Heart Failure: Exam 1 Flashcards
(60 cards)
1
Q
ALWAYS has a cause
“Heart Pump Failure”
A
HF
2
Q
L Sided HF caused by
A
HTN
3
Q
R or L HF caused by
A
MI
Congen Heart Dis
Pericarditis, Endocarditis, Myocarditis
4
Q
RV CHF
A
PE
Pulm Dis and Pulm HTN
5
Q
Causes of HF
HTN
L. side HF
A
- prolonged HTN== irrev damage== sub-opt actin-myosin crossbridge== less effective heart pump
6
Q
Causes of HF
MI
R or L HF
A
Zone of Necrosis is dead non-contract tissue==> heart pump dysf.
7
Q
Causes of HF
Congenital Heart Dis
R or L HF
A
incompetent valves, septal defect, holes in heart, hypertrophied LV==> alters dir. blood flow==> incd demand on heart==> heart pump dysf
8
Q
HF Causes
Pericarditis, Endocarditis, Myocarditis
A
- infection of one of layers of heart causes myocardial damage==> less effective heart pump
9
Q
Causes of HF
PE
RV CHF
A
- elevated pulm artery pressures==> irrev damage to RV==> sub opt actin-myosin crossbridge ==> less effective RV heart pump (cor pulmonale)
10
Q
HF Causes:
Pulm Disease and Pulm HTN
RV CHF
A
- inc’d pulm cap pressure== elevated pulm aa pressures== irrev damage to RV== subopt actin-myosin crossbridge== less effective RV heart pump (cor pulmonale)
11
Q
Heart not ejecting as much blood as it should===>
A
Heart “pump” Failure
12
Q
Cardiac MM and the Frank Starling Law
A
relationship b/w length and tension of heart
when the curve starts to DEC==CHF
Normal curve should be INC SV, INC EDV (proportional)
13
Q
Frank Starling Ex. W/ HF
A
see pics
14
Q
Frank Starling Ex w/ HF
A
NOTE: compensatory tachycardia
15
Q
Classification of HF:
HF w/ reduced EF or
A
Systolic Dysf
HFEF <40%
NOTE: EF=SV/EDV
- MORE common
- heart stretches
- INC EDV
- DEC SV
16
Q
Class. HF
HF w/ Preserved EF or
A
Diastolic Dysf
HFpEF
- take vitals more often***
- has DEC SV
- issue is DEC EDV during Diastole
- tend to be w/ medically fragile people
17
Q
L.Sided HF
can cause R sided HF
A
- LV weakens, cannot empty=== diastolic or systolic dysf
- DEC CO to system/DEC SV from LV
-
DEC renal blood flow stims RAS an aldosterone secretion
- INC blood vol and vasodilation
- backup of blood into pulm vein
- HIGH press in pulm caps leads to pulm congestion or edema
18
Q
R. sided HF
cor pulmonale
DEC preload (vent filling, blood returning)
A
- RV weakens and cannot empty
- DEC CO to system, DEC SV from RV, DEC blood TO LV
- DEC renal blood flow stims RAS and aldosterone
- backup of blood into systemic circ (vena cava)
- INC venous press results in edema in legs, liver, an abd organs
- VERY HIGH venous press causes distended neck vein an cerebral edema
19
Q
L. sided HF what edema more likely
A
Pulmonary edema
LV not working and fluid builds up (BACK TO LUNGS)
20
Q
S/S CHF
A
- Fatigue
- angina
- pulses alternans: altering pulse/diminished pulse
- periph extremities
- cold, pale, cyanotic
-
Pulm edema
- usually LHF
-
Periph edema
- usually RHF
- lower legs/abd’s
- usually RHF
- Wt. gain
- as tot. body fluid vol inc’s—so does BW
- LOW BP
- Sinus Tachy
- DEC ex tol.
- Dyspnea
- @ rest
- paroxysmal nocturnal dyspnea: SOB @ night
- orthopnea
- JVD
- RHF
- Auscultation
- crackles
- Presence of S3 or S4
- Myopathy
- Nocturia—> pee during night
21
Q
Inc’d peRiph edema
Inc’d abd. edema
A
R. HF
22
Q
PuLm edema
A
L HF
23
Q
MORE common abnorm heart sound
A
S3
early diastole—vents filling
“thud”
Dx== CHF/cardiomyopathy, restricted vent
24
Q
LESS common abnorm heart sound
A
S4
late diastole (during atrial systole)
uncommon
25
Subgroup of HF:
## Footnote
**Cardiomyopathy**
**what is impaired?**
contract/relax of **myocardial mm fibers impaired**
26
diff b/w HF and Cardiomyopathy
**HF:** all due to a cause
**Cardiomyopathy:** from heart alone
27
Cardiomyopathy:
## Footnote
**primary causes**
* **patho. process IN heart mm**
* ****Genetic hypertrophic cardiomyopathy
* athlete's hearts
* prolonged QT syndrome
* Myocarditis
28
Cardiomyopathy:
## Footnote
**Secondary Causes**
* **results of systemic dis processes**
* ****pregnancy induced
* stress induced----**broken heart synd "tako tsubo"---post meno women**
* amyloidosis
* genetic hemochromatosis
* drug, alco, hvy metals, chemo induced
* sarcoidosis
* DM/thyroid storm
* progress. NMSK dis's
* radiation
29
Types of Cardiomyopathies
see pics
30
Sx's Cardiomyopathy
**generally same as HF**
* SOB
* orthopnea
* JVD
* **periph edema**
* **tachycardia**
