Cardiac Diseases and Rehabilitation Flashcards
The powerful contributor of cardiovascular morbidity and mortality
Hypertension
JNC 8: SBP <120 & DBP <80 mmHg
Normal
JNC 8: >60 years old
SBP <150 & DBP <90 mmHg
JNC 8: Stage 1
SBP 130-139 & DBP 80-89 mmHg
JNC 8: <60 years old and > 18 yeards old with CKD or DM
SBP <140 & DBP <90
JNC 8: SBP 120-129 & DBP <80 mmHg
Elevated
JNC 8: Hypertensive Crisis
SBP >180 & DBP >120
JNC 8: SBP >140 & DBP >90 mmHg
Stage 2
Three factors of Acute Coronary Syndrome
Atherosclerosis, Thrombosis, and Vasospasm
Narrowing of blood vessels due to fatty plaque formation
Atherosclerosis
Theories behind Atherosclerosis
Intimal Injury
Blood vessel with the highest resistance
Arterioles
Blood vessel with the highest compliance
Vein
Narrowing of arteries due to hardening of the vessel
Arteriosclerosis
What layer of the blood vessel is thick in arteries?
Tunica Media
What layer of the blood vessel contains endothelial cells?
Tunica Intima
The obstruction due to intimal injury that creates clot formation in the blood vessel
Thrombosis
What component of a cigarette is a systemic vasoconstrictor?
Nicotine Factor
Blood vessel with the highest cross-sectional area
Capillaries
Six modifiable factors of CAD
Physical inactivity, tobacco smoking, increase serum cholesterol, increase BP, DM, and Obesity
Four non-modifiable factors of CAD
Age, Male, Family history, and Race
What race has a high risk for CAD?
African-American
The three common manifestations of CAD
Angina, Ischemia and Infarction
“Pre-infarction or Crescendo Angina”
Unstable Angina
Angina occurs during activity
Stable Angina
A cardiac-related chest pain
Angina
“Variant Angina”
Prizmental Angina
A potent vasodilator medicine usually given to patient’s with angina
Nitroglycerin
Angina occurs at rest
Unstable Angina
Angina due to vasospasm of coronary arteries
Prizmental Angina
“New acute MI”
Myocardial Injury
The most common cause of myocardial infarction
Thrombosis
The total occlusion of an artery
Myocardial Infarction
In patients experiencing MI, how long does chest pain lasts?
20 mins to 2 hours
Zone of MI: (+) ST elevation
Infarction and Injury
What is the ultimate complication of MI?
Cardiogenic shock
Zone of MI: (+) ST depression
Ischemia
How much urine output a patient undergoing is cardiogenic shock have?
<30ml/hr
What specific artery is the intra-aortic balloon pump inserted?
Subclavian artery
Zone of MI: (+) Abn Q-wave
Infarction
Five usual distribution of cardiac pain
(L) UE (shoulder, arm, and FA), Jaw, (R) Chest, Epigastric pain, and Back (in between shoulder blades and scapula)
What nerve distribution usually the cardiac pain referred to?
Ulnar distribution
Fist of the chest
(+) Levine Sign
ECG: start of ST segment
J point
ECG: (+) Large acute MI
STEMI
The golden hour of laboratory findings of MI
15-32 hours
Four cardiac enzymes tested in laboratory exams for MI
CKMB, Troponin I, Myoglobin, and LDH
ECG: (+) Small MI
NSTEMI
Cardiac Enzyme: CKMB 5-10%
(+) MI CKMB
Cardiac Enzyme: Myoglobin (+) MI
200-500 μg/ml
Cardiac Enzyme: 100-225 μg/ml
Normal LDH
Cardiac Enzyme: peak 24-36 hours
Troponin I
Cardiac Enzyme: >5-10 μg/ml
(+) MI Troponin I
Cardiac Enzyme: <100 μg/ml
Normal Myoglobin
Cardiac Enzyme: peak 14-36 hours
CKMB
Cardiac Enzyme: Normal CKMB
0.3%
Cardiac Enzyme: Normal Troponin I
0-0.2 μg/ml
Cardiac Enzyme: LDH (+) MI
300-750 μg/ml
PTCA healing time
2 weeks
Most common donor vessel used in CABG
Saphenous Vein
What are the two arteries inserted by catheter in PTCA?
Femoral and Radial artery
Most effective donor vessel used in CABG
Internal mammary artery
Triceps strengthening is postponed until when?
