Term
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Definition
abnormal structure or function
impairs heart's ability to pump or receive blood
exercise tolerance and functional abilities are mild/moderately reduced
decreased quality of life |
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Term
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Definition
CMD is most common cause
5.7 million cases (670,000 new/year)
risk of heart failure at age 40 is 20%
pulmonary congestion/pulmonary edema |
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Term
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Definition
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Term
| CMD: Angina and Myocardial Ischemia |
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Definition
| brought on by inadequate O2 supply/demand to heart |
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Term
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Definition
low ejection fraction
angina
cardiac arrhythmias
decreased myocardial function |
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Term
| Most common cause of CMD? |
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Definition
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Term
| Myocardial Infarction (MI) |
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Definition
| Chronically sustained ischemia to myocardium: Coronary artery spasm (smooth muscle), Sudden thrombotic occlusion (cell death), Dysfunction of left or right ventricle or both from injury, Scar formation and decreased contractility occur |
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Term
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Definition
| fix the cause: surgery, meds |
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Term
| Hypertension: Chronic Uncontrolled |
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Definition
ncreased atrial pressure = strain on left ventricle
LVH
Increased energy expenditure (Increased work of cardiac Mm cells to maintain pump/adequate Q |
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Term
| Hypertension: Compensation for increased afterload? |
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Definition
ventricle hypertrophy
myocardium stiffens: systolic and/or diastolic dysfunction
left ventrical weakens and dialates: CHF |
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Term
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Definition
ACE inhibitors
Ca2+ Channel blockers
diruetics
beta blockers
regular(continued through lifetime) exercise can reduce BP by 10mmHg(systolic) and 6-8mmHg(diastolic) |
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Term
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Definition
decreased myocardial function: too rapid/slow(affects muscle function),i.e. v-tach, a-fib
impaired atrioventricular conduction |
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Term
| Cardiac Arrythmias: Treatment |
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Definition
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Term
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Definition
fluid overload
goal: decrease the reabsorption of fluids from kidney and get it out of the body |
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Term
| Renal Insufficiency: Treatment |
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Definition
lasix
monitor electrolyte levels: Na+ and K+: too high=retention, too low=arrhythmias
dialysis for severe cases |
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Term
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Definition
| A disorder affecting heart muscle: inadequate pumping, contraction, relaxation |
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Term
| cardiomyopathy: general effect |
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Definition
| The heart muscle loses it ability to pump effectively. The heart becomes larger as it tries to compensate for its weakened condition. |
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Term
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Definition
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Term
| cardiomyopathy: nonischemic |
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Definition
disease of heart muscle
dilated
hypertrophy
restrictive |
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Term
| most common cause of CHF? |
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Definition
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Term
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Definition
idiopathic
middle aged people
men > women (2.5:1)
transplantation |
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Term
| dilated cardiomyopathy: causes |
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Definition
Familial (30-40%)
Viral infection
Chronic, excessive consumption of alcohol
Toxins (cobalt)
Cancer drugs:Doxorubicin, daunorubicin, anthrocycline
Pregnancy and childbirth
Long-term alcohol use
Cigarette smoking |
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Term
| dilated cardiomyopathy: anatomical changes |
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Definition
Dilated left ventricle and left atrium
Bulging interventricular septum from left to right
Thin ventricular walls
biopsy findings:The myocytes have lost myofibrils and empty spaces have appeared within the cytoplasm. |
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Term
| hypertrophic cardiomyopathy |
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Definition
mostly inherited (>100 mutations in 10 proteins):a utosomal dominant trait
Most common early onset (10-25 yrs)
Principal cause of sudden death: young healthy individuals, Athletes |
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Term
| hypertrophic cardiomyopathy: physiological changes |
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Definition
Inappropriate for the hemodynamic load
Proper myocardial mitochondria function
Characterized by diastolic dysfunction
Increased LV diastolic pressure: Eventually increased LA, PA and pulmonary capillary pressures: Hypercontractile LV |
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Term
| hypertrophic cardiomyopathy: anatomical changes |
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Definition
severe thickening of the interventricular septum
thickening of the left ventricular wall
tiny left ventricular chamber
biopsy: Myocyte disarray, with the cells arranged in whorls around foci of connective tissue. |
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Term
| hypertrophic cardiomyopathy: impaired functions |
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Definition
Exaggerated pump function (hypercontractile systolic function)
Poor heart relaxation (diastolic dysfunction) |
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Term
| Rarest form of cardiomyopathy? |
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Definition