* **Hypertrophic cardiomyopathy tend to be asymptomatic\*\*\*\***
31
Cardiomyopathy:
**Prognosis and Med mgmt**
**\*\*Ea. cause has its own prognosis\*\***
* can not be "cured" medically
* CAN be treated w/ **same pharma mgmt as CHF**
* LIFE SAVING MEASURES:
* **LVAD, IABP, heart transplant**
32
Cardiomyopathy and PT
* **Monitor Vitals** to det. approp ex intensity
* **TERM if SBP drops!**
* **and/or if DBP INCs \>= 10mmHg**
* improved ex. tolerance may be demo'd by **little change in HR and BP and fatigue**
33
CHF:
## Footnote
**Dx**
**Lab Findings in CHF:**
* BNP=== **R vent myocardium**
* **Cr: Creatinine**
34
CHF:
## Footnote
**DX**
**Echocardiography**
* LVEF== L vent ejection fraction
* norm== 65%
* structure of heart
* pressures of vents
* Pulm AA Press
* aorta==120/80
* CO== HR\*SV
* Norm== 4-6L/min
* CI: Cardiac Index
* 2.7-4.0L/min/m2
* **\>2.2 == cardiogenic shock==acute heart failure**
35
New York Heart Association (NYHA) Functional Class. of Breathlessness
**For HF pts**
NYHA Classes I-IV
36
CHF: Tx
## Footnote
**Med Mgmt**
* directed @ **underlying causes**
* **+ Inotropic drugs**
* improve heart pump
* **Beta Blockers**
* ****DEC excitability of heart and **optimize Preload (EDV)**
* **Diuretics, ACE inhibs, Alpha antagonist**
* ****Reduce AFTERload
* Pacemakers and AICD
* **if arrhythmias OR @ risk for acute HF**
* **cardiogenic shock**
37
CHF Tx:
## Footnote
**Lifestyle Alterations**
* control or DEC sodium intake
* RESTRICT H2O intake
* fluid restricts
38
CHF
## Footnote
**Prognosis**
**SLOW PROGRESSION**
* Sig predictors of Lack of Survival:
* DECing LVEF
* WORSENING NYHA funct. status
* Arrythmias or Dysrhythmias
* Renal insuff.
* intol to med mgmt
* Immobility
* QOL
* **Quads mm strength**
39
CHF
## Footnote
**Sx Mgmt**
* Intra-Aortic Balloon Pump
* works OPP L vent
* LVAD
* 6-8000 RPM to keep blood pumping
* NOT working w/ L vent
* BiVAD
* cannot leave hospital
* NO PULSE
* Heart Transplant
40
CHF: **PT Exam**
* QOL in CHF
* Minnesota Living w/ HF Questionnaire
* Depression---\> assoc'd w/ INCd risk functional decline
* 6min Walk Test
* Vitals!!!
* **esp resp to ex.**
41
PT Interventions for CHF
**NYHA Class II and III are Cardiac Rehab Pts**
42
Summary of Interventions for CHF:
In general
* LOW int
* LOW duration
* HIGH freq
* Progress **duration** and **freq** BEFORE **intensity**
* **Aerobic** AND **Strength components!**
43
Summary of Interventions for **CHF w/ LVAD**
* Obtain **clear baseline** of **endurance**
* **before and since LVAD**
* progress **int, duration, freq as tol'd**
* Values obtained on LVAD cent monitor
44
Summary of intervents for CHF:
## Footnote
**Expiratory mm training**
exp mm training
## Footnote
**breathing against resist**
45
Summary intervents for CHF
## Footnote
**Inspiratory mm training**
Insp mm trainig
## Footnote
**breathing IN against resist to work diaphragm**
46
intervents for CHF:
## Footnote
**Energy conservation**
do everything in **segments** and **rest**
47
intervents for CHF
Self-mgmt tech's -- resp for own health
Lifestyle mods\*\*\*
48
PT Education for CHF:
## Footnote
**Energy Conservation**
DEC workload on heart **w/out LOF**
49
CHF Self Mgmt Tech's
monitor wt same time/day
contact MD when change \>= 3lbs
monitor # pillows needed for sleeping --\> **orthopnea**
monitor sx's w/ **activty and rest**
50
Vital signs and CHF:
* HR
* BP
* O2 sats
* RPE Borg
* RR
* \*\***Must take BP often**
* **\*\*Use RPE if on _Beta Blocker_**
51
MET Lvls:
Met. Equiv of Task
see pics
\*remember Frank Starling----they can start crashing when reach certain point and SBP starts to DROP!!!
52
Frank Starling Law
more the vent mm's are stretched== more forcefully they will contract
## Footnote
**SV of L vent INCs as L vent volume INCs due to myocyte stretch===\> more powerful systolic contract**
53
pulm aa's carry
DeO2 blood TO lungs
54
Blood circ===
TPMA
Toilet Paper My Ass
55
SV==
EDV-ESV
blood pumped FROM L vent/beat
56
EF==
SV/EDV \*100
how much blood L vent pumps out w/ ea contraction
ex. 60% EF means 60% tot amt of blood in L vent is pushed OUT w/ ea beat
57
Orthopnea w/ HF Example
see pics
58
Preload===
EDV
initial stretch of myocytes PRIOR to contraction
**ventricular FILLING**
**blood returning**
59
Afterload===
TPR
**\*INC TPR==DEC SV\***
Force or load AGAINST which heart has to contract to eject blood
\*\*blood ejected out from pressure generated in vents
60
