Term
| What describes the most common cause of CHF? |
|
Definition
|
|
Term
| This is due to underlying abnormality of cardiac structure of function |
|
Definition
|
|
Term
| What Practice Pattern is cardiac ms dysfunction located under? |
|
Definition
| 6-D: Impaired Aerobic Capacity/Edurance Associated with Cardiovascular Pump Dysfunction or Failure |
|
|
Term
| Increased arterial pressure leads to what? |
|
Definition
| L ventricular hypertrophy |
|
|
Term
| This leads to overstretched contractile fibers and a less-efficient pump |
|
Definition
|
|
Term
| Name 5 medications that help with HTN |
|
Definition
ACE inhibitors
Calcium Channel Blockers
Diuretics
Beta-Blockers |
|
|
Term
| What is the second most common cause of CHF? |
|
Definition
| Coronary Artery Dz (Myocardial Infarction/Ischemia) |
|
|
Term
| This is related to dysfunction of the L or R ventricle or both as a result of injury. |
|
Definition
| CAD (Myocardial infarction/ischemia) |
|
|
Term
|
Definition
|
|
Term
| Rapid or slow arrhythmias can impair functioning of L and/or right ventricle. What do these two speeds of arrhythmias do to CO? |
|
Definition
|
|
Term
| Acute or chronic renal insufficiency produces fluid ___ |
|
Definition
|
|
Term
| What is the primary tx for renal insufficiency? |
|
Definition
| To decrease reabsoorption of fluid from kidneys |
|
|
Term
| Would you likely be on diuretics if you had renal insufficiency? |
|
Definition
|
|
Term
| Can be ischemic, hypertrophic, or dilated |
|
Definition
|
|
Term
| This is where contraction or relaxation of myocardial ms gibers are impaired. |
|
Definition
|
|
Term
| What is the primary cause of cardiomyopathy? |
|
Definition
| Pathological process in heart ms |
|
|
Term
| What are the secondary causes of cardiomyopathy? |
|
Definition
| Result of systemic dz process (autoimmune conditions) |
|
|
Term
| What is another term for a blocked valve? |
|
Definition
|
|
Term
| Blocked or incompetent (regurgitative) valves cause the heart ms to contract more ____ which makes the heart work harder. |
|
Definition
|
|
Term
| Associated with myocardial dilation and hypertrophy |
|
Definition
| Heart valve abnormalities |
|
|
Term
| Name 4 common surgeries done for heart valve abnormalities. |
|
Definition
Valve replacement
Valvuloplasty
Valvulotomy
Commissurotomy |
|
|
Term
| When talking about stenotic valvues, which 2 are the most problematic? |
|
Definition
|
|
Term
| Injury to the pericardium of heart may cause inflammation of the pericardial sac which is known as what? |
|
Definition
|
|
Term
| What does pericarditis lead to? |
|
Definition
|
|
Term
| Elevated intracardiac pressures, limited ventricular diastolic filling, reduced SV |
|
Definition
|
|
Term
| This is where the heart cannot expand to let blood come in |
|
Definition
| Limited ventricular diastolic filling |
|
|
Term
| What are some medical management techniques for pericardial effusion or myocarditis? |
|
Definition
| Nonsteroidal anti-inflammatory agents or corticosteroids |
|
|
Term
| This resulting dysfunction is due to elevated pulmonary artery pressures that increase right ventricular work. |
|
Definition
|
|
Term
|
Definition
SOB
Chest pain
Pale
Diaphoresis |
|
|
Term
| Is pulmonary embolism life threatening? |
|
Definition
| Yes and it comes on very quickly |
|
|
Term
| Name 4 medical management techniques for pulmonary embolism |
|
Definition
-Rapidly acting fibrinolytic agent
-Sedative to decrease anxiety and pain
-Oxygen
-Occasionally embolectomy |
|
|
Term
| Defined by mean pulmonary artery pressure |
|
Definition
|
|
Term
| Abnormal if >25 mmHg or in pts with COPD if >20 mmHg |
|
Definition
| Mean pulmonary artery pressure |
|
|
Term
| Typical in cervical spinal injuries (transection). Causes imbalance in parasympathetic and sympathetic control. Lack cardiovascular adaptations. Neurogenic edema. Cardiac filling pressures must be monitored. |
|
