Cardiac Flashcards
Heart layers
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Heart chambers
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Heart valves
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Circulation
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Conduction system
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Baroreceptors
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Blood pressure
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Electrical system pic
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HTN
Hypertension - high blood pressure
- systolic: pressure exterted by the heart when it contracts
- diastolic: pressure in arteries and arterioles between heart beats
HTN Pic
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HTN S&S
Risk factors
S&S
- most are asymptomatic - dull headaches - dizziness - nose bleeds - sweating (diaphoresis) - flushing - blurred vision - BP >140/90
Risk factors
- genetics - family history - age - stress -lifestyle - diet (high Na+ intake, ETOH) - pre-existing conditions - pre-hypertension (1/3 Americans)
HTN treatment
Only 54% have it under control
- Lifestyle changes: weight loss, exercise, relaxation techniques, and decrease alcohol consumption, smoking, caffeine intake
- Medications: diuretics, ACE inhibitors, beta blockers, calcium channel blockers
Diuretics
Removes excess sodium and water through kidneys, blocks their reabsorption
- water pills
- useful in tax of HTN and CHF, increases urine output, reduces blood volume, and edema
- also removes potassium, requires a replacement
- lasix
ACE inhibitors
Angiotensin-converting enzyme
- prevents an enzyme from producing angiotensin II, a substance that narrows blood vessels and releases hormones that can raise blood pressure
- this narrowing can cause high blood pressure
- captopril, vasotec
Beta blockers
Block the beta-adrenergic receptors in the heart to prevent increased heart activity
- blocks effects of the hormone epinephrine (adrenaline)
- heart beats more slowly and with less force, reducing blood pressure
- beat blockers also help blood vessels open up to improve blood flow
- very important for us to know when a pt is on this, because HR wont increase with exercise!
- atenolol, lopressor
Calcium channel blockers
Prevents calcium form entering cardiac and smooth muscle cells (blood vessels), results in lower blood pressure
- relax and widen blood vessels by affecting muscle cells in the arterial walls
- decreases cardiac contactility, helping to prevent arrhythmia
- cadizem
CHD
Coronary artery (heart) disease
- lack of adequate blood flow to cardiac muscle tissue
- includes angina pectoris, MI, and arteriosclerosis
- risk factors: smoking, high cholesterol, HTN, DM, stress, family history, obesity, and sedentary lifestyle
Arteriosclerosis
Hardening of the arteries
- idiopathic (multi-factorial)
- over time and too much pressure: walls of the arteries lose their elasticity and become thick and hard
- often associated with HTN
Atherosclerosis
Most common form of arteriosclerosis
- presence of plaques inside walls of large arteries
- plaque made up of fat, cholesterol, calcium, and other substances found in the blood
- over time plaque hardens and narrows arteries, limits oxygen-rich blood to organs and other parts of the body
- slow, progressive disease
- no symptoms until 75% blockage
Risk factors for atherosclerosis
Treatment
Age - gender - family history - lifestyle - cigarette smoking - diet - DM - HTN
Treatment
- Lowering cholesterol through diet and/or medication
- decrease sodium intake
- control of high blood pressure
- smoking cessation
- possible surgical intervention
Diagnostic test for arteriosclerosis and/or atherosclerosis
- blood work to check cholesterol levels
- exercise stress test
- angiogram
Cardiovascular changes
- Coronary atherosclerosis: most common cause of hospitalization and death in US
- aging: cardiac fibrosis, decreased mochetas and capillary density
