Cardiac Pathophysiology II: Cardiomyopathy
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Questions and Answers

What are common symptoms associated with heart failure?

  • Nausea and vomiting
  • Shortness of breath and fatigue (correct)
  • Increased appetite
  • Chest pain during rest

    • Which type of cardiomyopathy is most commonly asymptomatic until diagnosed?

  • Restrictive Cardiomyopathy
  • Ischemic Cardiomyopathy
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy (correct)

    • What is a primary characteristic of Dilated Cardiomyopathy?

  • Hypertrophy of the left ventricle
  • Marked endocardial scarring
  • Reduction in chamber size
  • Enlargement of the heart chambers (correct)

    • Which assessment technique is most relevant for evaluating heart function in patients with heart failure?

    <p>Echocardiography</p> Signup and view all the answers

    What class of medication is Mavacamten (Camzyos) used to treat in patients with Hypertrophic Cardiomyopathy?

    <p>Cardiac myosin inhibitor</p> Signup and view all the answers

    Which type of cardiomyopathy is characterized by marked endocardial scarring and impaired diastolic filling?

    <p>Restrictive Cardiomyopathy</p> Signup and view all the answers

    What are the potential effects of exercise training on patients with heart failure?

    <p>Improved cardiovascular fitness</p> Signup and view all the answers

    Which of the following is NOT a typical risk factor for developing Dilated Cardiomyopathy?

    <p>High physical activity levels</p> Signup and view all the answers

    Which of the following is a common symptom of heart failure?

    <p>Fatigue</p> Signup and view all the answers

    What does Jugular Venous Distention (JVD) indicate?

    <p>Increased volume in the venous system</p> Signup and view all the answers

    What is the primary aim of pharmacologic treatment for heart failure?

    <p>To enhance cardiac output and reduce edema</p> Signup and view all the answers

    Which test is found to be reliable for assessing aerobic capacity in heart failure patients?

    <p>6 Minute Walk Test</p> Signup and view all the answers

    What is the normal range for Ejection Fraction (EF)?

    <p>55-75%</p> Signup and view all the answers

    When assessing a patient for signs of heart failure, which finding would indicate potential worsening of the condition?

    <p>Increase in edema</p> Signup and view all the answers

    What is the recommended starting intensity for aerobic exercise in heart failure patients?

    <p>40-50% of heart rate reserve</p> Signup and view all the answers

    Which physical sign is commonly associated with left heart failure?

    <p>Pulmonary congestion</p> Signup and view all the answers

    Which of the following is a sign that a patient may be exercising intolerantly?

    <p>Decreased heart rate during exercise</p> Signup and view all the answers

    What should patients with heart failure avoid during exercise?

    <p>Supine position</p> Signup and view all the answers

    Which medication class is typically prescribed to reduce the workload of the heart?

    <p>Diuretics</p> Signup and view all the answers

    In patients with heart failure, which of the following is an important sign to monitor during exercise assessments?

    <p>Stable blood pressure response</p> Signup and view all the answers

    Which technique is recommended for evaluating heart sounds in heart failure patients?

    <p>Auscultation for S3 heart sound</p> Signup and view all the answers

    Which of the following can be a cause of right-sided heart failure?

    <p>Chronic obstructive pulmonary disease (COPD)</p> Signup and view all the answers

    What are the signs to monitor for exercise intolerance in patients with an LVAD?

    <p>Symptoms of fatigue or dyspnea</p> Signup and view all the answers

    Which training duration is recommended for patients in outpatient cardiac rehab after a heart transplant?

    <p>20-60 minutes</p> Signup and view all the answers

    Which precaution should be taken for patients with a permanent pacemaker?

    <p>Avoid shoulder flexion/abduction beyond 90 degrees for 4-6 weeks</p> Signup and view all the answers

    What is the appropriate Borg RPE scale range for exercise in patients with heart issues?

    <p>11-13</p> Signup and view all the answers

    How does a transplanted heart generally respond to exercise in terms of heart rate?

    <p>Delayed and blunted response with lower peak HR</p> Signup and view all the answers

    Which factor is crucial to monitor for patients on ECMO during mobility progression?

    <p>Vital signs and flows</p> Signup and view all the answers

    What type of exercise should be prioritized in the first few weeks following heart transplantation?