Definition
| SCI effects on Cardiac Ms Dysfunction |
|
|
Term
| Age appears to decrease ___ by altering contraction and relaxation of cardiac ms |
|
Definition
|
|
Term
| With age there is a higher prevalence of __, __, and other pathological processes. |
|
Definition
|
|
Term
| The result of altered embyronic development of normal structure or failure of structure to develop. |
|
Definition
| Congenital or Acquired Heart Dz |
|
|
Term
| What are the 2 most common congenital or acquired heart dzs? |
|
Definition
-Congenital bicuspid aortic valve
-Leaflet abnormality assoc. with mitral valve |
|
|
Term
| Name 5 age-associated changes in cardiac performance. |
|
Definition
-Increased systolic arterial pressure
-Decreased aortic distensibility
-May develop L ventricular hypertrophy
-Selective decrease in beta-adrenergic receptor
-Increased pericardial and myocardial stiffness and delayed relaxation |
|
|
Term
| When the aorta becomes stiff, what ventricle has to then work harder? |
|
Definition
|
|
Term
| A common clinical manifestation of heart failure is what? |
|
Definition
|
|
Term
| What is the most common cause of an increase in pulmonary capillary pressure? |
|
Definition
|
|
Term
| The function of this is dependent on several factors that create the dysfunction or can be used to treat. |
|
Definition
|
|
Term
| A syndrome with many pathophysiological and compensatory mechanisms |
|
Definition
|
|
Term
| R-sided heart failure means that the RV is not working properly and this will cause back up into where? |
|
Definition
|
|
Term
| Left sided heart failure causes a back up into where? |
|
Definition
|
|
Term
| What type of heart failure is most common? |
|
Definition
|
|
Term
|
Definition
|
|
Term
Length-tension ratio
The hearts ability to contract and fill
-The relationship between ventricular filling pressure and ventricular contraction ability. |
|
Definition
|
|
Term
| Name 7 influences on Stretch |
|
Definition
1. Atrial contribution to ventricular filling
2. Total blood volume in body
3. Body position
4. Intrathoracic pressure
5. Intrapericardial pressure
6. Venous tone
7. Pumping action of skeletal ms |
|
|
Term
| Why/How does body position effect stretch? |
|
Definition
| Sitting is harder for return. Supine is better for venous return to heart. The best way to get venous return is to elevate feet. Never do this with CHF pt because their heart can't handle it |
|
|
Term
| What is the formula for CO? |
|
Definition
|
|
Term
| What is the equation for SV? |
|
Definition
|
|
Term
| The result of the degree of myocardial stretch and myocardial contractility |
|
Definition
|
|
Term
| 2 things that are released from arterial and cardiac myocytes in response to increased stretch |
|
Definition
|
|
Term
| Natriuretic Peptides released by cardiac muscle have effects to reduce __ volume are minor. Used to diagnose and manage disease states. |
|
Definition
|
|
Term
| Levels of ___ are increased with heart disease, heart failure, and acute coronary syndrome. |
|
Definition
|
|
Term
| What is normal BNP levels? |
|
Definition
|
|
Term
| For a pt to be discharged, what must their BNP level be under? |
|
Definition
|
|
Term
| What levels of BNP are indicative of decompensated CHF? |
|
Definition
|
|
Term
| Issues with the lungs related to the heart |
|
Definition
|
|
Term
| What does non-cardiogenic mean? |
|
Definition
| Issues in the lungs themselves (no heart involvement) |
|
|
Term
| Name the 3 distinct stages of pulmonary function. |
|
Definition
1. Hard to detect; subtle
2. Accumulation of fluid in lungs (pulmonary congestion)
3. Edema; fluid in alveoli; big problems with gas exchange (frothy sputum) |
|
|
Term
| What does ionotropic mean? |
|
Definition
| Contractility of the heart |
|
|
Term
| What does chronotropic mean? |
|
Definition
|
|
Term
| What is the term used for too much CO2? |
|
Definition
|
|
Term
Are neural effects rapid or slow?