- female hearts: smaller, anatomically and hypertrophic stimuli different, left ventricle mass increases with age (estrogen is cardio protective)
Angina pectoris
Sub sternal chest pain after exertion
- pain or tightness typically on the left side of the chest may radiate to left arm/back/jaw
- dyspnea
- BP may also increase
- pallor
- diaphoresis
- nausea
- cyanosis (blue lips and nails)
- typically a symptom of MI
Angina pectoris
- etiology
- precipitating factors
- treatment
- Etiology: insuffficient myocardial blood supply, vasospasm, myocardial hypertrophy, respiratory disease, sever anemia
- Precipitating factors: increased activity, emotions, respiratory infection, extreme weather/pollution, large meals
- Treatment: rest, vasodilators, nitroglycerin, avoid stressors, anti-anxiety and stress edu
MI S&S
Myocardial infarction
- chest pain - sense of heaviness in chest - nausea/vomiting - arrhythmia - sweating - hypotension - weakness - shortness of breath - light-headedness - Levine sign
MI etiology
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries
- most common cause is atherosclerosis
- infarction may develop in 3 ways:
1. Thrombus builds up to obstruct artery
2. Vasospasm occurs
3. Part of the thrombus breaks away forming an embolus
MI pathophysiology
- coronary artery is totally obstructed
- heart tissue becomes necrotic
- necrotic zone - area of injury, inflammation, and ischemia around nectroci tissue
- myocardial contractility and conduction lost quickly as O2 supply is depleted
MI treatment
- cardiac rehabilitation: exercise program and lifestyle modification
- possible surgery: coronary artery bypass surgery and coronary angioplasty
- medications: aspirin, blood thinners, nitroglycerin, beta blockers, ACE inhibitors, CA channel blockers
CABG
Coronary artery bypass graft (open heart surgery)
- veins from pt’s leg grafted to replace damaged coronary artery
- sternal precautions: per surgeon, limites on pulling, pushing, overhead reaching, and driving for 2 months
PT for CHD
Be aware of pt’s medications, need for oxygen (at rest and during exercises/activities), dietary restrictions
- DNR do not resuscitate
- DNI do no intubate
Phase 1 of cardiac rehab
- takes place in the hospital
- pt edu about life changes
- encourage family support
- educate pt in bed mobility skills
- ankle pumps to prevent DVT’s
- transfer training following sternal precautions
- gait training
Phase 2 of cardiac rehab
- takes place in outpatient settings
- education for self monitoring of vitals
- ADLs
- upper body AROM exercises
- treadmill activities
- stationary bike
Phase 3 of cardiac rehab
- takes place when the pt is discharged from outpatient PT, but continues in a community based program or voluntary program of a pt’s choice
- pt continues a fitness program and activities of their choice in the community or at home
- progressing after precautions are lifted to resistance exercises
Deep vein thrombosis
- most common CV disease after acute conornary artery and stroke
- 30-60% major surgery, CV pathology develop DVT up to 4 weeks after operation or incident
- risk factors: immobility, trauma, lifestyle, hyper-coagulation, >60, DM, genetics (virchow’s triad)
- Tx: anti-coagulation, 24 hours bedrest, compression, heparin, avoid straining activities
- can lead to PT, venous stasis, insufficiency
Wells prediction rule
- active cancer (treatment within 6 months or palliation) 1 pt
- paralysis, paresis, or immobilization of lower extremity 1 pt
- bedridden for more than 3 days because of surgery (within 4 weeks) 1 pt
- localized tenderness along distribution of deep veins 1 pt
- entire leg swollen 1 pt
- unilateral calf swelling of greater than 3 cm (below tibial tuberosity) 1 pt
- unilateral pitting edema 1 pt
- collateral superficial veins 1 pt
- alternative diagnosis as likely as or more likely than DVT -2 pt
0 pt = 3% chance
1-2 pt = 17% chance
3+ = 75% chance
CHF
Congestive heart failure
- no a specific disease but a complication of HTN and ischemia
- results in the inability of the heart to pump enough blood
