Cardiopulm Unit 4 VOPP only Flashcards
What happens after the first hours after Acute MI?
- Ischemia leads to necrosis of cardiac tissue in the affected area within minutes of coronary artery occlusion
- Initiation of an inflammation response that involves the release of various inflammation mediators and signals the recruitment of WBCs to the site of injury
- The overall pumping efficiency of the heart decreases as the affected part of the heart may become hypokinetic or akinetic
What happens after the First days after Acute MI?
- The inflammatory response continues with the removal of dead cells and debris, preparing the groundwork for healing and scar formation.
- The area surrounding the necrotic tissue may become edematous and hemorrhagic due to the disruption of microvasculature.
- Fibroblasts begin to proliferate at the site of injury, laying down the extracellular matrix that will form the basis of the scar tissue.
What happens after the First week after Acute MI?
- The development of a fibrous scar begins as granulation tissue and collagen deposition begins to form by about the end of the first week.
- This area remains vulnerable to mechanical stress due to the ongoing remodeling and relatively weak tensile strength of the new tissue.
- The shape and size of the ventricle begins changes through a remodeling process
What happens after several weeks after an Acute MI?
- Over the next several weeks, the scar tissue continues to mature and strengthen, replacing the necrotic tissue.
- The collagen fibers reorganize, and the scar contracts. The process of ventricular remodeling can continue for months after an MI.
- This can involve hypertrophy (thickening) of the unaffected myocardium in an attempt to compensate for the lost muscle function
What is Ventricular Remodeling? What is it influenced by?
- Process whereby the shape, size, and thickness of the myocardium changes in both infarcted and non-infarcted areas.
- It is influenced by the:
-Size of infarct
-Patency of artery that was infarcted (how healthy the artery is after the MI)
-Ventricular load (via incr. pressure or volume)
What can Adverse Ventricular Remodeling lead to?
Can lead to impaired systolic and diastolic dysfunction and arrythmias
Ventricular Remodeling
What may cause a less favorable remodeling?
- Where there is increased size and load and decreased blood supply, there will be less favorable remodeling, possibly expansion of infarction, and higher risk of complications and mortality
Ventricular Remodeling
What may promote a “reversal” or “positive ventricular remodeling?
- Medical therapies, lifestyle modification, and cardiac rehabilitation have the potential to promote “reversal” or “positive” ventricular remodeling to improve size, shape, and function of the heart’s chambers
What are the Prognostic Factors for Mortality and Functional Status after an AMI?
(AMI = Acute Myocardial Infarction)
- Remaining Left Ventricular function (MOST IMPORTANT)
- Complications
- Infarction size
- Presence of disease in other coronary arteries which leave other parts of myocardium still at risk
What are Complications after AMI?
Complications after an MI can stem from diverse mechanisms and can be considered mechanical, ischemic, arrhythmic, or a combination of those, and can influence an individual’s clinical progression and overall prognosis
With AMI Complications, the severity and the type of complications depend on what factors?
- Factors like the extent of myocardial damage, the location of the infarct, the speed of medical intervention, and the overall health of the patient.
Increased levels of habitual physical activity before hospitalization for heart-related conditions are associated with better short-term cardiovascular outcomes
What is essential to minimize the risk of complications and reducing future risk?
Immediate and appropriate medical treatment(e.g., reperfusion therapy) is crucial to minimize the risk of these complications. Long-term management, including lifestyle changes and medication, is also essential for reducing future risks.
Patients with an “uncomplicated” profile will more often experience notably reduced rates of morbidity and mortality after their initial cardiac events
What is the Criteria for Complicated Myocardial Infarction?
(9 items in chart)
Complications after AMI
What happens if you have an occlusion of the L Main (L coronary) or LAD?
Most Common
- We will see pump dysfunction of failure
Complications of the (L coronary or LAD)
If there is an occlusion of the L coronary or LAD. What happens when the Left Ventical is ~15% is compromised?
Decreased contractility -> hypotension -> decreased driving pressure/coronary perfusion -> increased ischemia -> decreased contractility
If there is an occlusion of the L coronary or LAD. What happens when the Left Ventical is ~25% is compromised?
May see signs of heart failure (e.g., pulmonary edema)
If there is an occlusion of the L coronary or LAD. What happens when the Left Ventical is ~40% is compromised?
Increased mortality due to ventricular tachycardia and fibrillation. Cardiogenic shock (SBP < 90 mm HG / MAP < 60-65) occurs around this range as well
What happens if you have an occlusion of the RCA?
- Right Ventricular Dysfunction, SA/AV nodal dysfunction, and arrythmias
- The pt may experience bradycardia, AV block, Atrial Fibrillation and Atrial Flutter
Complications after AMI
What is Persistent Sinus Tachycardia?