4 weeks post-op
What activities are contraindicated after CABG?
STS or Supine to Long sitting
The three donor vessels in CABG
Saphenous Vein, Internal mammary artery, and Radial artery
Impaired cardiac pump
Heart Failure
Percentage of ejected blood
Ejection Fraction
The clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in the reduced ventricular filling.
Cardiac Tamponade
What kind of dysfunction has a compromised ventricular contraction?
Systolic Dysfunction
The normal range of Ejection Fraction
55-78%
True or False: There is an increased ejection fraction in diastolic dysfunction
False (no change)
How much ejections fraction decreases in systolic dysfunction?
40%
What kind of dysfunction has a compromised ventricular filling & relaxation?
Diastolic Dysfunction
Right or Left Heart Failure: Jugular Vein Distention
Right
Right or Left Heart Failure: Ortopnea & Trapopnea
Left
Right or Left Heart Failure: SOB
Left
SOP in an upright position
Platypnea
Right or Left Heart Failure: Ascites
Right
Right or Left Heart Failure: Bipedal Edema
Right
Right or Left Heart Failure: Pulmonary Edema
Left
SOP in a supine position
Orthopnea
Right or Left Heart Failure: Cerebral Hypoxia
Left
Right or Left Heart Failure: Cyanosis
Right
SOP in a side-lying position
Trapopnea
Right or Left Heart Failure: Muscle Fatigue
Both
Right or Left Heart Failure: Weight Gain
Right
Right or Left Heart Failure: Cough
Left
Right or Left Heart Failure: Muscle Weakness
Left
What heart sound is present in patients with CHF?
S3
NYHA: Marked Limitation
Class III
NYHA: Ordinary activity presents symptoms
Class II
NYHA: (+) Cardiac disease with no limitation of activity
Class I
NYHA: Symptoms presents at rest
Class IV
NYHA: Less ordinary activity presents symptoms
Class III
NYHA: 1.5 METs
Class IV
NYHA: 3-4 cal/min
Class II
NYHA: Class I METs
6 METs
NYHA: Class IV power
1-2 cal/min
NYHA: 4.5 METs
Class II
NYHA: Class I power
4-6 cal/min
NYHA: 2-3 cal/min
Class III
NYHA: Class III METs
3.0 METs
Four manifestations in NYHA
Fatigue, Palpitation, Dyspnea, and Angina
Cardiac neurohormones send signals to the kidney to decrease fluid volume
Atrial and Brain Natriuretic Peptide
What is a diuretic drug that decreases fluid volume?
Furosemide
Narrowing of heart valve
Stenosis
Backflow due to the incomplete valve closure
Regurgitation
Enlarged valve cusps
Prolapse
Most common valve involved in prolapse
Mitral Valve
Disturbance in electrical activity that leads to absent rhythm
Arrhythmia
A beat from a site other than SA node
Ectopic Beats
Beats from the ventricles create an irregular rhythm
Ventricular Ectopy
Quivering of atria
Atrial Fibrillation
Run of 4 or more PVCs
Ventricular Tachycardia
Quivering of ventricles
Ventricular Fibrillation
ECG: (-) P-wave and (+) QRS widening
Ventricular Ectopy
ECG: (+) P wave - non-sinus
Atrial Fibrillation
Two types of Ectopic Beats
PACs and PVCs
(+) Decrease Atrial Kick
Atrial Fibrillation
Symptom: no palpable pulse
Ventricular Tachycardia
The normal range of Atrial Kick
15-20%
“Irregularly Irregular”
Atrial Fibrillation
Firing from any location above the ventricle
Supraventricular Ectopic Beats
A lethal electrical conduction abnormality that can lead to cardiac arrest
Ventricular Tachycardia
(+) 150-250 bpm
Supraventricular Tachycardia
What are the two PT management that you can provide in a patient with Supraventricular Ectopic Beats?
Activate Baroreceptors by Carotid massage and Breathing technique such as holding breath
AV block: (+) prolonged PR interval only
First Degree AV block
AV block: (+) mismatch of the atrium and ventricular contraction
Third Degree AV block
AV block: (+) Prolonged PR interval + drop a beat
Mobitz I AV block
AV block: Normal PR interval + drop a beat
Mobitz II AV block
“Not a true arrhythmia”
Bundle Branch Block
“Wenckebach”
Mobitz I AV block
What is the ECG finding that presents a Bundle Branch Block?