- blood backs up into the pulmonary veins
CHF
S&S and treatment
S&S: dyspnea - orthopnea - tachypnea - anxiety - bilateral leg edema - cough - fatigue - diaphoresis - restlessness - confusion
Treatment: exercise - low sodium diet - medications (ACE inhibitor, beta blockers, diuretics in later stage)
Valve disorders
- etiology
When working properly, valves prevent backflow of blood
- tricuspid
- bicuspid / mitral
- aortic and pulmonary SL valves
- etiology: congenital defect into e valve structure, infection or inflammation due to infection, results in inefficient blood flow through the heart and decreased cardiac output
Valve disorders S&S
- individuals my be asymptomatic
- fatigue
- heart murmur
- abnormal hear sound
- possible tachycardia
- treatment: valve replacement and meds
Endocarditis
- etiology:
- defective heart valves low virulent (strep) = subacute
- normal valves highly virulent organism (staph) = acute - Signs
- subacute: heart murmur, low grade fever, fatigue, anorexia
- acute: sudden spiking fever, chills, drowsiness - Diagnosis: blood culture
- Treatment: anti-microbial drugs, support heart function
Arrhythmia
Electrical disturbances
- deviations from normal cardiac rate or rhythm d/t damage to the heart’s conduction system
- arrhythmia reduce the efficiency fo the heart’s pumping cycle
Electrocardiogram
A graphical recording of the cardiac cycle
- conduction of impulses in the heart produces an electric current that is picked up by electrodes placed on the skin
- 5 or 12 lead
ECG/EKG
Electrocardiogram shows
- speed of heart rate
- rhythm of the heart beat (steady or irregular)
- the strength and timing of electrical signals as they pass through each part of the heart
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Bradycardia
Slower than normal heart rate, typically under 60 bpm
- caused by parasympathetic or vagus nerve stimulation
- fainting may occur with sinus bradycardia
- may need a pacemaker
Syncope
Fainting
- cardiac syncope: arrhythmias, orthostatic hypotensin, aortic dissection, hypoglycemia, CAD
- vasovagal syncope: systemic vasodilation resulting in cerebral hypoperfusion (abnormal reflex); occurs after prolonged sitting or standing
Sinus tachycardia
Rapid firing of the sinoatrial (SA) node
- in response to exercise, exertion, excitement, pain, fever, excessive thyroid hormone, ow blood oxygen (hypoxia), or stimulant drugs (such as caffeine and amphetamines), etc.
- typically over 100 bpm
Ventricular tachycardia
Abnormal, rapid heart rhythm originating from the ventricle
- likely to reduce cardiac output because the filling time is reduced
Sinus arrhythmia
A slight variation in cycling of the sinus rhythm
- a normal finding in children and young adults, tends to diminish or disappear with age
- more prominent with fluctuation in the respiratory cycle as heart rate accelerates with inspiration, slows with experiration
Atrial fibrillation
Atria beat chaotically and irregularly, out of coordination with the ventricles
- irregular and often rapid heart rate that commonly causes poor blood flow to the body
- common symptoms: heart palpitations, shortness of breath and weakness
Premature venricular contraction (PVC)
Extra abnormal heartbeats that begin in one of the two ventricles
- these extra beats disrupt the regular rhythm, sometimes causing a flip-flop or skipped beat
- no preceded by a p wave
Ventrículo fibrillation
Life threatening
- abnormal irregular heart rhythm
- very rapid, uncoordinated, fluttering contractions of the ventricles
- most commonly associated with heart attacks or scarring of the heart muscle from previous heart attack
- causes severe hypoxia in the cardiac muscle
Echocardiogram
Echo
- ultrasound waves create a moving picture of the heart
- more detailed than a plain x-ray image, no radiation exposure
- see how the heart is beating and pumping blood
- can detect congenital heart defects in unborn babies
Cardiac catheterization
Checks for blockages in coronary arteries