Elevated HR originating from the SA node
Complications after MI
After an MI, how can this affect the patient HR?
- After an MI, the heart may become less efficient at pumping blood due to damage to the myocardial tissue. The body compensates by increasing the HR to maintain adequate cardiac output and perfusion to vital organs. This compensatory mechanism can result in persistent sinus tachycardia
After an MI, what would happen if the patients HR is too high? What S/S should we look for?
- Cardiac output may fall due to the markedly reduced ventricular filling time (affecting pre-load)
In these cases, look for signs of:
- Hypotension
- Acute Altered Mental Status (AMS)
- Ischemic chest discomfort due to increasing myocardial oxygen demand but reduced coronary blood flow
- Acute Heart Failure (e.g., fluid back up with pulmonary edema, dyspnea)
Complications after MI
With Persistent Sinus Tachycardia, what should PTs do when screening and managing the pt?
PTs should monitor the heart rate before, during, and after physical activity to ensure it remains within safe limits.
- Physical activity intensity may need to be adjusted based on heart rate responses, and adequate rest periods should be incorporated to prevent excessive cardiac strain
Complications after MI
Following an MI, what is Systolic Hypotension a Result from?
Results from diminished heart pumping capacity due to muscle damage, reducing stroke volume and systolic blood pressure, and potentially compromising organ blood flow.
Complications after MI
With Systolic Hypotension, what should PTs do when screening and managing the pt?
PTs should monitor the blood pressure before, during, and after physical activity to ensure it remains within safe limits.
- It’s important to observe for signs of hypotension, such as dizziness, lightheadedness, or fainting.
- Physical activity protocols may need to be modified to prevent sudden changes in blood pressure and ensure patient safety.
Complications after MI
What is a useful method to assess arterial blood flow and ensuring there is sufficient organ perfusion?
Monitoring Mean Arterial Pressure (MAP)
- MAP = [(2 x DBP) + SBP] / 3
- Normal Values 70-110 mm Hg
- A MAP less than 60 mmHg may indicate inadequate tissue perfusion and should, in a majority of circumstances, lead the clinician to modify the pt’s position and/or activity to increase MAP right away
After an MI, how can low-level activity affect the heart?
After an MI, the heart’s ability to increase blood flow in response to activity can be compromised.
- Even low-level activities may demand more oxygen and blood than the heart can supply, leading to ischemia.
Complications after MI
With Ischemia with Low-Level Activity, what should PTs do when screening and managing the pt?
While some degree of transient ischemia can be expected following an MI and revascularization procedures
- PTs should be vigilant for signs of persistent ischemia during rest or activity which could be due to incomplete revascularization, re-occlusion, or other complications
Complications after MI
With a patient that has Ischemia with Low-Level Activity, what happens once they are medically cleared to exercise?
- Once medically cleared, the use of graded exercise testing can help in establishing safe exercise intensities following MI.
- Physical activity should be paced and gradually progressed over time toward guideline-based parameters.
- Patient education on recognizing symptoms and appropriate actions is also crucial for patient safety
What is Pulmonary Edema?
Abnormal accumulation of fluid in the alveoli and interstitial spaces of the lungs
How does Pulmonary Edema result from an MI?
- Cases where the left ventricle is affected, the heart’s ability to effectively pump blood can be significantly compromised.
- This leads to an increase in pressure in the left atrium and subsequently in the pulmonary veins and capillaries.
- The elevated pulmonary capillary pressure forces fluid out of the capillaries and into the alveolar spaces, resulting in pulmonary edema.
- This fluid accumulation interferes with gas exchange, leading to decreased oxygenation of the blood and respiratory distress.
Complications after MI
With patients with Pulmonary Edema, during the screening process, what should PT look out for?
- Shortness of breath, especially when lying flat
- Rapid, shallow breathing
- Coughing, noting any presence of frothy sputum that may be tinged with blood
- Audible “crackles” or wheezing upon auscultation of the lungs
Continuous monitoring of respiratory rate, oxygen saturation, and subjective reports of dyspnea during therapy sessions is critical for any patient who has pulmonary edema. Immediate action should be taken if signs of worsening pulmonary edema are observed.
With patients with Pulmonary Edema, how should these patients be managed in terms of activities?
- Activities should be tailored to the patient’s tolerance, avoiding excessive exertion that might exacerbate respiratory distress.
- Positioning strategies can be employed to facilitate breathing and optimize oxygenation, avoiding positions the increase dyspnea or work of breathing.
- Coordinate with the medical team regarding the use of supplemental oxygen during therapy sessions if indicated.
