Cardiac Conditions Flashcards
Ischemic Heart disease
•Cardiac Muscle has insufficient oxygen
•Two Solutions
–Reduce cardiac Oxygen demand•Decrease Preload•Reduce Contractility•Reduce Afterload
–Increase cardiac oxygen supply•Increase Coronary Flow•Increase Oxygen extraction
Angina
•Chest pain due to ischemia •Imbalance of O2supply and demand to the myocardium •EKG changes •Increased lactate - wall motion abnormalities
Angina treatments
- Nitrates- decrease O2 demand
- Beta-blockers- decrease O2 demand
- Calcium channel blockers - increase O2 supply & decrease O2 demand
- Ranolazine–no effects on O2 supply or demand; mechanism unknown
Stable angina
- O2 demand> o2 supply
- usually seen with physical exertion
Prinzmetal’s angina (variant)
- can occur at rest
- caused by vasospasm -> decreased o2 supply
unstable angina
- decreased O2 supply (blocked artery) and increased O2 demand
- caused by atherosclerotic plaque rupture
management of angina pectoris
- Organic Nitrates
- Beta Blockers
- Calcium Channel Blockers
- Ranolazine
Organic nitrates
•Peripheral Vasodiation by promoting Nitric Oxide Release
1.Veins
2.Arteries
3.Arterioles
•Decrease Preload
•Short acting first line for Angina Attacks (nitroglycerin)
•Long acing second line after Beta Blockers for Symptom Relief
Nonpharmacologic management of angina
- Weight loss
- Smoking cessation
- Stress reduction
- PCI/CABG
Angina pectoralis impact on rehab
- Ensure proximity and availability of drug during rehabilitation sessions
- Avoid over-challenging the heart during sessions
- Artificial increase in tolerance to exercise
- Guard against orthostatic hypotension
Myocardial infarction
- All patients post MI should be on the following medications unless contraindicated:•Aspirin •P2Y12inhibitor for at least 12 months •Beta blocker •Statin •+/-ACE inhibitor
- In addition they should receive information regarding: •Weight management •Smoking cessation •Exercise
PT considerations for MI
- Signs/symptoms to look for: •Diaphoresis •Chest pain (often radiates to jaw or arm) •Shortness of breath (not necessarily with exertion)
- What to do: •Call 911 •Administer nitro if patient uses •Administer 325mg of aspirin –chew and swallow •If O2 available, administer via NC if O2sat is <90% •Hospital acronym: MONA
CHF
- Chronic overwork of the heart muscle causes hypertrophic remodeling
- Reduced cardiac output
- Fluid retention
CHF Treatment
Treat to: decrease cardiac load, decrease resistance, increase contractility
cardiac glycocides ace inhibitors beta blockers aldosterone antagonists vasodilators diuretics
Cardiac glycoside
- Positive inotrope –will increase contractility of heart
- No impact on mortality but can reduce hospitalizations
- Narrow therapeutic index medication
- Signs/symptoms of toxicity: •Visual disturbances •Bradycardia and heart block •Anorexia •Nausea and vomiting
PT and CHF
- Know signs of CHF exacerbation: •Dyspnea •Cough
- Be aware of medication side effects, especially digoxin
- Be aware of hypotension and dizziness
- Use caution when doing activities that may cause vasodilation and further drops in blood pressure
Arrhythmias
- Irregular heart rhythms
- Can be categorized based on heart rate •Bradyarrhythmia •Tachyarrhythmia
- Can be categorized based on origin of irregular electrical activity •Supraventricular •Ventricular
Anti-arrhythmics Class 1
sodium channel blockers
Anti-arrhythmics Class 2
beta blockers
Anti-arrhythmics class 3
drugs that prolong polarization
anti-arrhythmics class 4
ccN
non-pharmacological management of arrhythmias
ablation
aicd
pacemakers
PT and arrhythmias
- Be aware of medication side effects - Especially dizziness and syncope
- Assess rate & rhythm by checking pulse
- Help with compliance
KEY POINTS
- Organic nitrates, beta blockers, and calcium channel blockers are the primary drugs to treat angina
- Antianginal drugs used alone or in combination to treat or prevent the various forms of angina
- Sodium channel blockers, beta blockers, and calcium channel blockers can prolong the cardiac action potential to treat arrhythmias.
- ACE inhibitors and beta blockers treat congestive heart failure by decreasing the counterproductive changes that increase cardiac workload in heart failure.
- Rehabilitation providers need to monitor these patients closely during exercise and help educate patients on cardiac risk factors and symptoms related to CV disease