    <p>Gradual mobility and low-intensity exercise</p> Signup and view all the answers

    What is the recommended intensity for aerobic training in patients after a heart transplant?

    <p>RPE 11-14 or talk test</p> Signup and view all the answers

    What inappropriate response should patients not exhibit during exercise post-heart transplantation?

    <p>Dizziness and confusion</p> Signup and view all the answers

    In which condition is an implantable cardioverter defibrillator (ICD) most commonly indicated?

    <p>Frequent life-threatening arrhythmias</p> Signup and view all the answers

    Which exercise program component should be initiated after 4-8 weeks post-cardiac transplant?

    <p>Strength training</p> Signup and view all the answers

    What is a common symptom of pacemaker malfunction?

    <p>Shortness of breath</p> Signup and view all the answers

    What is the preferred type of exercise for patients after heart transplantation during outpatient rehab?

    <p>Aerobic exercises like walking or cycling</p> Signup and view all the answers

    What is a primary benefit of Cardiac Resynchronization Therapy (CRT)?

    <p>Decreases mortality and improves symptoms</p> Signup and view all the answers

    What is a critical monitoring consideration for a patient with an Intra Aortic Balloon Pump (IABP)?

    <p>Monitor for signs of infection at the insertion site</p> Signup and view all the answers

    What is the main function of the Impella device?

    <p>Expels blood into the ascending aorta to reduce left ventricular workload</p> Signup and view all the answers

    What is a key characteristic of hypertrophic cardiomyopathy?

    <p>Reduction in chamber size</p> Signup and view all the answers

    Which indication is appropriate for the use of a Left Ventricular Assist Device (LVAD)?

    <p>Long-term solution for end-stage heart failure</p> Signup and view all the answers

    Which of the following can be a possible cause of dilated cardiomyopathy?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What should be considered when mobilizing a patient on an Impella device?

    <p>Evidence on mobilizing patients on Impellas is limited</p> Signup and view all the answers

    What is the most common symptom associated with restrictive cardiomyopathy?

    <p>Heart failure symptoms</p> Signup and view all the answers

    What effect does a Continuous Flow Left Ventricular Assist Device (LVAD) typically have on pulse detection?

    <p>Pulses are often non-palpable due to continuous flow</p> Signup and view all the answers

    What is a proposed treatment for obstructive hypertrophic cardiomyopathy?

    <p>Septal myectomy</p> Signup and view all the answers

    For which patient condition is Cardiac Resynchronization Therapy (CRT) primarily indicated?

    <p>Patients with heart failure and severe left ventricle dysfunction</p> Signup and view all the answers

    What is a significant risk associated with the Intra Aortic Balloon Pump (IABP) when inserted via the femoral artery?

    <p>Immobility caused by hip flexion restrictions</p> Signup and view all the answers

    Which type of heart condition is characterized by both decreased stroke volume and cardiac output?

    <p>Hypertrophic cardiomyopathy</p> Signup and view all the answers

    What is the common mechanism by which cardiomyopathies such as DCM and HCM impair cardiac function?

    <p>Enlargement of heart chambers</p> Signup and view all the answers

    What happens to exercise capacity after Left Ventricular Assist Device (LVAD) placement?

    <p>Exercise capacity remains low despite intervention</p> Signup and view all the answers

    What is a potential effect of hypertrophic cardiomyopathy on young athletes?

    <p>Sudden death</p> Signup and view all the answers

    Which treatment strategy is commonly utilized for managing restrictive cardiomyopathy?

    <p>Symptom management</p> Signup and view all the answers

    What is the primary cause of heart failure related to cardiomyopathy?

    <p>Inadequate ability to pump blood</p> Signup and view all the answers

    Which risk factor is commonly associated with the development of restrictive cardiomyopathy?

    <p>Connective tissue disorders</p> Signup and view all the answers

    What is the primary characteristic of diastolic heart failure (HFpEF)?

    <p>Ventricular wall hypertrophy</p> Signup and view all the answers

    Which laboratory finding indicates a heart failure diagnosis if BNP is greater than 400 pg/mL?

    <p>NT-ProBNP &gt; 900 pg/mL</p> Signup and view all the answers

    Which of the following is a lifestyle modification recommended for treating heart failure?

    <p>Weight loss</p> Signup and view all the answers

    What is a common sign that may indicate worsening heart failure during a physical assessment?

