CardioResp Pathologies Flashcards
What is Cystic Fibrosis?
- Inherited autosomal recessive disease -defect on chromosome 7.
- Impacting protein CFTR responsible for Ion Transport
- Affecting several organs
- duct obstruction with mucus – impairment in the transport of chloride ions + levels of sodium and water in the cell - leading to inflammation and tissue scaring.
What does CFTP Stand for?
Cystic Fibrosis Transmembrane Regulating Protein
What happens in CFTR defect related respiratory disease?
- Concentrated fluid in the lungs
- Viscous secretions in airways
- Mucus not cleared - predisposes patient to disease and infection
What happens in CFTR defect related Pancreatic insufficiency?
- Abnormal ion transport leads to dehydration of pancreatic secretions
- Stagnation in pancreatic duct
What are some complications of CFTR Defect?
- High sodium sweat- Prevention of sodium absorption
- Biliary disease
reduction in water movement results in concentrated bile which can damage walls of lumen
-Infertility
Absence of Vas Deferens
-Cirrhosis of the Liver
Abnormality in ion transport - Gastrointestinal Disease
Intraluminal water deficiency - all of which related to a lack of Na +, Cl- or water diffusion problem
Give a Brief overview on the Prevalence of CF-
- 1 in 15 Caucasians carries the gene
- 2 carriers = 1 in 4 of affected baby and 1 in 2 of a carrier
- Affecting more than 10,400 people
- 1 in 2,500 babies born with CF
- Claiming 2 lives a week
Name the 3 ways in which CF is diagnosed
- Genetic testing
- Heal Prick Test - Babies leading to early diagnosis
- Sweat test - higher concentrations of chloride in sweat
Give the Symptoms of CF at birth-
- 10% babies = bowel obstruction - Meconium lleus
- Meconium - thick black substance
- Surgery often needed to remove this
- Jaundice
Give the Symptoms of the lungs in CF
- Persistent Cough
- Coughing fits
- Inflammation
- SOB
- SOB after exercise
- Chest and Lung infections
- Cross Infection
- Impaired diaphragm due to enlarged liver
Give the Symptoms of Digestive System in CF
- Large smelly stools
- Malnutrition/ poor weight/stunted growth
Give the general symptoms of CF
- Diabetes
- Sinusitis
- Arthritis
- Infertility
- Liver failure
- Urinary Incontinence
- Muscle weakness
- Kyphosis of the Spine
- Delayed Puberty
State the Medication used in CF treatment
- Bronchodilators
- Hypertonic saline nebs
- Antibiotics
- Steroids
- Vaccinations
- Creon
- DNAse
State the management strategies for CF
- Dietary advice
- Education
- Exercise
- Lung Transplant
- Psychological support
Give the ways in which Physio is used in the treatment of Cf
- PD- Postural Drainage
- Percussion,vibs/shakes
- ACBT-Active cycle of breathing techniques
- AD- Assisted Drainage
- Adjuncts
- Mobilisation /Exercise
- Suction - ITU
Outline the Prognosis for CF
- No cure or Prevention
- 1/2 will live past 40 - some to 47
- Lung complications are normally the cause of death
- Quality of life depends on specific protein mutation.
What is Bronchiectasis?
- Permanent abnormal dilation in one or more of the lungs Bronchi
- Extra mucus in airways
- Prone to infection
- Similar symptoms to COPD but does not always show as airflow obstruction.
Give a brief overview of the Pathogenesis of Bronchiectasis-
1 - Impaired mucocilliary clearance = accumulation of secretions
2- leading to infection by bacteria
3-leading to increased mucus production , impaired cilliary performance and inflammatory response
4-= tissue damage
5-leading to dilated Bronchi , loss of ciliated epithelium and impaired mucocilliary clearance
VISCIOUS CYCLE
What causes Bronchiectasis?
- Idiopathic
- Infection
- CF
- Immunodeficiency
- Cilliary dysfunction
- Inflammation
- Aspiration/obstruction
- ABPA
Give the Clinical features of Bronchiectasis
- Cough
- Chronic sputum production
- 75% dysponea and wheeze
- 50% chest pain
- 1/3 = chronic sinusitis and nasal polyps
- recurrent exacerbations are common
- 50% = haemoptysis
Give the ways in which Bronchiectasis is diagnosed
- chest xray
- HRCT
- Blood and Sputum
- PFTs
State the 3 types of Bronchiectasis
- Saccular - large bronchi = large and balloon-like
- Cylindrical- medium sized bronchi - symmetrically dilated
- Varicose - constrictions and dilations deform the bronchi
State the management strategies for Bronchiectasis
- Physio
- Antibiotics
- Bronchodilators
- Steriods
- Nasal spray
- Vaccinations
- Surgery
What is the definition for pneumonia?
