Heart Failure Flashcards by Emily Symon

What is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood?

Heart failure

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What are 3 cardinal manifestations of heart failure?

dyspnea
fatigue
fluid retention

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Is heart failure preferred over congestive heart failure?

YES

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What are the 3 clinical manifestations of heart failure?

marked decrease in exercise tolerance
decline in functional status
decrease in quality of life

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The abnormal stroke volume that comes with heart failure is due to what 3 things?

impaired contractility
increased afterload
impaired ventricular filling

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What is defined at “tension on muscle fibers at EDV”?

Preload

–> heart cannot contract fully - get increased volume in ventricles

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Measurements of Heart function?(5)

ejection fraction
cardiac output
LVEDV or LVEDP
echocardiogram
exercise stress test

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What is defined as the resistance encountered by left ventricle when it tries to eject blood (systole)?

afterload

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afterload increases with what?

increase in arterial vasomotor tone

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increased afterload causes what?

increases myocardial oxygen consumption (pumping against resistance)
decreased stroke volume

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What are the 3 main types of cardiomyopathy?

dilated
restrictive
hypertrophic

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Effects of dilated cardiomyopathy?

muscle fibers have stretched

- heart chambers enlarged

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Effects of hypertrophic cardiomyopathy?

growth and arrangement of muscle fibers are abnormal

- heart walls thicken, especially in the left ventricle

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Effects of restrictive cardiomyopathy?

ventricle walls stiffen and lose flexiblity

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What occurs during systolic dysfunction?

loss of contractility
dilated ventricle
increase LVEDV
lead to decreased EF

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What occurs during diastolic dysfunction?

impaired filling due to hypertrophy or decreased filling

- results from hypertension or aortic stenosis

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What is a sign of cardiac dysfunction?

decreased ejection fraction

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What is an example of a diagnosis that can lead to heart failure?

cardiomyopathy

Three cardinal symptoms of heart failure?

chronic fatigue
activity intolerance
shortness of breath

Causes of right sided heart failure?

increased pulmonary resistance
increased afterload - pulmonary HTN or valve stenosis
low preload or poor pump

Causes of left sided heart failure?

impaired contractility
increased afterload
loss of myocardial tissue
low preload

Symptoms of right sided heart failure?

venous congestion
weight gain
peripheral edema
hepatomegaly
jugular venous distention

Symptoms of left sided heart failure?

dyspnea
orthopnea
paroxysmal nocturnal dyspnea
S3 heart sound
excessive weight gain
decreased exercise tolerance

What neurohormone maintains normal fluid status and promotes normal cardiac function?

B-type natriuretic peptide

What neurohormone is secreted by the left ventricle in response to volume expansion and pressure overload?

B-type natriuretic peptide (BNP)

What is the purpose of BNP?

counter regulates renin-angiotensin-aldosterone system by encouraging vasodilation

Functional classification of heart failure?

Class I -- no limitation to physical activity Class II -- Slight limitation of activity - OK at rest Class III -- OK at rest Class IV -- Symptoms present at rest

Medications that decrease cardiac workload?

- ACE inhibitors -- decrease afterload - Diuretics -- decrease volume - Beta-Blockers -- limit SNS stimulation to heart, hold HR down

What agent increases cardiac muscle contraction?

Digitalis (glycosides)

Cardiac function correlate _____ with the clinical severity of heart failure.

poorly

Acute CARDIAC responses to exercise in patients w/ heart failure?

- progressive decrease in CO, SV, and HRR | - limited exercise tolerance

Acute CIRCULATORY response to exercise in patients w/ heart failure?

- reduced blood flow | - changed in distribution of blood flow

Acute SKELETAL MUSCLE METABOLIC responses to exercise in patients w/ heart failure?

- higher lactate levels at submaximal workloads | - slower on- and off- kinetics w/ exercise

Is aerobic interval training or moderate continuous training better for patients w/ heart failure?

aerobic interval training (VO2 peak increased greater)

Benefits of exercise in heart failure?

exercise training may reverse peripheral abnormalities - - autonomic function - - skeletal muscle blood flow - - localized oxidative capacity

What 3 things does aerobic exercise improve?

- VO2 max - Dyspnea - LV function

What 3 things does resistance exercise improve?

- LV function - peak lactate levels - muscle strength and muscle endurance

Do you want aerobic or resistance exercise for HF patients?

BOTH

For every 1 MET increase in fitness, what percent reduction do we get in mortality?

10% reduction in mortality

4 indications for terminating exercise testing?

- BP - Angina - ECG - Signs

What is the equation for RPP?

HR x SBP = RPP

What is the best indicator of workload of the heart?

RPP

For a patient post-MI, what should their HR be in order to be allowed to exercise?

For a patient post-surgery, what should their HR be in order to be allowed to exercise?

30 beats above resting