    <p>Inspiratory crackles in lung auscultation</p> Signup and view all the answers

    What physiological state does right heart failure typically cause?

    <p>Venous congestion</p> Signup and view all the answers

    Which statement best describes decompensated heart failure?

    <p>It can present suddenly or gradually and often requires urgent medical care.</p> Signup and view all the answers

    Which of the following is NOT a main cause of left-sided heart failure?

    <p>COPD</p> Signup and view all the answers

    What should be the starting intensity range for aerobic exercise in heart failure patients?

    <p>40-50% of Heart Rate Reserve (HHR)</p> Signup and view all the answers

    What is a recommended form of exercise for heart failure patients?

    <p>Stationary cycling and overground walking</p> Signup and view all the answers

    What is a key characteristic of the heart rate response in a transplanted heart?

    <p>Delayed and blunted response to exercise</p> Signup and view all the answers

    Which of the following should be monitored for exercise intolerance in patients with an LVAD?

    <p>Blood pressure and RPE</p> Signup and view all the answers

    What precaution is necessary for patients who have received a permanent pacemaker?

    <p>No lifting or pushing for 4-6 weeks</p> Signup and view all the answers

    In the context of cardiac rehabilitation post-heart transplantation, what is the recommended frequency of aerobic training sessions?

    <p>3-5 days a week</p> Signup and view all the answers

    Which specific exercise response signifies that a patient has reached a level 3 rejection during recovery?

    <p>No exercise should be undertaken</p> Signup and view all the answers

    What is a beneficial type of resistance training after a heart transplant?

    <p>Progression to 70% 1-RM over time</p> Signup and view all the answers

    What is the purpose of ECMO treatment in patients?

    <p>To support with severe cardiopulmonary dysfunction</p> Signup and view all the answers

    What significant factor should be monitored during mobility progression for patients on ECMO?

    <p>Medical stability and vital signs</p> Signup and view all the answers

    Which of the following is true regarding the leadless pacemaker?

    <p>It has all components contained within one device</p> Signup and view all the answers

    What is the typical survival rate after heart transplantation?

    <p>85-90%</p> Signup and view all the answers

    What is the primary characteristic of Hypertrophic Cardiomyopathy?

    <p>Reduction in chamber size and LV hypertrophy</p> Signup and view all the answers

    Which type of cardiomyopathy has an unknown cause and is marked by scarring that impairs diastolic filling?

    <p>Restrictive Cardiomyopathy</p> Signup and view all the answers

    Which condition is most likely to cause sudden death in young athletes?

    <p>Obstructive Hypertrophic Cardiomyopathy</p> Signup and view all the answers

    What is the effect of Dilated Cardiomyopathy on stroke volume?

    <p>Decreases stroke volume and cardiac output</p> Signup and view all the answers

    Which treatment is specifically indicated for obstructive Hypertrophic Cardiomyopathy?

    <p>Septal myectomy</p> Signup and view all the answers

    What physiological issue characterizes heart failure?

    <p>Reduced ability of the heart to pump enough blood</p> Signup and view all the answers

    Which statement about the treatment of Restrictive Cardiomyopathy is true?

    <p>It focuses on managing symptoms and treating underlying causes</p> Signup and view all the answers

    What risk factor is commonly associated with Restrictive Cardiomyopathy?

    <p>Sarcoidosis</p> Signup and view all the answers

    Which symptom is often absent in patients with Hypertrophic Cardiomyopathy?

    <p>Asymptomatic status</p> Signup and view all the answers

    What is a common effect of both Dilated and Hypertrophic Cardiomyopathy on cardiac function?

    <p>Decreased stroke volume</p> Signup and view all the answers

    What is the primary indicator that Jugular Venous Distention (JVD) is present?

    <p>The veins distend above the clavicles</p> Signup and view all the answers

    Which laboratory finding is indicative of heart failure when its level exceeds 400 pg/mL?

    <p>BNP</p> Signup and view all the answers

    In which type of heart failure is ejection fraction often less than 40%?

    <p>Systolic heart failure</p> Signup and view all the answers

    What is a common reason for hospital admissions related to heart failure?

    <p>Decompensated heart failure</p> Signup and view all the answers

    What is the recommended frequency of aerobic exercise for patients with heart failure?