- Inflammatory condition of the lung leading to abnormal alveolar filling with consolidation and exudation
Give a brief overview of the pathology behind Pneumonia
- Infection ,chemical or aspiration irritant.
- Acute inflammation results in the migration of neutrophils out of capillaries and into airspaces
- these cells phagocytose and release antimicrobial enzymes and inhibitors
- leading to more inflammation and subsequently more oedema
What is the first stage of pneumonia?
- Congestion
- First 24 hrs
- Vascular engorgement
- Intra-alveolar fluid
- Numerous bacteria
- Lung is heavy, boggy and red
What is the second stage of pneumonia?
Red Hepatization
- 2-3 days
- Exudation
- red blood cells , leukocytes and fibrin filling the alveolar spaces
- affected are is red and firm and airless
- Liver like consistency
What is Third stage of Pneumonia?
Grey hepatization
- 4-6 days
- Progressive disintegration of red blood cells and the persistence of fibrin exudate
What is the forth stage of Pneumonia ?
- Resolution
- > 6 days
- Exudate = progressive digestion
- resulting in debris that is later reabsorbed , ingested by macrophages or coughed up
Give the causes of Pneumonia
- Bacteria
- Fungi
- Varis
- Paracites
- Chemical
- Aspiration
- Inhalation
What does CAP Pneumonia stand for?
Community Acquired Pneumonia
what does HCAP Pneumonia stand for?
Health care acquired Pneumonia
What does HAP Pneumonia stand for?
Hospital acquired pneumonia
What does VAP Pneumonia stand for?
Ventilator acquired pneumonia
Give the common symptoms of pneumonia
- Fever
- Malaise
- Muscle ache/fatigue
- Coughing
- Tactile fremitus on palpation
- Dyspnoea
- Pleuritic or chest pain
- Loss of appetite
- Rapid heartbeat
Give the less common symptoms of Pneumonia
- Coughing up blood
- Fatigue
- Nausea/vomiting
- Diarrhoea
- Wheezing
- Confusion
What complications can arise from Pneumonia?
- Lung abscess
- Pleural effusions
- Empyema - Infection/pus in between the neural cavity
- Septic shock
Give the main indicators for a medical diagnosis
- temp above 37.8
- Hr above 100bpm
- Crackles
- Decreased breath sounds of bronchial breath sounds
- Absence of asthma
These clinical features can be used to create a clinical prediction rule where by percentage of probability decreases with each clinical feature not present
Give 3 other diagnostic tests used for Pneumonia
- Sputum culture
- Pleural fluid culture
- Bronchoscopy
How is Pneumonia managed medically ?
- Antibiotics/fungal
- oxygen
- IV fluids
- Analgesics
- Cough suppressant
- fever reduction
How is physiotherapy used in treatment of Pneumonia?
- increase o2 consumption and demand
- treat the clinical signs and symptoms
- non production , positioning V/Q , mobilising, no intervention
- Productive , sputum clearing techniques including positioning , breathing techniques and adjuncts
What is COPD?
- Airflow obstruction
- Progressive in severity
- Not fully reversible
- Does not change markedly over several months
- Umbrella term - Chronic Bronchitis , Emphysema, Chronic Asthma
What is the result of systemic inflammation?
- Weight loss
- Skeletal muscle dysfunction
- Cardiovascular disease
- Osteoporosis
- Depression and fatigue
- Cancer
- Looking at the patient as a whole
What is normal airway clearance?
- Cilia - continually beat - moving mucus along until it reaches the throat - swallowed
- Cells producing mucus - trapping dust particles and bacteria .
What goes wrong with airway clearance in COPD?
- Excess mucus
- Mucus = thicker and stickier
- cilia unable to beat
- Smoking - paralyses the cilia
- Dust /bacteria - trapped
- Mucus build up
- Infection can develop.
What is Bronchitis?
- Chronic
- Bronchi become inflamed
- Increased sputum and overproduction of mucus- airways become hard to clear
- Airway narrowing
- Wheezing
- Chronic cough - tired, fatigue
- Bronchospasm
- Reduces the amount of air into the lungs
What is Emphysema?
- Alveoli become inflamed
- Loose elasticity
- Lose ability to fill and expand
- Can result in rupture
- Reduction of surface area
- Air becomes trapped
- Breathing becomes very difficult
What is Asthma?
- Approx 5 mil people
- Episodic increase in airway obstruction
- Various stimuli - Allergies
- Reversible
- Inflammation - Bronchoconstriction
- Breathless , wheeze , tightness
- Results in sensitive airways , irritated ,m inflamed and narrowed. Reduction in airflow
- Can become chronic with fixed airways damage - then under COPD umbrella.