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Term
| restrictive cardiomyopathy |
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Definition
worst prognosis
not inherited
diastolic dysfunction |
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Term
| restrictive cardiomyopathy: forms |
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Definition
amyloidosis, in which abnormal protein fibers (amyloid) accumulate in the heart's muscle;
sarcoidosis, an inflammatory disease that causes the formation of small lumps in organs (lungs);
hemochromatosis, an iron overload of the body, usually due to a genetic disease. |
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Term
| restrictive cardiomyopathy: anatomical changes |
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Definition
stiffened ventricle walls with decreased flexibility
due to infiltration by abnormal tissue |
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Term
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Definition
chest x-ray: cardiac silhouette, fluid in lungs
EF < 30%
cold, pale, cyanotic extremities (increased sympathetic activity)
abnormal heart sounds (S3 occurs when LV is non-comliant and has poor relaxation during diastole) |
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Term
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Definition
sinus tachycardia(^'d symp activity)
quick, shallow breaths(no change with positioning)
peripheral edema (>3lb weight gain)
crackles/rales: heard at lung bases
systolic BP with controlled expiratory maneuver(no change, should decrease)
jugular vein distension
decreased ex tolerance
decreased quality of life |
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Term
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Definition
dyspnea
abdominal ascities
ventilatory muscle weakness
inadequate O2
sudden SOB upon waking
awaken with orthopnea(sitting up helps) |
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Term
| New York Heart Association Classification |
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Definition
Class I: Cardiac disease w/o limitations
Class II: Cardiac disease slight limitation:Physical activity results in fatigue, palpitations, dyspnea (SOBOE) and anginal pain
Class III: Cardiac disease marked limitation: OK at rest; less than ordinary activity causes symptoms above
Class IV: Cardiac disease but inability to perform physical activity w/o discomfort: Symptoms above may be felt at rest, Physical activity intensifies symptoms |
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Term
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Definition
Neurohomonal: sympathetic system
muscle wasting
pulmonary edema
renal: water retention d/t decreased Q
urine: oligurea |
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Term
| CHF: Medical Interventions |
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Definition
| directed by pathophysiologic causes |
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Term
| CHF: improve heart's pumping |
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Definition
| beta blockade, vasodilator therapy |
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Term
| CHF: control sodium intake |
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Definition
| diet, heart healthy, low cholesterol and low fat |
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Term
| CHF: treat water retention |
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Definition
| diuretics: increase urine output |
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Term
| People with CHF should avoid: |
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Definition
Antiarrhythmic agents: Act as cardiodepressants and have proarrhythmic effects
Ca2+ channel blockers: Can lead to worsening of CHF and increased risk of CV events
Nonsteroid anti-inflammatory drugs: Increase sodium retention, Peripheral vasoconstriction |
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Term
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Definition
Bi-ventricular pacing (aka cardiac resynchronization therapy (CRT)
ICD (Implantable cardiac defibrillators): Recommended by AHA in 2009, EF <35%, Good functional capacity extends beyond 1 year
Intraaortic balloon pump (Fig 4-17): Inflates during diastole, improves myocardial blood flow
Left ventricular assistive device: Helps maintain the pumping ability of a heart that can't effectively work on its own, Sometimes used as a "bridge to transplant" for patients waiting for a heart transplant, Hospitalization ~7-10 days
Cardiac Transplantation |
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Term
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Definition
sx begin?
chest pain, claudication, SOB, sleep hx
Activity Level(FITT)
Objective measures/labs: EKG, Echo, blood gas levels, auscultation, 6mwt, appearance, RR, breath pattern |
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Term
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Definition
flexibility
cycling
ambulation (treadmill)
30 min, 3-5 day/week, 50-70% peak cycle work rate
energy conservation
self management
transfers
education |
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Term
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Definition
flexibility
cycle
walking
20-60 min, 3-7 day/week, 2-6 months, 50-80% peak cycle HR or O2
self management
diet
activity
energy conservation
ther ex/act
ADL's/IADL's |
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Term
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Definition
Various methods of aerobic activity
Most use cycle ergometry
20-60 minutes, 3-7 days/wk, 2-57 months, 40-90% of peak cycle heart rate or VO2 |
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Term
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Definition
unilateral ex's better than 2 legged exercises
for pt's with severe CHF |
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Term
| CHF: criteria for modification or termination of ex |
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Definition
Marked dyspnea or fatigue
RR > 40 breaths/min
Development of S3 heart sound
Increase in pulmonary crackles
Decrease in HR or BP of > 10 bpm or mmhg during steady state or progressive exercise
Diaphoresis, pallor or confusion |
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Term
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Definition
Heart valve abnormalities
Blocked valves or incompetent valves
Heart contracts more forcefully to expel Q
Leads to hypertrophy
Decreased ventricular distensibility, diastolic dysfunction
Incompenent valves associated with hypertrophy
Regurgitant blood fills atria or ventricles forcefully
Spinal cord injury
Transection to cervical spinal cord
Disconnect between cardiovascular system and control with SNS
Pericardial Effusion
Increased pressures (fluid fills pericardial sac)
Decreased diastolic function |
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