    <p>At least 3 days/week, preferably 5 days</p> Signup and view all the answers

    What is the appropriate intensity range for aerobic exercise in patients with heart failure?

    <p>40-50% of HRR</p> Signup and view all the answers

    Which of the following symptoms is important to monitor during physical therapy assessment for heart failure?

    <p>JVD</p> Signup and view all the answers

    Which cardiovascular condition is a known cause of right-sided heart failure?

    <p>Chronic obstructive pulmonary disease (COPD)</p> Signup and view all the answers

    What change in weight should prompt further assessment in patients with heart failure?

    <p>Gaining more than 2-3 pounds in a day</p> Signup and view all the answers

    What is a primary goal of lifestyle modifications for patients with heart failure?

    <p>Reduce workload on the heart</p> Signup and view all the answers

    What is a significant benefit of Cardiac Resynchronization Therapy (CRT)?

    <p>Enhances myocardial coordination and increases cardiac output</p> Signup and view all the answers

    Which device is specifically designed to provide short-term support to the left ventricle?

    <p>Impella Device</p> Signup and view all the answers

    What precaution is necessary for a patient with an Intra Aortic Balloon Pump (IABP) inserted via the femoral artery?

    <p>No hip flex greater than 30 degrees in supine position</p> Signup and view all the answers

    For which condition is the Left Ventricular Assist Device (LVAD) primarily indicated?

    <p>End-stage heart failure unresponsive to medical intervention</p> Signup and view all the answers

    What impact does a Continuous Flow Left Ventricular Assist Device (LVAD) have on pulse detection?

    <p>Pulses are absent and manual BP readings may not be possible</p> Signup and view all the answers

    What should be monitored pre and post mobility for patients with an Impella device?

    <p>Vital signs</p> Signup and view all the answers

    Which of the following patients is most likely to achieve maximum benefits from Cardiac Resynchronization Therapy (CRT)?

    <p>Patients with severe heart failure symptoms and wide QRS duration</p> Signup and view all the answers

    Which of the following is a primary goal when using an Intra Aortic Balloon Pump (IABP)?

    <p>Lower afterload and increase coronary blood flow</p> Signup and view all the answers

    What is one of the main challenges in mobilizing patients on Impella devices?

    <p>There is a lack of comprehensive evidence on effective mobilization</p> Signup and view all the answers

    What characterizes the exercise capacity of patients after placement of a Left Ventricular Assist Device (LVAD)?

    <p>Patients often show improved exercise capacity over time</p> Signup and view all the answers

    What is a significant characteristic of a heart that has undergone transplantation?

    <p>It exhibits a denervated heart rate response.</p> Signup and view all the answers

    What is the recommended intensity for aerobic training in outpatient cardiac rehabilitation after a heart transplant?

    <p>11-14 on the Borg RPE scale.</p> Signup and view all the answers

    What should be avoided during exercise in patients with a permanent pacemaker?

    <p>Exercises involving shoulder flexion beyond 90 degrees.</p> Signup and view all the answers

    Which of the following is a precaution for patients post-heart transplantation?

    <p>Sternal precautions for 4-6 weeks.</p> Signup and view all the answers

    What type of exercise should be prioritized during the first few weeks after heart transplantation?

    <p>Aerobic exercise like walking.</p> Signup and view all the answers

    What is an important monitoring consideration for patients on ECMO during mobility progression?

    <p>Monitoring cannulas and vital signs.</p> Signup and view all the answers

    Which pacemaker type does not require leads or a generator?

    <p>Leadless Pacemaker.</p> Signup and view all the answers

    What is a common symptom of pacemaker malfunction?

    <p>Shortness of breath.</p> Signup and view all the answers

    What is indicated when a patient's rejection level reaches a grade 3 after heart transplantation?

    <p>No exercise should be undertaken.</p> Signup and view all the answers

    What is a critical component of managing a patient’s activity tolerance after heart transplantation?

    <p>Gradual progress from supine to upright positions.</p> Signup and view all the answers

    Study Notes

    Cardiac Pathophysiology & Intervention II

    • Cardiomyopathy (CM) is a disease of the heart muscle.

    • CM can impair the ability of the muscle fibers to contract and/or relax.

    • CM often leads to heart failure.

    • Acquired or hereditary disease of the heart muscle.

