Week 6 - Cardiac Muscle Dysfuncton And Failure Parts 4 And 5

Question 1

Treatment options for CHF

Answer 1

Lifestyle/dietarty/PA
Correct underlying problem medically - anti hypertensive meds to compensate
Devices to supplement heart’s output
Correct underlying problem surgically - repair/replace valve
Heart transplant

Question 2

Medical management of heart failure

Answer 2

Directed at underlying cause/causes
Improve heart pump
Reduce workload
Control sodium intake and water retention

Question 3

Dietary changes and nutritional supplementation management of heart failure

Answer 3

Supplement vitamins, minerals and amino acids
Decrease sodium intake
Fluid restrictions
Eating heart healthy food w low cholesterol/fat

Question 4

What vitamins help maintain lab values with heart failure?

Answer 4

Vitamin E and C

Question 5

Weigh daily to monitor fluid - management of heart failure

Answer 5

Rapid weight gain usually due to fluid retention
More than 3 pounds in one day usually requires hospitalization

Question 6

Pharmacological treatments for HF

Answer 6

ACE inhibitors
Diuretics
Beta blockers
Digoxin
Pressures

Question 7

ACE inhibitors

Answer 7

Decrease retention of water and vasoconstriction
Name ends in -opril
Angiotensinogen II receptor antagonists as alternative

Question 8

Diuretics

Answer 8

Treat backward symptoms as maintenance or emergency
May combine for severe cases
Reduce fluid in veins reduces load on heart

Question 9

Beta blockers

Answer 9

Decrease cardiac work
May be combined with ACEI and diuretic
Ameliorate effects of chronic elevation of catecholamines

Question 10

Digoxin

Answer 10

Increase contractility, decrease HR
Used for arrhythmias
LOW THERAPEUTIC INDEX - low dose has to be used, small window for when it can be used therapeutically

Question 11

Emergent use of pressers

Answer 11

Reserved for refractory CHF in ICU
Temp following surgery, illness, trauma
Increase contractility and BP through vasoconstriction
Maintenance until heart transplant

Question 12

Physical activity management

Answer 12

Decrease/discontinue exhaustive activites
Decrease/discontinue full time work
Introduce rest periods during the day
Progressive exercise/activity that fluctuates
Exercise intensity set by level of dyspnea or below level of adverse response
Start with ADLs in hospital, enter cardiac rehab ASAP
Progression to resistance exercise is recommended

Question 13

Mechanical devices

Answer 13

Pacemaker
Implantable cardiac defibrillator
Cardiac resynchronization therapy

Question 14

What do pacemakers do?

Answer 14

Help with regulation

Question 15

What does cardiac resynchronization therapy do?

Answer 15

Improve cardiac function and hemodynamics by coordinating the contraction

Question 16

Dialysis and ultrafiltration

Answer 16

Removal of fluid from pleural and abdominal cavities

Question 17

Assisted circulation

Answer 17

Intraaortic balloon counterpulsation using a pump (IABP)

Question 18

Ventricular assist device

Answer 18

Provides force to eject blood

Question 19

Left ventricular muscle flap - surgery management for chronic heart failure

Answer 19

Cardiomyoplasty - assists w LV contraction

Question 20

L partial ventriculectomy (PLV) - surgical management for chronic heart failure

Answer 20

Reduces cardiac volume

Question 21

Cardiac transplantation

Answer 21

Xenograft - non human primate
Allograft - human
Orthotopic
Heterotopic

Question 22

Measuring left HF: pulmonary capillary wedge pressure

Answer 22

Estimates pressure in L atrium (preload)
Indicates severity of L ventricular HF
Pressure > 20 likely result in pulmonary edema
Causes: mitral or aortic stenosis/regurgitation

Question 23

Signs and symptoms of decompensation

Answer 23

Cyanosis of hands, feet and lips
Dyspnea/SOB /DOE
Gurgling sounds
Pink, frothy sputum
Sudden onset of fatigue
Decreased HR or systolic BP

Question 24

Benefits of exercise training as intervention

Answer 24

Improvement in symptoms, clinical status and exercise duration

Question 25

Exercise training and QOL

Answer 25

QOL is related to ability to exercise

Question 26

Exercise training during continuous intravenous dobutamine fusion

Answer 26

No adverse effects
No clinically significant differences

Question 27

Exercise training w/ ventricular assist devices

Answer 27

Improved technology has enabled patients to exercise

Question 28

Exercise training during CPAP ventilation

Answer 28

CPAP and BiPAP have improved exercise performance

Question 29

Clinical practice guidelines for PT management of CHF

Answer 29

Advocate for increased total daily physical activity as an essential component of care
Educate on and facilitate self management of S/S of exacerbation, weight monitoring, nutrition, meds

Question 30

For NYHA class II-III, physical activity/training should include:

Answer 30

Aerobic
HIIT: High intensity interval
Resistance
Combo resistance and aerobic
Inspiratory mm training
Combo inspiratory w aerobic

Question 31

Initial interventions for CHF

Answer 31

Transfer and balance training
Low level, low impact (like walking, increasing as tolerated)
Breathing exercises: facilitate diaphragmatic breathing; inspiratory/expiratory exercises

Question 32

What is the goal of energy conservation?

Answer 32

To decrease workload on heart without loss of function

Question 33

Self management techniques for education

Answer 33

Assist patient with taking responsibility for own health
Monitor weight daily at same time everyday
Monitor symptoms w activity and being aware of increasing symptoms w activity
Optimization of medical therapy
Vigilant follow up

Question 34

Early attention to fluid overload education

Answer 34

Watch daily weight and contact physican with changes
Watch amount of pillows needed for sleeping