Cardiac Disease Flashcards
Ischemic heart disease (ischemia)
Occurs when part of the heart is temporarily deprived of sufficient oxygen to meet demand
Common cause: coronary artery disease (CAD)
CAD
Coronary artery disease
- develops over many years
- injury to internal wall of artery
- irregular shape of wall prone to collecting plaque
Artherosclerosis
- resulting from coronary artery disease (CAD)
- plaque and platelets gather along arterial wall and clogs it.
- artery narrows, allows smaller volume of blood to pass through.
- part of the heart supplied may not receive sufficient O2
Angina
Type of chest pain resulting from partial blockage of a coronary artery (a symptom)
- displays as chest pain with eating, exercise, exertion, exposure to the cold.
- can be squeezing, tightness, fullness, pressure, or sharp
- can radiate to arm, back, neck, jaw
Tx: rest and/or medication
MI
Myocardial infarction (heart attack)
- seek emergency medical attention
- blood flow to heart muscle interrupted because arteries blocked
- starved of 02, muscle will die
- can lead to cardiac arrest (heart stops pumping) if too much is damaged
CHF
Congestive heart failure
- results from CAD or infection
- develops over time
- heart becomes progressively weaker, unable to pump effectively
- fluid backs into lungs or body
- heart size enlarged because it’s working so hard (hypertrophy: increased muscle thickness)
Tx: diet, medication, rest, graded return to activity
Functional Classification of Heart Disease
Class I
- Pts with cardiac disease without limitations in physical activity
- fatigue, palpitations, dyspnea, anginal pain not caused by ordinary activity (walking etc.)
- angina occurs with strenuous or prolonged exertion
- can perform activities requiring </ 7 METs to completion
OT: preventative care
Functional Classification of Heart Disease
Class II
- Pts with cardiac disease with slight limitations in physical activity. comfortable at rest.
- less than ordinary activity causes fatigue, palpitations, dyspnea, angina
- can perform activities requiring /7 METS
OT: preventative
Functional Classification of Heart Disease
Class III
- Pts with cardiac disease with marked limitations in physical activity. comfortable at rest.
- ordinary and less than ordinary physical activity significantly limited
- fatigue, palpitation, dyspnea, angina
- can perform activity requiring </2 METS to completion
Functional Classification of Heart Disease
Class IV
- Pts with cardiac disease, inability to carry out any physical activity without discomfort
- cardiac insufficiency and angina present at rest
- increased discomfort with any activity
- cannot perform activities to completion requiring >/2METS
Cardiac risk factors
- heredity
- male
- age
- high BP
- smoking
- cholesterol levels
- inactive lifestyle
- diabetes
- stress
- obesity
- sleep apnea
- high levels triglycerides
- high levels C-reactive protein
Valvular disease
2 complications
- volume overload
2. pressure overload
Valvular disease: volume overload
- results when…
- symptoms
- increased potential for…
- Fluid accumulates in lungs
- shortness of breath
- atrial fibrillation (results in irregular/ineffective constrictions of both atria)
Valvular disease
Aortic insufficiency
- Aortic valve fails to close properly
- may cause CHF or ischemia
Valvular disease: pressure overload
Aortic stenosis
- narrowing of aorta
- left ventricle works harder to open valve, becomes enlarged
- cardiac output decreases
- may result in ventricular arrhythmia, cerebral insufficiency, confusion, syncope, or sudden death
Medical management of MI: settings and timeline
- Emergency care
- Coronary care unit
- 2-3 days in ICU, then to monitored hospital bed (must be stable)
- 4-6 days in hospital after acute onset
- in hospital, vitals monitored, observed for complications , activity gradually increased
OT tx for MI in the hospital
- monitor patient’s response to activity
- educate about disease process, risk factors, lifestyle modification
CAD surgical procedures
Balloon angioplasty/ percutaneous translumial coronary angioplasty (PTCA)
- PTCA: surgical procedure that can correct circulatory problems resulting from CAD.
- wire mesh tube (stent) may be implanted in coronary artery to keep it open.
- catheter inserted to femoral artery, guided through circulatory system into coronary arteries.
- lesion pinpointed, balloon inflated to push plaque against arterial walls
- results in improved circulation to myocardium
- REST 8 hours after procedural to prevent hemorrhage from femoral artery*
CAD surgical procedures
Coronary artery bypass grafting (CABG)
- performed if lesion is too diffuse for balloon angioplasty/PTCA or if artery closes again after PTCA.
- blood vessels taken from another part of the body and used to bypass diseased sections of coronary arteries.
- sternum usually cracked by surgeon to open chest wall, ribs spread to access heart.
Coronary artery bypass grafting (CABG) postsurgical precautions
- last for 8 weeks after surgery
- avoid Valsalva maneuvers (i.e. straining during bowel movements)
- avoid rapid movements of upper body
- adhere to 10 pound lifting restriction
- wearing compressive hose
- refrain from driving (problem because of upper body torque)
- refrain from traveling in a seat without an airbag when riding in car
Cardiac rehab: day 1-3 after MI
- stabilization of pt’s medical condition usually attained
- followed by period of early mobilization
Cardiac rehab: phase 1
- inpatient cardiac rehab
- monitored low-level physical activity (self-care, reinforce cardiac and post-surgical precautions, instruct in energy conservation and graded activity, establish guidelines for appropriate activity levels at discharge)
Cardiac rehab: phase 2
- outpatient cardiac rehab
- begins at discharge
- exercise can advance while pt is closely monitored as outpatient
Cardiac rehab: phase 3
-community-based exercise programs
signs and symptoms of cardiac distress
- angina
- dyspnea
- orthopnea
- nausea/emesis
- diaphoresis
- orthostatic
cardiac distress: dyspnea
- shortness of breath with activity or at rest
- note activity that brought on the dyspnea and amount of time it took to resolve
- dyspnea at rest with a respiratory rate >30 is a sign of acute CHF
cardiac distress: orthopnea
- dyspnea brought on by lying supine
- count # of pillows needed to breathe comfortably during sleep (more pillow–>more upright–>less dyspnea)
cardiac distress: nausea/emesis
-look for vomiting signs or signs that the pt feels sick to the stomach
cardiac distress: diaphoresis
-look for cold, clammy sweat
cardiac distress: fatigue
- generalized feeling of exhaustion
- can use Borg Rate of Perceived Exertion Scale to grade
- cerebral signs: ataxia, dizziness, confusion, fainting (syncope)-signs that brain is not getting enough O2
cardiac distress: orthostatic
-drop in systolic blood pressure and hypotension of greater than 10 mmHg with a change jun position from supine or sitting to standing
How to monitor response to activity
- symptoms
- HR
- BP
- rate-pressure product (RPP)
- ECG
HR
Heart rate-number of heart beats per min
-feel pulse at radial, brachial, carotid sites
BP
Blood pressure
-pressure that the blood exerts against the walls of any vessel as the heart beats
RPP
Rate-pressure product
-can give a more accurate indication of how well the heart is pumping
RPP=HR X SBP (systolic blood pressure)
5 digit #, recorded as 3 digits, drop the last 2