    • CM can occur in adults and children.

    • Cardiomyopathy (CM) main types:

      • Dilated
      • Hypertrophic
      • Restrictive

    Dilated Cardiomyopathy (DCM)

    • Characterized by enlarged heart chambers, which impairs pumping ability (decreased stroke volume [SV] and cardiac output [CO]).
    • Possible causes include CAD/MI, ETOH abuse, HTN, DM, viral infections, toxins, pregnancy and drugs.
    • Can be idiopathic.
    • Symptoms include fatigue, weakness, chest pain, and normal or low blood pressure (BP).
    • Treatment depends on the cause of DCM.
    • Treatments such as lifestyle changes, medications, and surgery may be used.
    • Cardiac device implantation may also be applied as a treatment method.

    Hypertrophic Cardiomyopathy (HCM)

    • Characterized by LV hypertrophy (enlarged left ventricle) and a rigid ventricular wall, reducing chamber size.
    • Results in decreased stroke volume and cardiac output.
    • Often genetic.
    • Most common type of CM.
    • Often asymptomatic and undiagnosed.
    • Can cause sudden death in young athletes.
    • Hypertrophic Cardiomyopathy (HCM) types:
      • Obstructive
      • Nonobstructive
    • Symptoms:
      • Asymptomatic
      • Heart failure symptoms (SOB, fatigue, LE edema)
    • Treatment:
      • Medical (Mavacamten [Camzyos]– cardiac myosin inhibitor, other cardiac meds)
      • Surgical (septal myectomy, alcohol septal ablation)
      • Implantation cardiac devices
      • Heart transplant

    Restrictive Cardiomyopathy

    • Least common type of CM.
    • Characterized by marked endocardial scarring (fibrosis), impairing diastolic filling (↓ CO).
    • Unknown cause.
    • Risk factors include sarcoidosis, connective tissue disorders, and some cancer treatments (XRT/chemo).
    • Symptoms are heart failure symptoms.
    • Treatments focus on managing symptoms and treating the underlying cause.

    Heart Failure

    • A chronic, progressive condition where the heart muscle is unable to pump enough blood for the body's needs for blood and oxygen (↓ Cardiac Output).
    • Often accompanied by shortness of breath and fatigue.
    • Prevalence of Heart Failure:
    • In 2017 there were 6 million people with heart failure.
    • In 2020 there were 6.7 million people with heart failure.
    • Projections for 2030 indicate 8.5 million people with heart failure.
    • Incidence rates of HF by race/ethnicity in the US:
    • Highest: Black population: 4.6 per 1000 per year
    • Middle: Hispanic population: 3.5 per 1000 per year
    • Middle: White population: 2.4 per 1000 per year
    • Lowest: Chinese population: 1.0 per 1000 per year
    • Prevalence of heart failure in the US by age:
    • 20-39: 0.4% for males and 0.4% for female populations.
    • 40-59: 2.3% for males and 1.2% for female populations.
    • 60-79: 7.5% for males and 4.3% for female populations.
    • ≥80: 7.1% for males and 10.9% for female populations

    Heart Failure: Risk Factors/Causes

    • CAD/MI
    • HTN
    • DM/Metabolic syndrome
    • Family Hx of heart disease
    • Obesity
    • Chronic pulmonary diseases
    • Inflammation or infection
    • Treatment with cardiotoxic agents (Certain chemo drugs)

    Mechanisms of Heart Failure

    • A complex process involving multiple system contributors that result in reduced functional and exercise capacity, including:
      • decreased cardiac output due to increased sympathetic nervous system, renin-angiotensin system, antidiuretic hormone, and circulating volume
      • peripheral edema and pulmonary congestion due to fluid retention and impaired venous return

    Types of Heart Failure

    • Structural classification:
      • Left-sided heart failure
      • Right-sided heart failure
    • Functional classification:
      • Systolic heart failure (HFrEF) (reduced EF)
      • Diastolic heart failure (HFpEF) (preserved EF)

    Right Heart Failure

    • Venous congestion and systemic symptoms.
    • Reduced cardiac output and pulmonary symptoms.
    • Left-sided Heart Failure often leads to Right-sided Heart Failure.

    Left Heart Failure

    • Reduced cardiac output and pulmonary symptoms.