What about hormonal effects? |
|
Definition
Neural - rapid
Hormonal - slow |
|
|
Term
| Are beta blockers negative or positive chronotropes? |
|
Definition
| Negative because they decrease HR |
|
|
Term
| The most influential receptor agonists are sympathetic neurotransmitters __ and __ |
|
Definition
|
|
Term
| Alpha-adrenergic receptors have a __ effect on the heart. |
|
Definition
|
|
Term
| Beta-adrenergic receptors have a ___ effect on the heart. |
|
Definition
|
|
Term
| Parasympathetic via vagus nerve and neurotransmitter acetylcholine are __ |
|
Definition
|
|
Term
| Name 2 alpha-adrenergic receptors? |
|
Definition
|
|
Term
| Marginally increases ionotropic effect |
|
Definition
|
|
Term
| Activates inhibitory G protein, which decreases ionotropic effect |
|
Definition
|
|
Term
| Name 2 beta-adrenergic receptors |
|
Definition
|
|
Term
| __ Stimulation promotes vasodilation of capillary bed and ms relaxation of bronchial tracts |
|
Definition
|
|
Term
| ___Stimulation increases HR and myocardial force of contraction |
|
Definition
|
|
Term
| __ proteins transmit stimulatory (Gs) or inhibitory (G1) signals to catalytic unit |
|
Definition
|
|
Term
| Activation of __ __ leads to an increase in myocardial force of contraction |
|
Definition
|
|
Term
| Sympathetic neural function of heart is profoundly affected in __ |
|
Definition
|
|
Term
| Falling ___ complex function in CHF is related to insensitivity of falling heart to beta-adrenergic stimulation |
|
Definition
|
|
Term
| Can result in cirrhosis if long term |
|
Definition
|
|
Term
| Increased fluid volume leads to __ __ __, preventing adequate perfusion of O2. |
|
Definition
| Hepatic venous congestion |
|
|
Term
| Body stimulated erythropoeitin to get more RBC b/c the heart needed more oxygen |
|
Definition
|
|
Term
| severe, long standing HF can be caused by this |
|
Definition
|
|
Term
| Thrombocytopenia - low platelets |
|
Definition
|
|
Term
| CHF without cardiomyopathy tends to have a __ in average diameter of type 1 and 2 |
|
Definition
|
|
Term
| CHF with cardiomyopathy tends to have Type 1 and 1 muscle fiber __ |
|
Definition
|
|
Term
| Isometric maximal ms strenth of persons with CHF is reduced by __ % |
|
Definition
|
|
Term
| Sympathetic neural function can reduce blood flow to the pancreas and impair __ secretion and __ tolerance. |
|
Definition
|
|
Term
| What is the importance of sympathetic neural function on the pancreas? |
|
Definition
| Importance is related to hypoxic and dysfunctional heart ms and depends on glucose metabolism |
|
|
Term
| Sympathetic neural function causes a an increase in __ by the pancreas which increases the synthesis of triglycerides. |
|
Definition
|
|
Term
| Name 5 nutritional and biochemical aspects |
|
Definition
1. Stomach and intestinal abnormalities occur
2. Anorexia and malnutrition
3. Protein-calorie deficiency
4. Persons with CHF may demonstrate a decreased production of erythropoeitin, decreased synthesis of 1,25-dihydroxycholecalciferol, and impaired intermediary metabolism
5. Persons with CHF may benefit from enteral and parenteral products |
|
|
Term
| Persons with CHF may demonstrate what 3 things? |
|
Definition
1. Decreased production of erythropoietin
2. Decreased synthesis of 1,25-dihydroxycholecalciferol
3. Impaired intermediary metabolism |
|
|
Term
| Breathlessness or air hunger |
|
Definition
|
|
Term
| Unexplained episodes of shortness of breath occur in the supine position |
|
Definition
| Paroxysmal Nocturnal Dyspnea |
|
|
Term
| The development of dyspnea in recumbent position |
|
Definition
|
|
Term
| Name 3 symptoms of abnormalities in sympathetic neural function |
|
Definition
Orthopnea
Dyspnea
Paroxysmal Nocturnal Dyspnea |
|
|
Term
|
Definition
1. Breathing patterns
2. Rales (Crackles)
