparing diuretics adverse- electrolyte imbalance, dehydration, monitor for OH

Question 55

beta blockers

Answer 55

Reduce heart rate Decrease cardiac workload and prevent arrhythmias Adverse - hypotension, blunts heart rate with exercise

Question 56

if channel blocker

Answer 56

indicated for patients with symptomatic HFrEF; LVEF<35% and HF >70bpm Inhibits the pacemaker current of the SA node Reduces heart rate without affecting the force of contraction of the heart or lower BP Adverse - blurred vision, bradycardia, and headaches

Question 57

cardiac glycosides

Answer 57

Inhibits the sodium pump indirectly promoting calcium influx, improving the heart muscles ability to contract Adverse effects, arrhythmias and bradycardia

Question 58

medication not recommended for heart failure with reduced ejection fraction

Answer 58

statins oral anticoagulant and anti-platelet medications Calcium channel blockers