Special Pops: CHF

what are the causes of heart failure?

• CVD (60%)

• prolonged HTN

• diabetes (indirect link)

• valvular disease

• alcohol abuse (cardiomyopathy)

• idiopathic causes

What is heart failure?

• heart is unable to pump blood adequately

• enlarged ventricles or enlarged myocardium

What is systolic dysfunction?

• decreased ejection fraction

• left ventricle can’t pump blood out—→lots of blood left inside ventricles (increased end systolic volume)

What is diastolic dysfunction?

• decreased compliant chamber/stiffness

• decreased end diastolic volume

• resistance to filling LV

Which type of heart failure is the EF normal?

• diastolic dysfunction

What does the LVEF have to be to be diagnosed with heart failure?

• less than 45%

What is the criteria for Severe LV dysfunction?

• less than 30%

What are the signs and symptoms of heart failure?

• Exercise intolerance —→dyspnea on exertion

• fluid retention

• difficulty while sleeping flat (supine)

• paroxysmal nocturnal dyspnea

• fluid in lungs (pulmonary congestion) —→rales (cracking sounds)

What is peripheral edema?

• swelling in lower limbs

• causes weight gain

What is paroxysmal nocturnal dyspnea?

• waking to catch breath (coughing and SOB)

Should prediction equations be used to estimate VO2 with heart failure patients?

• no

• overestimates functional capacity

What VO2 should be used with heart failure patients?

• peak VO2

When should exercise test be terminated?

• dysrhythmia > 2mm ST-depression/elevation

• T wave inversion

• SBP > 250

• DBP > 115

• exertional hypotension

• 3+ on dyspnea scale

How much lower is VO2 peak when measured with cycle ergometry than with a treadmill?

• 10-15% lower

When can a transplant patient begin cardiac rehab?

• 4 weeks after surgery

What is it meant by the donated heart is permanently decentralized?

• parasympathetic nerves are removed or severed and not connected in the new body

How to transplant patients respond to exercise?

• resting HR 90-100, HR may change very little when exercising

• at peak exercise, HR is lower, cardiac output and SV are 25% lower than normal

• decline of HR in recovery takes longer than normal

What are transplant patients unable to experience during exercise?

• unable to experience the sensation of angina due to ischemia

What lifestyle changes can improve EF?

• heart healthy diet, low sodium

• quit smoking

• avoid alcohol or reduce intake

• exercise regularly

• get to/stay at healthy weight

• reduce stress

How much can exercise improve EF?

• 6% in 6+ months

Cardio FITT

• F: 4-5 days/week

• I: RPE 11-14, 50-80% VO2R/HRR

• T: aerobic (bike/treadmill)

• T: 30-60 min (bouts 4-8 minutes)

Resistance FITT

• F: 2-3 days/week

• I: 40-70% 1RM

• T: initially start 1 set 10-12 reps, progress to 12-15 reps

• T: fully body, machines, free weights, resistance bands