3. Heart Sounds
4. Peripheral Edema
5. Jugular Venous Distension
6. Pulsus alternans
7. Changes in extremeties
8. Weight gain
9. Sinus tachycardia
10. Decreased exercise tolerance |
|
|
Term
| What might breathing patterns look like in a pt with CHF? |
|
Definition
| Rapid respiratory rate at rest with quick and shallow breaths (short shallow breaths are not engaging the diaphragm) |
|
|
Term
| Abnormal breath sounds that occur during inspiration reflecting fluid in alveoli |
|
Definition
|
|
Term
| What actually makes the crackles sound? |
|
Definition
|
|
Term
| __ heart sound indicates a noncompliant left ventricle and is associated with CHF |
|
Definition
|
|
Term
| Retention of fluid/pitting edema |
|
Definition
|
|
Term
| Jugular venous distention results from what? |
|
Definition
|
|
Term
| A mechanical alteration of femoral or radial pulse. Characterized by a regular rhythm and alternating strong or decreased pulse. |
|
Definition
|
|
Term
| How might the extremeties change with CHF? |
|
Definition
| May become cold and appear pale and cyanotic. Indicative of hypoxia or venous insufficiency |
|
|
Term
| Why might a person with CHF have weight gain? |
|
Definition
| As total body fluid volume increases, so does body weight |
|
|
Term
| Why will a person with CHF have decreased exercise tolerance? |
|
Definition
|
|
Term
| Name 4 S&S of Pulmonary Congestion |
|
Definition
1. Dyspnea, dry cough - hard to bring air in b/c of fluid in lungs
2. Orthopnea
3. Paroxysmal nocturnal dyspnea
4. Crackles and wheezing |
|
|
Term
| Name 7 S&S of Acute Pulmonary Edema |
|
Definition
1. Marked dyspnea
2. Pallor or cyanosis
3. Diaphoresis
4. Tachycardia
5. Anxiety
6. Agitation
7. Pink/frothy sputum |
|
|
Term
|
Definition
1. Hypotension (because of low CO and BV)
2. Tachycardia
3. Lightheadedness, dizziness (not getting enough O2 to brain)
4. Fatigue (not getting good O2 to tissues)
5. Weakness
6. Poor exercise tolerance |
|
|
Term
| What are the 2 adventitious heart sounds? |
|
Definition
|
|
Term
| Name 4 clinical manifestations associated with CHF. |
|
Definition
Low CO
Adventitious heart sounds
Enlarged heart
Possible functional mitral and tricuspid regurgitation |
|
|
Term
| Why might a person with CHF have an enlarged heart? |
|
Definition
| Because of the volume overload overtime stretches out the heart |
|
|
Term
| What is the most common cause of R ventricle heart failure |
|
Definition
|
|
Term
| Nae 2 things that right ventricular failure can result from |
|
Definition
Mitral valve disease
Acute or chronic lung disease |
|
|
Term
| Name 7 Clinical Manifestations of RV failure. |
|
Definition
1. Dependent edema
2. Jugular Venous Distension
3. Weight gain (3 lbs in 1 day is a lot)
4. Hepatomegaly
5. Ascites (truncal edema - makes it hard to breath)
6. Cyanosis
7. Anorexia, nausea, bloating |
|
|
Term
| Elevated pressures caused by LV failure end up causing RV failure as well. |
|
Definition
|
|
Term
| Various compensatory mechanisms and therapeutic intervention allow the heart to return to a functional, albeit reduced, CO. This scenario is defined as what? |
|
Definition
| Compensated heart failure |
|
|
Term
| Exercise tolerance is usually markedly limited with what? |
|
Definition
| Compensated heart failure |
|
|
Term
| Used to evaluate effects of pharmacological agents and exercise training in CHF. Looks at how the pt thinks they are responding to the medication. |
|
Definition
| Minnesota Living with Heart Failure Questionnaire |
|
|
Term
| Depression is associated with __ risk of functional decline in pts with congestive heart failure. |
|
Definition
|
|
Term
| What are some radiological findings in CHF? |
|
Definition
| Evaluation of size and shape of cardiac silhouette (L VEDV) and the presence of interstitial, perivascular, alveolar edema (fluid in lungs) |
