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Cardiopulmonary > Unit 2 Week 6 CHF > Flashcards

Unit 2 Week 6 CHF Flashcards

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1
Q

what is heart failure?

A

the inability of the heart to pump adequate amounts of blood through the circulation

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2
Q

what is the main job of the cardiac pump?

A

Pump blood from veins to arteries

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3
Q

what is BP created by?

A

volume of blood in vessels & the heart pump

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4
Q

what is systolic pressure?

A

peak pressure generated

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5
Q

what is diastolic pressure?

A

lowest pressure before next contraction

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6
Q

what is Mean arterial pressure (MAP)?

A

measure of BP over time.
MAP = 1/3 x SBP + 2/3 x DBP

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7
Q

what is Total peripheral resistance (TPR)? what is it affected by?

A

the amount of force exerted against the circulating blood by the vasculature of the body.
Affected by blood volume & resistance to flow in b. vessels

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7
Q

what is pulse pressure? what does it indicate?

A

how hard the heart is working
PP = SVP - DVP
indicates efficiency of heart

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8
Q

what is afterload?

A

the amount of pressure that the heart needs to exert to eject the blood during ventricular contraction (squeeze)

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9
Q

Cardiac Pumping increases ___.

A

arterial pressure

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10
Q

___ decreased at same time as pumping increased prevents excessive pressure

A

TPR

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11
Q

Preload of heart by venous pressure increases ___.

A

pumping force (contractility w/ stretch)

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12
Q

Greater pumping effectiveness also decreases ___.

A

venous pressure

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13
Q

SNS maintains venous pressure and preload on the heart by ___.

A

constricting veins when pumping increases

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14
Q

what is preload?

A

volume of blood received by the heart (stretch)

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15
Q

what causes blood to circulate?

A

small decreases in venous pressure and large
increases in arterial pressure

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16
Q

what droves stroke volume and cardiac output?

A

The differences in arterial and venous pressure

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17
Q

what is ejection fraction?

A

% of blood in ventricle ejected into arteries
efficiency of cardiac pump (normally 50 or 55-70%)
EF= (EDV-ESV)/EDV

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18
Q

what is CHF?

A

Heart failing to do its job: pumping blood from the veins to the arteries
* Arterial pressure may not rise enough with each contraction or
* Venous pressure may become too high
* EF typically low in HF- used to determine severity

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19
Q

what is the difference between pumping of left vs right ventricle?

A
  • Left ventricle is basically a thick cone pumping against a high pressure
  • Right ventricle is basically a thin flap pumping against a very low pressure
  • Left ventricle has a much greater oxygen consumption than the right
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20
Q

Right and left-sided cardiac output must be ___.

A

identical over a small time frame or one side will become back-up (congested) and the other will have low pressure

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21
Q

If cardiac output is balanced, regardless of demand on the heart, we can say it is ___

A

COMPENSATED

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22
Q

If the cardiac output is not balanced, or cannot keep up with demand, we can say it is

A

DECOMPENSATED

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23
Q

How is Cardiac Output Maintained?