Widen QRS
Bening Bundle Branch Block
Right Bundle Branch Block
Pathological Bundle Branch Block
Left Bundle Branch Block
How long before an artificial pacemaker gets replaced?
5-10 years
Infection of the inner lining of the heart
Endocarditis
Wall inflammation that presents an MI like symptoms (Sharp shooting pain for days)
Pericarditis
A rare wall inflammation condition
Myocarditis
Three things to watch out for in patients with wall inflammation?
HR, SOB, and Fever
The dilation of the arterial wall
Aneurysm
Four most common sites of Aneurysm
Thoracic Aorta, Femoral Artery, Popliteal Artery and Abdominal Artery
Two risk factors of Aneurysm
Ehlers-Danlos Syndrome and Marfan Syndrome
One way to detect an aneurysm
Pulsating sensations at the abdomen
Most common artery affected with Aneurysm
Abdominal Artery
Most common congenital defect
Ventricular septal defect
Septal defect due to the patent foramen ovale
Atrial septal defect
A congenital heart defect where the blood that travels from the aortal will go back to the pulmonary artery.
Patent Ductus Arteriosus
Four presenting conditions of Tetralogy of Fallot
Pulmonary stenosis, (R) ventricular hypertrophy, ventricular septal defect, and an overriding aorta.
A presenting sign of babies with TOF where a cry elicits for cyanosis on their body
Tet spells
Right to Left or Left to Right shunt: Atrial Septal Defect
Left to Right
Right to Left or Left to Right shunt: Patent Ductus Arterious
Left to Right
Right to Left or Left to Right shunt: Tetralogy of Fallot
Right to Left
Right to Left or Left to Right shunt: Ventricular Septal Defect
Left to Right
A condition caused by the reversal of shunting (left to right shunts lead to the right to left shunt due to the overfilling of (R) side of the heart
Eisenmenger Syndrome
The ability of the individual to do work or perform an exercise
Aerobic capacity
The formula for Rate Pressure Product
RPP = HR x SBP
Unit of Aerobic Capacity
VO2max
True or False: VO2max = MET
True
The normal range of RPP
25-35 mmHg x bpm/10*3
Karvonen’s Formula
THR = RHR + 60-70% (MHR - RHR)
Blood volume per heartbeat
Stroke Volume
Blood volume per minute
Cardiac Output
Five factors to consider before doing aerobic training
Aerobic Capacity, HR, SV, CO and MVO2
An increase of what will lead to an increase of MVO2?
Workload
Four determinants of exercise
Frequency, Intensity, Time and Type of Exercise (FITT)
Minimum time for aerobic exercise
20-30 minutes
The frequency for moderate-intensity exercise
3x/wk
Components of Intensity in exercise
Max HR and THR
The frequency for low-intensity exercise
5x/wk
What benefits of exercise should increase?
VO2 max, CO, and SV
What factors should decrease after constant aerobic training?
HR at rest, MVO2, Peripheral Resistance
True or False: Maximum HR doesn’t change after exercise
True
Three factors that increase MVO2
Cold weather, after eating, after smoking
METS: 5
Sex with wife
METS: Office Work
1.3-2.3
RPE: weak
2
METS: 1.5
Eating
METS: 5.7
2 step climb
RPE: 5
very strong
RPE: 7
very very light
METS: 4
Bed Pan
METS: 7.4
Running
METS: 1.4-2.0
Standing
RPE: very very hard
19
METS: Walking 3mph
4.3
RPE: 3
Moderate
RPE: 11
Fairly Light
METS: Ascending Stairs
9
METS: Wheelchair and drive
2.8
METS: Walking 1mph
2.3
RPE: 13
Somewhat Hard
METS: 3.5
Shower
METS: sitting
1.2-1.6
Cardiac Rehab Phase: MET 1-2, RPE 11
Phase 1
Cardiac Rehab Phase: 70-85% HR max
Phase 2
Cardiac Rehab Phase: 3-4x/wk
Phase2
Cardiac Rehab Phase: Maintenance
Phase 3
Phase I Level: Increase ambulation by frequency and time
Level 4-6
Phase I Level: ICU
Level 1
Phase I Level: Increase ambulation
Level 3
Phase I Level: Bed Side
Level 2
Phase I Level: 2-2.5 METs
Phase 3-6
Phase I Level: 1.5-2 METs
Phase 2