|
|
Term
| What lab findings will be noted in CHF? |
|
Definition
Proteinuria
Elevated uring specific gravity
Elevated BUN
Elevated Creatine levels
Decreased erythrocyte sedimentation rate
Elevated liver enzymes |
|
|
Term
| What will an echocardiography look at in pts with CHF? |
|
Definition
Left Ventricular EF
Structure of LV
Other structual abnormalities |
|
|
Term
| Name 5 treatments for heart failure. |
|
Definition
-Depends if its chronic or acute
-Correction of underlying cause is possible
-Aggressive management of HTN and CAD
-Pharmacologic therapies
-Sx intervention |
|
|
Term
| There are several medications used to treat CHF, what are they trying to fix? |
|
Definition
-Directed at underlying cause(s)
-Improve heart pump
-Reduce workload
-Control sodium intake and water retention |
|
|
Term
| If you are taking too many fat-soluble vitamins your body can't get rid of them as easily as what type of vitamins? |
|
Definition
|
|
Term
| What dietary changes and nutritional supplementation should a person with CHF do? |
|
Definition
-Supplement vitamins, minerals, and amino acids
-Decreased sodium intake
-Fluid restrictions
-Eating heart healthy foods with low cholesterol/fat |
|
|
Term
| What all types of pharmacological treatments would a person with CHF need? |
|
Definition
1. Diuretics
2. Aldosterone agents
3. Digoxin and other positive ionotropic agents
4. Dopamine
5. Dobutamine
6. Amrinone/Milrinone
7. Vasodilators/Venodilators
8. Angiotensin-converting enzyme inhibitors and alpha receptor blockers
9. Beta-adrenergic antagonists and partial agonists
10. Anticoagulation (INR, PT, PTT) |
|
|
Term
| What 3 types of medications can exacerbate heart failure |
|
Definition
Antiarrhythmic agents
Calcium channel blockers
NSAIDs |
|
|
Term
| When is ICD (implantable cardioverter defibrillator) recommended? |
|
Definition
| When EF is less than or equal to 35% and mild to mod symptoms |
|
|
Term
| Electrical stimulation of R and L ventricles in synchronized manner provided by biventricular pacemaker device. Improves cardiac function and hemodynamics. |
|
Definition
| Cardiac Resynchronization Therapy |
|
|
Term
| Name 3 types of mechanical treatment that can be done on CHF pts? |
|
Definition
1. Dialysis and ultrafiltration
2. Assisted circulation
3. Ventricular assist device |
|
|
Term
| These remove fluid from pleural and abdominal cavities |
|
Definition
| Dialysis and ultrafiltration |
|
|
Term
| An intraaortic balloon counterpulsation using a pump (IABP) |
|
Definition
|
|
Term
| This device provides force to eject blood (helps heart to contract) |
|
Definition
| Ventricular Assist Device |
|
|
Term
| Name 3 surgical treatments for pts with CHF |
|
Definition
-LV muscle flap - cardiomyoplasty; assists with LV contraction
-Cardiomyoplasty (partial left ventriculectomy) - ms flap that helps ventricles contract
-Cardiac transplantation |
|
|
Term
| Name methods of cardiac transplantation |
|
Definition
-Xenograft - non-human primate
-Allograft - human
-Orthotopic - take a heart out and put another in
-Heterotopic - use of 2 hearts |
|
|
Term
| Name 11 significant predictors of survival and prognosis for CHF pts. |
|
Definition
1. Decreased LVEF
2. Worsening NYHA functional status
3. Degree of hyponatremia
4. Decreasing peak exercise oxygen uptake
5. Decreasing hematocrit
6. Widening QRS on 12-lead ECG
7. Chronic hypotension
8. Resting tachycardia
9. Renal insufficiency
10. Intolerance to therapy
11. Refractory volume overload |
|
|
Term
| What are the benefits of exercise training with CHF pts? |
|
Definition
| Improvement in symptoms, clinical status, and exercise duration. |
|
|
Term
| In pts with CHF, qualify of life is related to what? |
|
Definition
|
|
Term