Causes of COPD?
- Smoking- 90% - 20 pack years or more - Number of packs per days times years smoking
- Occupational exposure - coal miners
- Alpha-1 antitrypsin deficiency - Genetic
- Social deprivation
How is COPD diagnosed?
- Detailed MDT history
- Clinical signs - Cough , breathless , sputum, risk factors , other causes.
- Spirometry - gold standard - Diagnose , categorise and monitor
- Chest x ray
What is the Early disease classification of COPD?
- few symptoms
- Morning cough
- Winter chest infection
- Breathless on vigorous exercise
- Reduced Spirometry
What is the Moderate disease classification of COPD?
- Range of symptoms , cough , wheeze , breathless with moderate exertion
- Clinical examination - wheeze , barrel chest, flattened diaphragm on CXR
What is the severe disease Classification of COPD?
- Severe symptoms - Cyanosis - blue nose and mouth
- Weight lose
- Accessory muscle use
- peripheral oedema
How is Spirometry used in COPD classification?
- FEV1 % - Predicted values
Mild - 80%
Moderate - 50-80%
Severe -30-50%
Very severe - <30%
- FVC% - Predicted
- > 50 %
What is the Treatment for COPD ?
- Smoking cessation
- 4 x likely to quit with help , advice and Nicotine replacement.
- Stop smoking services
- Physio - refer to smoking cessation
What is the medication for COPD?
- Inhalers
- Steroids and Antibiotics
- Mucolytics- breakdown sputum
- Flu and Pneumonia vaccines
How is pulmonary rehab used of COPD?
- Exercise
- education
- Self management
- Diet
- Lifestyle modifications
What is Idiopathic Pulmonary Fibrosis?
- Restrictive disease
- Inflammation and Scarring in the lungs
- Progressive conditions
- Progression on scarring is the fibrosis
- Reduces gas exchange
- Lung tissue becomes less compliant , lung tissue becomes stiff
Causes of Pulmonary Fibrosis?
- Approx 5,00 people diagnosed a year
- More common in men 6/10
- Older people
- Unknown cause - idiopathic
- Smoking link
- Occupationally exposure link
- Infection and Viruses - herpes /hep C
- GORD - Gastrol-oesophageal reflux
- Few cases - genetic link
Symptoms of Pulmonary fibrosis?
- Breathlessness , come cases very severe
- Gradually get worse over years or very quickly
- No Cure
- Poor prognosis , 3 years post diagnosis
- Constant cough
- Tired , reduced gas exchange
- Clubbing of fingers and toes
- Is not infectious
How do we Diagnose Pulmonary Fibrosis?
- MDT patient history
- Clinical signs
- Spirometry
- Bronchoscopy - look at lung tissue via a small camera
- Chest x-ray , followed by CT
How do we treat Pulmonary Fibrosis?
- Not generally treated with inhalers
- 02 therapy
- Pulmonary rehab - manage breathlessness , maintain and improve exercise tolerance
- Meds - sedatives , morphine or Oramorph
- Treatments for heartburn and blocked nose , antiacids
- Lung Transplant - very rare
What medications are used to treat pulmonary fibrosis ?
- Pirfenidone - Mild - moderate IPF , slow down inflammation and build up scar tissue , some side effects - sick , tired , diarrhea
- Nintedanib - jan 2016 , reduced rate of flare up , some side effects , nausea , vomiting , pain , decreased appetite etc.
How is Pulmonary Rehabilitation used for Pulmonary fibrosis?
- Exercise
- Education
- Self management
- Diet
- Lifestyle modifications
How can patients help themselves?
- Stop smoking
- Have the early flu jab
- Have vaccinations
- Avoid those with chest infections and colds
- Stay fit and active
- Eat a healthy balanced diet
- Get in touch with british lung foundation
What is Coronary heart disease?
- Narrowing or complete blocking of the arteries that supply the heart
- Angina
- Myocardial infarction
- Heart Failure
What is the Prevalence of CHD ?
- Most common cause of death worldwide
- 66,000 Deaths a year in the Uk
- 1 in 7 men , 1 in 12 women
- North england and scotland being higher.
- 1 death every 8 mins
- 2.3 million people living with the disease.
Give CHD risk factors-
- age
- Gender
- Social deprivation
- Smoking
- diet
- Exercise
- Alcohol
- Psychosocial well being
- Blood pressure
- Cholesterol
- Obesity
- Hypertension
- Diabetes
- Ethnicity
- Family history
What is Angina?
- Chest pain due to an inadequate supply of oxygen to the heart muscle
- Tends to be Transient
- Types =
- Stable
- Unstable
- Variant
- Microvascular
What is the treatment for Angina?