    Decompensated Heart Failure

    • Sudden or gradual onset of symptoms requiring unplanned visits (office, ER or hospitalization).
    • Ranges from mild to life-threatening.
    • Increased edema, dyspnea, and weight gain are common symptoms.
    • In many cases the cause is undetermined, some causes include non-compliance with medications, uncontrolled HTN, ischemia, arrhythmias, or COPD.

    Diagnosis of Heart Failure

    • Symptoms and physical assessment
    • Lab findings (BNP > 400 pg/mL; NT-ProBNP > 900 pg/mL)
    • Imaging (chest X-ray, echocardiogram)
    • EKG
    • Stress test

    Classification of Heart Failure: NYHA Class

    • Class 1: No symptoms; able to perform all normal daily activities
    • Class 2: Some limitations in ability to perform activities
    • Class 3: Marked limitation of physical activity
    • Class 4: Unable to perform any physical activity

    Classification of Heart Failure: ACC/AHA

    • Stage A: At risk of heart failure
    • Stage B: Pre-heart failure
    • Stage C: Symptomatic heart failure
    • Stage D: Advanced heart failure

    Treatment of Heart Failure

    • Lifestyle modifications (exercise, healthy diet, decreased sodium and water intake, weight loss)
    • Pharmacologic treatment (reduction of work of heart, reduction of edema, increasing CO; ACE inhibitors/ARBs, diuretics, beta blockers, inotropes [for more severe HF])

    Exercise Training for Patients with Heart Failure

    • Exercise training improves quality of life, physical function, exercise capacity, and decreases hospitalizations (safe).

    FITT for Heart Failure - Aerobic Exercise

    • Frequency: Minimum 3 days/week, prefer 5 days.
    • Intensity: Start at 40-50% and progress to 70-80% of HHR.
    • Time: Progressively increase to 20-60 min/day.
    • Type: Aerobic exercise (treadmill, walking, stationary cycling; Interval training if deconditioned patients).

    FITT for Heart Failure - Resistance Exercise

    • Frequency: 1-2 nonconsecutive days.
    • Intensity: Begin at 40% and progress to 70% of 1RM.
    • Time: 1-2 sets of 10-15 reps of multiple muscle groups.
    • Type: Weight machines, dumbbells, elastic bands and body weight.

    Tips for Treating Patients with Heart Failure

    • Watch for weight gain (>2-3 pounds/day).
    • Note any LE edema.
    • Don't exercise in supine.
    • Monitor vital signs, breath/heart sounds and watch for intolerance.
    • Initiate exercise at a lower intensity (40-50%), potentially lower for very low EF.
    • Assess cognition and self-management skills.

    Education for Heart Failure

    • Disease process
    • Benefits of exercise
    • Self-monitoring techniques
    • Signs of exercise intolerance
    • Positioning and energy conservation (Pacing)
    • Home exercise program

    Medical Treatment for Heart Failure: Interventions

    • CABG/Valve surgery
    • Cardiac Resynchronization Therapy (CRT)
    • Mechanical Assist Devices (Intra aortic balloon pump [IABP], Impella, Ventricular Assist Device [VAD], Heart Transplant, ECMO)

    Cardiac Resynchronization Therapy (CRT)

    • Special type of PM that helps to treat HF.
    • Paces both ventricles.
    • May help to improve symptoms (SOB) and decrease mortality
    • Not all patients achieve expected benefits.

    Intra Aortic Balloon Pump (IABP)

    • Inserted via artery into the descending aorta
    • Lowers afterload, increases coronary blood flow.
    • Insertion into femoral artery – no hip flex greater than 30 degrees in supine.
    • Monitor vital signs and insertion site during mobilization.

    Impella Device

    • Mini ventricular assist that provides short-term support for the left ventricle.
    • Continuously draws blood from the left ventricle to the ascending aorta.

    Mobilization on Impellas

    • Patients are only in the ICU.
    • Type of device affects patient's ability to be mobilized.
    • Monitor vital signs before and after mobility.

    Left Ventricular Assist Device (LVAD)

    • Used for end-stage HF that is unresponsive to medical intervention.
    • Performed via sternotomy or thoracotomy.
    • Provides continuous flow.
    • No pulse – unable to palpate HR or obtain manual BP readings.
    • Often low functioning but capable of showing improvement with rehab/exercise training.