| Exercise training during continuous intravenous __ fusion. This helps to improve heart contractility. There are no adverse effects and no clinically significant differences. |
|
Definition
|
|
Term
| How does ventricular assist devices help with exercise training? |
|
Definition
| Improved technology has enabled pts to exercise |
|
|
Term
| What 2 ventilation techniques can improve exercise performance |
|
Definition
|
|
Term
| What is the difference between CPAP and BiPAP? |
|
Definition
| CPAP is continuous and BiPAP alternates air pressure |
|
|
Term
| What are some types of ventilatory muscle training that help faciliate diaphragmatic breathing. |
|
Definition
Breathing exercises
Expiratory ms training
Inspiratory ms training |
|
|
Term
| What is the goal of exercise training in pts with CHF |
|
Definition
| To decrease workload on heart without the loss of function |
|
|
Term
| Name 8 self-management techniques for muscle training. |
|
Definition
1. Assisting pt with taking responsibility for their own health
2. Individualized and family education and counseling
3. Optimization of medical therapy
4. Vigilant follow-up
5. Increased access to health care professionals
6. Early attention to fluid overload
7. Coordination with other agencies
8. Physician directed care |
|
|
Term
| In pts with CHF, the PT should assess for S&S of __ at each visit. |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
SOB
Irritable
Aggitation
Increased respiratory effort |
|
|
Term
| Name 4 S&S of exercise intolerance |
|
Definition
Fatigue easily
SOB
Dizziness
Diaphoresis |
|
|
Term
| What are 2 things to watch that might suggest pt has decompensation |
|
Definition
Increased HR and low BP at rest
Chronotropic incompetence |
|
|
Term
| PT must know to terminate exercise early if any of the following are observed (5) |
|
Definition
1. Acute decrease in BP
2. Onset of angina
3. Significant dyspnea or fatigue
4. Feeling of exhaustion
5. Serious exercise-induced arrhythmias |
|
|
Term
| Name 4 treatment modifications that are frequently indicated in CHF pts. |
|
Definition
1. Low level initially and progress slowly
2. Frequent 1-2 min. rests interspersed with activity will reduce cost of more demanding activities
3. Caution positioning pt in supine or prone due to complaints of orthopnea
4. Avoid breath holding and Valsalva maneuver because of decreased CO |
|
|
Term
| Acute CHF can occur due to __ or __ drug levels |
|
Definition
|
|
Term
| Many drugs used to treat CHF are associated with what 3 things? |
|
Definition
1. Orthostatic and postexercise hypotension
2. Caution against quick changes to upright positions
3. Exercise cooldown imperative so blood doesn't pool in legs |
|
|
Term
| What is the ultimate exercise-related goal in CHF pts. |
|
Definition
| Exercise duration of 30 min of continuous exercise |
|
|
Term
| How should exercise be progressed in pts with HF? |
|
Definition
-Low level, gradually progressive aerobic exercise improves exercise capability (starting intensity often based on symptomatology)
2. Interval training with brief rest periods as needed allows to accumulate greater volume of exercise
3. Warm-up and cooldown are VERY important |
|
|
Term
| Low to moderate intensity resistance training is often beneficial for patients with what type of HF? |
|
Definition
|
|
Term
| Is inspiratory ms training advantageous for pts with HF? |
|
Definition
|
|
Term
| Pt education includes what 4 things? |
|
Definition
-Weight 1st thing in the morning
-Take action if 3lbs or more is gained
-Symptoms of decompensation and exercise intolerance
-Side effects of meds and symptoms of toxicity |
|
|
Term
| What precaution should you take when working with a pt on telemetry? |
|
Definition
| YOu can leave the room but be sure to stay within range! |
|
|