- Nitrates , anticoagulants - causing headaches as they target non - specific blood vessels.
- lifestyles changes
- Surgery - angioplasty.
What is Myocardial Infarction?
- Blood supply to the heart seriously reduced or cut off.
- Resulting in ischaemia of the heart muscle and scar formation.
How is MI diagnosed?
- Cardiac enzyme testing - Troponin , Creatinine Kinase
- ECG - Inversion of T wave and enlarged Q Wave and ST elevation.
Symptoms of MI -
- Sweating , cold
- Dizzy
- Pain , discomfort
- pain and pressure on the chest
- SOB
- Nausea and vomiting
- Increase / irregular heart beat
Prognosis of MI
- Sudden death - 20%
- Heart failure - scar tissue
- Cariogenic shock
- Arrhythmias - irregular heart beat.
- Thrombus formation
- Rupture
- 68% will have further complications
- 13% Will still die
- Depending of site and degree of damage.
How is MI treatment ?
- Vasodilation drugs
- Beta-blockers
- PTCA
- Stenting
- Laser
- Physio are heavily involved in cardiac rehab and preop care, cardiac rehab in patient or outpatient. Critical care to discharge.
Where do MIs usually occur?
- Left ventricle has the highest demand and therefore is the most common site of ischaemia
- 50-70% involves left coronary artery /territory
What is Heart failure?
- Unable to adequately pump the blood around the body - usually because the heart has become weak and stiff.
What are some other causes of heart failure? (not- MI)
- Damaged valves
- Infections
- Arrhythmias
- Chemotherapy
- Excessive alcohol
- Anaemia
- Thyroid disease.
What are the main symptoms of heart failure?
- SOB on exertion +/- at rest
- Swollen feet , ankles , stomach and lower back
- Fatigue or feeling sick
What are the treatments for heart failure as there is no cure?
- Diuretics
- pacemakers
- Implantable cardioverter defibrillator ( ICD)
What is heart valve disease?
- can affect any 4 valves
- Causes - CHD , Rheumatic fever , cardiomyopathy , MI , endocarditis and ageing
- Symptoms - SOB , Ankle/feet swelling , fatigue
- Can affect the flow of blood via valve stenosis or narrowing/ valve incompetence or regurgitation or a leaky valve.
What is a Coronary Bypass graft ?
- used to treat Coronary heart disease
- bypassing a blocked portion of a coronary artery using another piece of blood vessel
- can be single or multiple arteries
- lasting 8-12 years
Give a brief overview of the CABG procedure
- incision via median sternotomy
- Cold solution results in cardioplegia
- heart kept going through cardiopulmonary bypass
- less invasive techniques = key hole surgery
- Cardioplegia
- end of graft attached above the blockage
- 3-6 hours
Give some common graft sites for CABG
- Saphenous vein
- Radial artery
- R and L internal thoracic artery
- R gastroepiploic artery
- interior epigastric artery
Give some complications to CABG
- preoperative MI
- low cardiac output
- AF, 40% of patients - atrial fibrillation
- lower lobe collapse
- chest infection/ pneumonia
- non union of sternum
- late graft stenosis
- pericardial tamponade- blood collecting around and compressing the heart
- pulmonary oedema/ pleural effusion
- renal impairment and failure
- chronic pain
- CVA 1-5%
- Psychosis - air bubbles into the brain
- wound infection
Give the way in which physiotherapy management is used in cardiac surgery
- secretion clearance
- decrease WOB
- increase lung volume
- early mobilisation
- stair climbing day 3/4
- home 4/5
- rehab 2 weeks post
Give the 5 types of valve replacement
- Mechanical , 15-25 years , anticoags, made of pyrolytic carbon
- Tissue , bioprosthetic , animal donors, 10-20 years
- Donor , least common , last 10-20 years
- Ross procedure, aortic value replaced with pulmonary valve , which is then also replaced
- TAVI/TAVR- Transcatheter aortic valve implantation or replacement
What are the complications of a Valve replacement ?
- stroke
- clotting
- valves getting damaged
- chest infection
- non union
- pulmonary oedema
When is a heart transplant needed ?
- in severe CHD
- Cardiomyopathy
- Congenital heart disease
Complications of a heart transplant
- transplant rejection
- Graft failure
- Cardiac allograft vasculopathy - artery narrowing
- vulnerability to infections , immunosuppressants
- same as CABG and valve surgery surgery
Management post heart transplant
- follow ups
- immunosuppressants
- Exercise
- diet
- Pregnancy
Causes of heart valve disease -
- congenital heart disease
- Rheumatic fever
- Cardiomyopathy
- MI
- Endocarditis
