Week 11 - Heart Failure and Pulmonary Hypertension

Question 1

Describe the difference between acute and chronic heart failure.

Answer 1

ACUTE:
Rapid onset of low cardiac output
Caused by shock, MI/heart attack, virus etc
Life threatening condition requiring urgent medical treatment

CHRONIC:
Complex clinical syndrome, where the ability of the ventricle to fill or eject blood is impaired for some reason, such as structural abnormality or cardiac dysfunction

Question 2

What are some symptoms of left HF?

Answer 2

Pulmonary congestion
Coughing with frothy sputum
Reduced CO
Paroxysmal nocturnal dyspnoea (wakes from sleep)
Orthopnoea (breathlessness when lying down)
Impaired gas exchange and hypoxia

Question 3

Describe the NYHA classification for heart failure

Answer 3

1 - Disease but no symptoms
2- Mild symptoms during ordinary activity
3 - Marked symptoms, comfortable only at rest
4 - Symptoms at rest, bedbound

Question 4

How does CHF affect muscle, bone and cardiac cachexia? (all of these affects can be modified by exercise).

Answer 4

MUSCLE: More type II so less endurance, reduced CSA, both lead to exercise intolerance and fatigue.
BONE: Elevated aldestrone leeches calcium, which increases the risk of fracture.
CARDIAC CACHEXIA: CHF is associated with high catabolic and low anabolic hormones causing muscle wasting.

Question 5

What are the main limitations to exercise for this population (3 points)?

Answer 5

Minimal ability to increase CO (remember CO=HRxSR) due to:
Chronotropic incompetence (due to Beta-blockers)
Can't increase SV

Question 6

How would you prescribe exercise for heart failure patients?
Mode
Intensity
Duration
Frequency

Answer 6

Mode: Aerobic; continuous or interval
Intensity: 9-14 Borg, or 6-80% HRR
Duration: 20-30mins I guess (not given)
Frequency: 3-5x/week

Question 7

What else would you include in exercise prescription for HF?

Answer 7

UL and LL strength
UL endurance
Balance
Flexibility
Respiratory muscle retraining

Question 8

What tools could you use to assess a HF patient?

Answer 8

BMI
6MWT
TUG
QoL
Patient goals

Question 9

What three things would you monitor on the 6MWT for people with pulmonary hypertension?

Answer 9

HR
Pulse oximetry (02 sat)
Leg fatigue

Question 10

What intensity of training would you choose for a person with pulmonary hypertension?

Answer 10

60% HRR to begin with
Borg 3-4
Interval training, alternate days
Eventually 20-40mins duration