Cardiac System Flashcards
Left
sided heart
failure
Failure of the left ventricle, resulting in back flow into the lungs.
Right
sided failure
Failure of the right side of the heart, resulting in back flow into the
systemic venous system.
High
output failure
HF that is secondary to renal system failure to filter off excess fluid -> places a higher load on the heart, which cannot be maintained.
Low
output failure
The condition in which the heart is not able to pump the minimal
amount of blood to support circulation.
Systolic dysfunction
A problem with systole or the actual strength of myocardial
contraction (heart failure w/ reduced ejection fraction HFrEF
Diastolic dysfunction
A problem during diastole or the ability of the ventricle to allow blood filling (heart failure w/ preserved ejection fraction ( HFpEF
Signs of Heart Failure
• Cold, pale, possibly cyanotic extremities • Weight gain • Peripheral edema • Jugular venous distention • Tachypnea • Crackles (rales) • Tubular breath sounds • S3 and S4 heart sounds • Sinus tachycardia • Pulsus Alterans • Decreased exercise tolerance and physical work capacity
Symptoms of Heart Failure
• Dyspnea • Tachypnea • Paroxysmal nocturnal dyspnea • Orthopnea • Cough • Fatigue
New York Heart Association
NYHA )
Functional Classification of HF
Functional Classification of HF
Grades I - IV
New York Heart Association
NYHA )
Grade IV
Symptoms at rest; unable to do any physical activity without
symptomology
Revascularization & Reperfusion of the Myocardium
Thrombolytic therapy
Percutaneous revascularization
Transmyocardial revascularization
Coronary artery bypass graft:
Thrombolytic therapy:
anticoagulant used to remove a clot
Percutaneous revascularization:
The use of stent to reopen to revascularize the area
Transmyocardial revascularization:
tiny canals via laser that causes smaller vessels to perfuse the area
Coronary artery bypass graft:
The use of a healthy artery taken from another part of the body (mainly LE), that is brought to the location where CAD is present to reroute flow of blood
Median Sternotomy
type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided,
sternal precautions
- pushing or pulling
- lifting >10lb
- scapular adduction
- Resistive exercises of UEs past 90 deg of flex/ abd
- Min use of arms for supine to sit and sit to stand transfers
sternal precautions
- pushing or pulling
- lifting >10lb
- scapular adduction
- Resistive exercises of UEs past 90 deg of flex/ abd
- Min use of arms for supine to sit and sit to stand transfers
PT Considerations for Pacemaker
• If no rate modulation, low level activity with
small increases in metabolic demand is
preferred.
– RPE, BP, and symptoms are used to monitor
tolerance.
• For pacemaker w/rate modulation, consider
the type of rate modulation.
Non Modulated Pace Maker
it is important to know that HR can not be used to determine pts activity level, instead you would need to use the borg scale (RPE) or BP to check the pt
Modulated Pace Maker
would be ideal way b/c HR can change with activity. It is important to know what kind of modulation the pt is using because this will allow the PT to use the appropriate interventions to address how much intensity to give the pt. Different modulation types: sensory, ventilation, etc.
Modulated Pace Maker
would be ideal way b/c HR can change with activity. It is important to know what kind of modulation the pt is using because this will allow the PT to use the appropriate interventions to address how much intensity to give the pt. Different modulation types: sensory, ventilation, etc.
PT Intervention (Goals)
• Assess hemodynamic response in conjunction with medical
or surgical management during self care activities and
functional mobility.