    Indications for LVAD

    • Individuals with HFrEF (NYHA Class IV)
    • Bridge-to-transplant
    • Destination therapy
    • Bridge-to-recovery

    Functional Status post LVAD

    • Exercise capacity remains low after LVAD placement.

    Exercise Guidelines for LVADs

    • Borg RPE 11-13 (6-20 scale)
    • Dyspnea < 5 (0-10 scale)
    • MAP between 70-90mmHg
    • LVAD flow > 3 L/min
    • ECG changes
    • Decreased SpO2 if available (important for safe exercise parameters)
    • Watch for symptoms of exercise intolerance

    Acute Care Setting: LVAD

    • Management of factors (wound/skin integrity)
    • Pulmonary hygiene.
    • Progressive mobilization
    • Monitor flow rate, MAP, HR, RPE, and watch for exercise intolerance.
    • Education (how to hook/unhook LVAD to/from batteries).

    Outpatient Setting: LVAD

    • Cardiac rehab (exercise training).
    • Goal is 20-60 minutes.
    • RPE of 11-13
    • Strength training after 4-8 weeks (timing).

    Heart Transplantation

    • Surgery replaces diseased heart with a healthy one.
    • Used for end-stage heart failure.
    • Results in a deinnervated heart (low exercise response).
    • Survival rate 85-90%.

    Post-Transplantation (Acute Phase)

    • Address pulmonary issues.
    • Gradual mobility progression (supine → sitting → standing → walking).
    • Warm-up and cool-down are needed
    • Monitor HR, BP, RPE and watch for fatigue.
    • Provide education (sternal precautions, denervated heart rate response, HEP).

    Rejection Scale

    • Grading scale for patient's responses to transplantation.

    Exercise Capacity Post Transplantation

    • Exercise capacity often remains lower after transplant

    Outpatient Cardiac Rehabilitation Post Transplantation

    • Aerobic training
    • Strength training
    • Addressing musculoskeletal problems is a crucial part of post-transplant cardiac rehab.
    • Education and patient self-monitoring.

    FITT for Heart Transplant

    • Aerobic Training (frequency, intensity, type, time)
    • Strength Training (frequency, intensity, time, type)

    Exercise Tips Post Heart Transplant

    • Need prolonged warm-up and cool-down periods.
    • Initial exercise intensity may need to start at 40-50%.
    • Monitor patient vitals and respond appropriately to symptoms of intolerance.
    • Avoid exercise when rejection levels reach level 3.
    • Sternal precautions for 4-6 weeks need to be observed.
    • Alternate exercise between upper (UE) and lower extremities (LE).

    Extracorporeal Membrane Oxygenation (ECMO)

    • Used to support patients with severe cardio-pulmonary dysfunction unresponsive to conventional treatment (such as cardiogenic shock, bridge to heart or lung transplant and COVID-19- associated issues).
    • Patients experience significant weakness and lower levels of mobility due to prolonged bedrest on ECMO support.

    Mobility on ECMO

    • Determine medical stability and obtain orders.
    • Gather team (RN, perfusionist RT) if needed.
    • Slowly progress mobility as tolerated.

    Implantable Cardiac Devices

    • Pacemakers and other implantable devices
    • Pacemakers and AICDs produce an artificial action potential to control certain arrhythmias such as Bradycardia, Heart Blocks, and Tachycardia.
    • Implantable devices may be combined with other interventions.

    Pacemaker Malfunction

    • Malfunction can occur from leads failing or internal malfunction.
    • Symptoms include Dizziness, Syncope, Shortness of breath, Confusion, Chest pain and Cardiac arrest.

    Automatic Implantable Cardioverter Defibrillator (AICD)

    • Detects and corrects life-threatening arrhythmias (like VT/VF) via delivering electrical shocks.
    • Same postoperative precautions as a PM

    Wearable Cardioverter Defibrillator (Life Vest)

    • Aids in detection and defibrillation of VT/VF.
    • Often used when AICD implantation has to be deferred (ie., active infection)

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    Cardiac Pathophysiology & Intervention II PDF

    Description

    This quiz explores the various types of cardiomyopathy, including dilated and hypertrophic forms, and discusses their causes, symptoms, and treatment options. Understand how these conditions affect heart function and lead to complications like heart failure. Perfect for students of cardiac pathophysiology.

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