Cardio D/D Flashcards
Describe L CHF?
PULMONARY EDEMA
-CRACKLES, RALES, OPACITIES IN X RAY
-orthopnia- SOB recumbent
-Parosysmal nocturnal dyspnea - SOB at night
-Fatigue
-Tachycardia, intolerance to COLD
-Decreased CO
Describe R CHF?
PERIPHERAL EDEMA, JUGULAR DISTENTION, BILATERAL SWELLING (ANKLE, LB GAIN, FULLNESS IN ABDOMEN, PITTING EDEMA)
-Venous HTN
-Fatigue
-Decreased CO
What are the 3 types of anginas?
-Stable, unstable and variant
What is stable angina?
Classic exertional angina occurring during exercise or activity; occurs at a predictable RPP (HR x BP), relieved with rest and or nitroglycerin
Unstable angina?
(Preinfarction)
-coronary insufficiency at any time w/o any precipitating factors or exertion. Chest pain increases in severity, frequency, and duration; refractory to trx.
-Increases risk for myocardial infarction or lethal arrhythmia; pain is difficult to control
Variant angina?
Prinzmetals angina
-caused by vasospasm of coronary arteries in the absence of occlusive disease.
-Responds well to nitro or calcium channel blockers long term
What is the angina scale?
0- no angina
1- mild barely noticeable
2- moderate, bothersome
3- moderate severe, very uncomfortable
4- most severe or intense pain ever experienced
What is a myocardial infarction?
Prolonged ischemia, injury and death of an area of the myocardium caused by occlusion of one or more of the coronary arteries
-precipitating factors: atherosclerotic heart disease w/ thrombus formation, coronary vasospasm, or embolism, cocaine
What are the zones of infarction?
- Zone of infarction: consists of necrotic, no contractile tissue; electrically inert; on the ECT St segment deviation >1mm
- Zone of injury: area immediately adjacent to central zone, tissue is noncontractile, cells undergoing metabolic changes; electrically unstable on ECG, elevated ST segment
- Zone of ischemia: outer area, cells also undergoing metabolic changes, electrically unstable, on ECG T wave inversion
What is Myocardial ischemia?
ST segment depression
Phase one cardiac rehab?
-Initiate early return to ADL’s after 24 hours or stable for 24 hours
-3-5 days in hospital for uncomplicated MI
-Early supervised ambulation
-Initial activities: low intensity (2-3 METs) progressing to >= to 5 METs by DC
-Post MI: limited to 70% HR and/or 5 METs until 6 week post MI
-Short exercise sessions 2-3x a day (gradually increase duration and decrease frequency)
What is the HEP for stage 1 inpatient cardiac rehab?
Low risk pt’s may be safe candidates for unsupervised exercise at home
-Gradual increase in ambulation time: goal of 20-30 minutes, 1-2x/day at 4-6 weeks post MI
-UE and LE mobility exercises
Outpatient Cardiac Rehab phase 2?
-Frequency: 2-3 sessions per week
-Duration: 30-60 minutes with 5-10 minutes of WARM UP AND COOL DOWN
-TM, cycle ergometer, arm ergometer, strength training
-Suggested exit point 9 METs (5 MEts is needed for resumption of safe ADL’s)
Strength training:
-After 3 weeks cardiac rehab; 5 weeks post-MI, or 8 weeks post CABG
-begin with use of elastic bands and light hand weights 1-3 lbs**
-Progress to moderate loads 12-15 repetitions
Phase 3 cardiac rehab?
Maintenance phase
-Community centers YMCA or clinical facilities
-Entry level criteria: functional capacity of 5 MEts, clinically stable angina, medically controlled arrhythmias during exercise
-Progression to 50-85% of functional capacity, 3-4x/week, 45 minutes or more / session
-DC typically 6-12 months
What is the patient criteria for resistance training in phase 3 of cardiac rehab?
-American Association of Cardiovascular and Pulmonary Rehab Guidelines
-Post MI: resistance training permitted if remain under 70% maxHR or 5 METs for 6 weeks post MI, be cautious of valsalva maneuver
-Cardiac surgery: LE resistance training can be initiated immediately in the absence of peri-operative MI. AVOID UE resistance training until soft tissue and bony healing has occurred: 6-8 weeks
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What is the exercise prescription for cardiac rehab phase 3?
-Start with low resistance (one set of 10-15 reps) and progress slowly
-Resistance can include:
A. Weights, 50% or more of maximum weight used to complete one repetition (1RM)
B. Elastic bands
C. Light 1-5 lbs cuff and hand weights
D. Wall pulleys
-RPE should range from 11-13 but should correlate to hemodynamic activity
-RPP should not exceed that prescribed during exercise
What is Class 1 of New York Heart Association Functional Classification schedule?
Cardiac disease
no limits in physical activity
6.5 METs
What is Class 2 of New York Heart Association Functional Classification schedule?
Cardiac disease
Limitations in ordinary physical activity 4.5 METs
Results in fatigue, palpitations, dyspnea, angina
What is Class 3 of New York Heart Association Functional Classification schedule?
”3 for 3”
Cardiac disease
Limitations in less than ordinary physical activity (3 METs)
Results in fatigue palpitations, dyspnea, angina
What is Class 4 of New York Heart Association Functional Classification schedule?
Cardiac disease
Inability to carry any physical activity (1.5 METs)
uncomfortable at rest
Results in fatigue, palpitations, dyspnea, and angina
What activity correlates to 1.5-2 MEts
Standing, walking slowly 1 mph
What exercise correlates to 2-3 METs?
Level walking (2mph), level bicycling (5mph)
What exercise correlates with 3-4 METs?
Level walking (3mph) bicycling 6mph
What exercise correlates with 4-5 METs?
Walking (3 1/2 mph), bicycling 10 mph
What exercise correlates to 5-6 METs?
Walking at brisk pace (4mph), bicycling 10 mph
What activity correlates to 6-7 METs?
Walking at 5 mph, bicycling 11mph and swimming leisurely
What activity correlates to 7-8 METs?
Jogging 5 mph, bicycling 12 mph
What activity correlates to 8-9 METs?
Running 5.5 mph, bicycling 13 mph, swimming 30 yards/minute
What activity correlates to >10 METs?
Running 6, 7, 8, 9, 10 mph and swimming moderate/hard
What is a MET level?
The amount of O2 consumed at rest
MET levels (multiples of resting VO2) can be directly determined during ETT: using collection and analysis of expired air
What is the Well’s Criteria for DVT?
- Active cancer +1
- Paralysis, paresis, or recent immobilization of LE +1
- Collateral superficial vein (nonvaricose) +1
- Recently bedridden for >3 days or major surgery <4 weeks ago +1
- Localized tenderness along the distribution of the deep venous system +1
- Entire leg swollen +1
- Calf swelling at least 3 cm larger than asymptomatic side +1
- Pitting edema confined to the symptomatic leg +1
- Previously documented DVT +1
- Alternative diagnosis to DVT as likely or more likely -2
DVT likely = or >2
DVT unlikely <2