• Maximize activity tolerance
• Provide patient & family education regarding behavior
modification and risk factor reduction
Absolute Indications,
Withheld PT
- Decompensated CHF
- Second
degree heart block coupled w/ (PVCs) at rest - Third
degree heart block - More than 10 PVCs per minute at rest
Multifocal PVCs, USA w/ recent changes in symptoms (< 24
hrs ), and ECG changes
associated w/ ischemia/injury - Dissecting Aortic Aneurysm
- New onset (< 24
hrs ) of A fib with RVR at rest (HR >100 bpm) - Chest pain w/ new ST segment changes on ECG
Relative Indications,
Modify or Withheld
- Resting heart rate >100 bpm - Resting BP (systolic >160 mm Hg, diastolic >90 mm Hg) - Resting BP (systolic <80 mm Hg) - MI or extension of infarction within the previous 2 days - Ventricular ectopy at rest - A fib with RVR at rest (HR >100 bpm) - Uncontrolled metabolic diseases - Psychosis or other unstable psychologic condition
Relative Indications,
Modify or Withheld
- Resting heart rate >100 bpm - Resting BP (systolic >160 mm Hg, diastolic >90 mm Hg) - Resting BP (systolic <80 mm Hg) - MI or extension of infarction within the previous 2 days - Ventricular ectopy at rest - A fib with RVR at rest (HR >100 bpm) - Uncontrolled metabolic diseases - Psychosis or other unstable psychologic condition
3 phases of PT Interventions
- Warm up phase
- Conditioning phase
- Cool-down (relaxation) phase
Ways to Monitor Activity Tolerance (HR)
• In general, a 20 to 30 beat increase from resting value during
activity is a safe intensity.
• If undergone stress test (during hospital stay), use 60% to 80% of
the max HR achieved during the test.
• Disproportionate HR response to low level activity: >120 bpm or
<50 bpm.
HRR formula
HRR = peak HR minus the HR at 60 seconds after the completion.
– Abnormal if ≤12 bpm w/ a cool down and <18 bpm w/o a cool down.
HRR formula
HRR = peak HR minus the HR at 60 seconds after the completion.
– Abnormal if ≤12 bpm w/ a cool down and <18 bpm w/o a cool down.
Ways to Monitor Activity Tolerance (BP)
• Disproportionate response:
– Systolic pressure decrease of 10 mm Hg below the resting.
– Systolic response of more than 180 mm Hg.
– Diastolic response of more than 110 mm Hg.
• Normal systolic blood response should increase 5 to
12 mm Hg per increase in METs.
• If the patient is on a pacemaker that does not have rate
modulation, BP response can be used to gauge intensity.
Training SBP
Training SBP = (SBP max SBP rest) Intensity 60%
80% SBP rest
Ways to Monitor Activity Tolerance (Borg)
• The “Borg RPE Scale” (6 20 or 0 10) is a subjective feelings of
exercise intensity. Can also be used for breathlessness and muscle fatigue
• The preferred method of prescribing exercise intensity for a
patient taking beta blockers.
• General guideline: exercise to a point no greater than 5 on
the 10 point scale and no greater than 13 on the 6 20 scale.
• Instructions of the scale should be followed exactly as
designed and not be modified.
Ways to Monitor Activity Tolerance (RPP)
• Rate Pressure Product (RPP) is HR × SBP and is an
indication of myocardial oxygen demand.
• If a patient undergoes maximal exercise testing and
has myocardial ischemia, RPP can be calculated at
the point when ischemia is
occurring to establish the pt’s
ischemic threshold
• This RPP value can then be used
during exercise to provide a safe
guideline of exercise intensity.
• Hemodynamic Response/ RPP
- High = >30000 RPP
- High Intermediate = 25000 - 29999
- Intermediate = 20000 - 24999
- Low Intermediate = 15000 - 19999
- Low = 10000 - 14999
Ways to Monitor Activity Tolerance (RPP)
• Rate Pressure Product (RPP) is HR × SBP and is an
indication of myocardial oxygen demand.
• If a patient undergoes maximal exercise testing and
has myocardial ischemia, RPP can be calculated at
the point when ischemia is
occurring to establish the pt’s
ischemic threshold
• This RPP value can then be used
during exercise to provide a safe
guideline of exercise intensity.
• Hemodynamic Response/ RPP
- High = >30000 RPP
- High Intermediate = 25000 - 29999
- Intermediate = 20000 - 24999
- Low Intermediate = 15000 - 19999
- Low = 10000 - 14999
Ways to Monitor Activity Tolerance (ECG)
ECG continuously monitored, know baseline rhythm, most recently
observed rhythm, and the reason for monitoring.
Automaticity
Ability to initiate its own electrical impulse
Excitability
Ability to respond to electrical stimulus
Conductivity
Ability to transmit electrical impulse from cell to cell w/I the heart
Contractility
Ability to stretch as a single unit and then passively recoil while actively contracting
Rhythmicity
Ability to repeat the cycle in synchrony w/ regularity