A

by compensations

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24
Lack of compensation (decompensation) leads to:
* Too much fluid in the central veins * Too much blood volume in the heart chambers * Insufficient cardiac output
25
what is hypertension?
Increased arterial pressure leads to left ventricular hypertrophy Leads to overstretched contractile fibers and less effective pump
26
what is medical management of hypertension?
ACE inhibitors, calcium channel blockers, diuretics, beta-blockers
27
what causes coronary artery disease?
Related to dysfunction of left or right ventricle or both as a result of injury
28
what are the types of cardiac muscle dysfunction?
Coordination issues Cardiac arrhythmias
29
what is dyskinesia?
Uncoordinated movement
30
what is hypokinesia?
decreased movement
31
what is akinesia?
Localized area of no movement
32
what is Abnormal Automaticity?
Pacemaker not regular * Tachycardia or Bradycardia * Multiple areas of automaticity at once (fibrillation)
33
what is a balloon valculoplasty?
catheter is inserted in the vessel of an extremity (femoral artery) and snaked up through the aorta to the stenotic aortic valve. the balloon is inflated to push the valve open
34
what is cardiomyopathy?
progressive disease where the heart muscle is abnormally stretched thin in dilated cardiomyopathy, thickened in hypertrophic cardiomyopathy, and stiffened in restrictive Contraction and relaxation of myocardial muscle fibers are impaired
35
what is a Saddle Pulmonary Embolus?
Total or near total blockage of pulmonary arteries No pulmonary blood flow No filling of left ventricle No output of left ventricle Rapid onset of dyspnea, LOC, deat
36
what is Hemopericardium?
pressure inside pericardium prevents filling of right ventricle Cardiac tamponade
37
what indicates class 1 on the New York Heart Association Functional Classification of CHF?
* No limitation is experienced in any activities * No symptoms from ordinary activities
38
what indicates class 2 on the New York Heart Association Functional Classification of CHF?
* Slight, mild limitation of activity * Patient is comfortable at rest or with mild exertion
39
what indicates class 3 on the New York Heart Association Functional Classification of CHF?
* Marked limitation of any activity * Patient only comfortable at rest
40
what indicates class 4 on the New York Heart Association Functional Classification of CHF?
* Any physical activity causes discomfort * Symptoms present at rest
41
what are the common signs of CHF?
* Elevated jugular venous pressure * Hepatojugular reflux * Third heart sound * Bilateral pulmonary wheezes * Retention of excessive body fluid * Peripheral edema * Weight gain
42
what are the common symptoms of CHF?
* Fatigue * Dyspnea on exertion * Decreased exercise tolerance * Paroxysmal nocturnal dyspnea * Orthopnea * Inability to sleep unless partially upright * Quantified by number of pillows used to allow one to sleep * Signs and symptoms vary with the classifications of heart failure
43
what is Acute Heart Failure?
* Life-threatening condition * Cardiogenic shock and death without intervention * Catastrophic loss of one-way valve system or other structural integrity
44
what happens with left acute heart failure?
rupture of aorta, blow out of aortic valve
45
what happens with right acute heart failure?
blockage by saddle embolus or hemopericardium
46
what are the signs of right-sided HF?
* Jugular distention * Systemic congestion * Dependent edema * Sacral edema and ascites * Nocturia as fluid is displaced from LEs to thorax while asleep * Congestion of liver and spleen-hepatomegaly and splenomegaly * Impaired liver function and immunity: further edema and decreased blood clotting
47
what are the signs of left-sided HF?
* Congestion of pulmonary veins and capillaries * Dyspnea, orthopnea, paroxysmal nocturnal dyspnea * Low cardiac output * Symptoms of decreased cerebral perfusion * Cool extremities may progress to rubor of dependency and to cyanosis
48
what is the most common cause of RHF?
LHF
49
what is forward HF? how does it present?
problems primarily due to low cardiac output * Ischemic injury to tissues * Cool, cyanotic extremities and face
50
what is backward HF? how does it present?
problems primarily due to venous congestion * Increased venous pressure with leakage of fluid from capillaries * Pulmonary edema with LHF * Peripheral edema with RHF
51
what is the pitting edema scale?
* 1+ Not obvious without checking; ~2-mm pit; pit lasts a few seconds * 2+ Obvious to a trained person; ~4-mm pit; pit last several seconds * 3+ Obvious to eye, ~ 6-mm pit; pit lasts a few minutes * 4+ Grossly distorted limb; “Sausage fingers or toes”; ~8-mm pit; pit lasts several minutes
52
what is systolic failure?
Insufficient myocardial muscle strength relative to conditions too much back pressure in the arteries or the heart is weak, stretched out so much that it can't pump hard enough
53
what is diastolic failure?
* Insufficient filling/low SV * Ventricle(s) too stiff to allow sufficient filling
54
what is MAP used to monitor? what are normal MAP ranges?
perfusion of organs * MAP = CO x TPR 65 to 110mmHg
55
what are the treatment options for CHF?
Lifestyle/dietary/PA Correct underlying problem medically Antihypertensive meds to compensate Devices to supplement heart’s output Correct underlying problem surgically Repair/replace valve Heart transplant
56
what does medical management do for heart failure?
 Directed at underlying cause or causes  Improve heart pump  Reduce workload  Control sodium intake and water retention
57
how can dietary changes and nutritional supplementation affect the management of HF?
 Supplement vitamins, minerals, and amino acids  Decrease sodium intake  Fluid restrictions  Eating heart healthy foods with low cholesterol/fat
58
what pharmacologic treatments are there for HF?
 ACE Inhibitors: Cause vasodilation and fluid reduction  Diuretics: Reduced fluid in veins reduces load on heart  Beta blockers: Decrease cardiac work  Digoxin: Increases contractility, decreases HR  Pressors: for Acute (emergent) Decompensation
59
what type of symptoms do diuretics treat?
backward symptoms
60
what is the proper physical activity prescription for those with HF?
 Decrease/discontinue exhaustive activities  Decrease/discontinue full-time work  Introduce rest periods during day  Progressive exercise/activity that fluctuates (day to day)  Exercise intensity set by level of dyspnea or below level of adverse response (angina or DBP drop)  Start with ADLs in hospital, enter cardiac rehab ASAP  Progression to resistance exercise is recommended (see Cardiac Rehab for more info)
61
what is cardiac resynchronization therapy?
 Implantation of biventricular pacemaker device Electrical stimulation of right and left ventricles in synchronized manner provided by  Improves cardiac function and hemodynamics
62
what is Dialysis and ultrafiltration?
removal of fluid from pleural and abdominal cavities
63
what is Assisted circulation
intraaortic balloon counterpulsation using a pump (IABP)
64
what is a Ventricular assist device?
provides force to eject blood
65
what is Pulmonary Capillary Wedge Pressure?
 Estimates pressure in L atrium (preload)  Indicates severity of left ventricular HF  Pressures > 20 likely result in pulmonary edema
66
what are the S&S of Decompensation?
 Cyanosis of the hands, feet and lips  Dyspnea/SOB/DOE  Gurgling sounds  Pink, frothy sputum  Sudden onset of fatigue  Decreased HR or systolic BP
67
what special equipment is used with CHF>
-may have numerous lines -continuous infusion of pressors by an IV pump -minimum of pulse oximeter and equipment to take BP
68
For NYHA Class II-III: PA/ training should include:
Aerobic HIIT: High intensity interval Resistance Combo resistance and aerobic Inspiratory mm training Combo inspiratory w/ aerobic
69
what are the initial interventions for CHF?
Transfer and Balance training Low level, low impact ex like walking, increasing as tolerated from 6 mins to 30. Intensity monitored with dyspnea/RPE, 1-2x/day Breathing exercises—facilitate diaphragmatic breathing Inspiratory/expiratory ex
70
what is the goal of energy conservation with those with CHF?
decrease workload on heart without loss of function
71
what are the signs and symptoms of heart failure?
Dyspnea: Breathlessness/shortness of breath Paroxysmal nocturnal dyspnea: shortness of breath (SOB) episodes in supine Orthopnea: recumbent position dyspnea Crackles- Rales: abnormal breath sounds during inspiration Heart sounds: S3 Pitting edema in Extremities Jugular venous distention: Fluid overload Weight gain: Fluid/amount of decompensation Sinus tachycardia: Compensation for low stroke volume Decreased exercise tolerance

Cardiopulmonary (23 decks)

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