- catheter inserted in artery or vein groin, neck or arm, threaded through blood vesssels to heart
- used to located narrowing, aneurysm or blockages in blood vessels by injecting dye
- post op precautions:
1. Prevent bleeding and infection on first day bathroom privileges only
2. For 2 days: no driving, lifting >20 lbs, deep knee bends, or pushing/pulling
Angiogram
Die in the heart to see shit
Exercise stress test
Max or sub max
- how the heart responds to exertion
- treadmill or pedaling stationary bike at increasing levels of difficulty, while electrocardiogram, heart rate, and blood pressure are monitored
- astrand-rhyming bruce, YMCA, 6 MWT, step test
Vasodilators
Dilate coronary blood vessels, reducing peripheral resistance
- work directly on artery wall muscles, preventing them from tightening and narrowing
- results in improved balance between O2 supply and demand; blood flows more easily through the arteries, the heart doesn’t need to pump as heard and blood pressure is reduced
- nitroglycerin
Digoxin
To for heart failure and atrial dysrhthmias
- slows conduction of impulses and pulse
- improves efficiency by increasing contractility
- narrow range between efffective and toxic
Anticoagulants
Blood thinners
- reduces risk of blood clots in coronary or systemic arteries
- tend to prevent new clots from forming or an existing clot from enlarging
- the don’t dissolve a blood clot
- aspirin, Coumadin
Pericarditis
Inflammation of pericardium
- Pathogenesis: epicardium and parietal pericardium rub together due to edema cardiac tamponase (compression of the heart)
- Etiology: trauma, viral/bacterial infection, neoplasms, radiation-induced
- Symptoms: sharp chest pain, aggravated by coughing or in supine
- Signs: fever, SOB, friction rub (sound)
- Diagnostic: abnormal ECT, echocardiogram
- Therapy: rest, anti-inflammatories, NO EXERCISE
Myocarditis
- inflammation of heart muscle
- etiology: viral/bacterial/fungal infection
- S&S: chest pain, abnormal heart ear, fatigue, fever, bilateral leg swelling, SOB
- therapy: decrease activities, medications (antibiotic, inflammatory, diuretics)
Cardiomyopathy
Disease of heart muscle - enlarged, thick and rigid heart muscle
- etiology: acquired or inherited
- treatment: surgery, devices, lifestyle changes
Aortic aneurysm
Dilation and weakening of arterial wall
- etiology: atherosclerosis, trauma, syphilis, infections, congenital HTN
- S&S: palpable pulsating, dysphasia, severe pain
- Diagnosis: radiography, US, CT, MRI
- treatment: surgery, graft, avoid exertion, stress
Peripheral vascular disease
- Arteries: vasculitis, buerger’s disease, arteritis
2. Veins: DVT, varicose veins, chronic venous insufficiency, raynaud’s
PVD info
- etiology: atherosclerosis
- S&S: intermittent claudicación ( pain with min activity) and wounds
- Surgical treatment: revascularization (by-pass)
- medical treatment: ACE inhibitors, statins, antiplatelet agents
- PT to: supervised exercise training significantly improves walking ability
Lymphatic system components
Secondary circulation
- tonsils
- spleen
- thymus gland
- lymph nodes
- lymphatic vessels
Lymphatic system functions
Prevents interstitial edema
- assists in the digestion of fats
- immunological functions
- makes WBC
- drains all but CNS tissue in regions
Lymphedema defined
- abnormal accumulation of protein rich fluid in the interstitium
- results in chronic inflammation and reactive fibrosis of the tissues
- progressive
- primary
- secondary
lymphedema S&S
- onset may be slow or rapid
- progressive
- pitting (varies)
- often starts distally: squaring of toes, stemmer’s sign positive, loss of anatomicalal contours, asymmetrical
- cellulitis
- discomfort is common (heavy, achy)
- skin changes (later stages- hyperkeratosis, papilloma)
- ulceration are unusual
- in contrast with venous disease the skin maintains hydration and elasticity for longer in the disease process
5 components of complete decongestive therapy
- Manual lymph drainage
- Compression bandaging
- Exercise
- Skin and nail care
- Instructive in self-care
